The knee follows the arch/ankle.

*in the video, watch the left knee
Hopefully this video and post will make you think deeper about patellofemoral tracking, runners knee, meniscal issues and anterior knee pain syndromes as a whole.

This is subtle, but in this case, this is relevant to the LEFT knee complaints of this client.
When the foot complex is a little weak, the arch can collapse more than it should, rendering too much pronation, this means the talus will adduct, plantarflex and medially rotate more than it should. Since the tibia sits on top of this talus it must follow. This will allow more internal tibia spin (medial rotation) and this will drag the knee medially (it appears in the video to be a valgus load but it is more internal/medial rotation than valgus).
So, what the foot-ankle complex does, the knee follows. Conversely, when the knee moves medially or valgus because of a hip weakness (poor external rotation control) the foot will move medially.
So, are you going to "fix" this with an orthotic ? A stability shoe? Or are you going to actually help the client gain better control ?
You can see that our "raise the toes, to raise the arch" helps the client find the more appropriate arch posture with the help of more anterior compartment engagement and windlass effect at the 1st MPT-hallux joint. This is where our reteaching of the component parts via "motor chunking" via the Shuffle Walk (see our youtube channel) can help them control the rate and amount of arch "collapse" and thus control the rate of medial knee spin.
i say it on our podcast all the time, the knee is a simple sagittal hinge joint between 2 multiaxial joints. It is often a follower, not a leader.
Or you can bandaid this client with an expensive orthotic and never fix their problem. This keeps them coming back over and over for symptom management. It is a good business model (insert sarcasm), but helping this client learn and remedy their deficiency is a better one. Happy people talk to their friends, even strangers.

Shawn Allen, the other gait guy

#gait, #gaitproblems, #gaitanalysis, #ovepronation, #archcollapse, #valgusknee, #tibialspin, #internalhiprotation, #thegaitguys, #kneepain, #runnersknee, #patellapain, #anteriorkneepain

Landing strategies focusing on the control of tibial rotation in the initial contact period of one-leg forward hops - Chen - 2016 - Scandinavian Journal of Medicine & Science in Sports - Wiley Online Library→

“If the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee” - Dr. Allen

If you cannot control pelvis position on the femoral head, or hip rotation or initial foot arch mechanics, the knee is going to give in to the directional loading response and that typically means medial valgus movement. This is internal tibial rotation or spin.  

Here is an analogy i use with all my patients. The knee is like the middle child. In the simplest terms, you have 3 lower limb joint complexes. The foot/ankle, the knee and the hip. The knee is the middle of these 3 joint complexes.  

Similarly if you put 3 children in the back of the car, the one sitting in the middle is the one directly impacted by the child on the right and the left.  When you hear the middle child screaming and whining, the smart parent first looks at the two apparently “innocent” children looking out the windows (with blood dripping off their elbows). 

Similarly, the knee takes this same seat. IF the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee

Changing landing strategies with the focus of control of tibial rotation, requires the astute clinician to look at all the children.

Dr. Shawn Allen, one of the gait guys.