Fun with flat feet, skinny legs and painful patellas
May 24, 2018
When I started running I was expecting a few aches and pains. I’d been fitted with the best shoes for my feet and embarked on an easy plan that wouldn’t finish me off before really getting started. Everything went well for a while but when I reached the point of doing regular 40 minute runs, aches and pains started to become a real problem.
I first noticed pain under the front of the right knee which would start as soon as I had finished running. This was accompanied by a pain which ran from the top of the right hip, extending down the the outside of the knee. I also began to feel niggling pains in my lower back approaching the end of a run. I figured it wasn’t caused by stress resulting from excess weight as I am a on the skinny side of light. Unfortunately I also have skinny, pencil like legs with a pronounced bow in them.
The final niggling pain occurred in the sole of the foot. This was something I had experienced on and off for years and was particularly noticeable after walking long distances or standing for a long time.
A visit to a the physiotherapist seemed like the only solution and after a thorough examination I was relieved to hear that my knees were OK. Since the worst pain was directly under the patella, this was the area I was most concerned with. I had also worried that bow legs prevented the patella tracking properly.
The physio noted two problems, the first being overpronation. I already knew I had flat feet and overpronated but didn’t realize that this could cause pain elsewhere. The pain in the sole of the foot was plantar fasciitis. The second problem was skinny legs. The muscles in the thigh that should stabilize the knee were small weak and insipid and so weren’t doing their job.
I was advised to stop running for a while and build up the quadriceps (thigh muscles) so that they would stabilize the knee joint. The condition is quite common in runners and is known as Runners Knee or patellofemoral pain syndrome (PFPS) and doesn’t just affect those with skinny legs!
Although I suffered with anterior knee pain the term runners knee is also used to describe lateral knee pain (pain along one side). This is often the symptom of an overuse injury and can be caused by iliotibial band syndrome (ITBS), rather than the muscle imbalance I suffered from. However, it has been suggested that muscle weakness can contribute to ITBS. The pain I felt from the outside of the hip to the knee was coming from the iliotibial band but was not the cause of the knee pain.
The physiotherapist felt I was a moderate overpronator but it was decided to deal with this later after strengthening the quadriceps. These are a group of muscles with the vastus medialis being important in stabilizing the knee or patella. This muscle is divided into the vastus medialis oblique (VMO) and vastus lateralis (VL). There is currently some debate about the extent to which each part stabilizes the patella. The vastus medialis is a muscle just above the knee.
I was given an exercise program that focused on strengthening the muscles of the quadriceps and particularly the vastus medialis. I was taken through each exercise to ensure it was being performed correctly. The exercises were:
- Walking Lunges: Standing upright, step forward with one leg landing on the heel, letting the knee bend to 90 degrees. The trailing leg drops close to the ground. Push off with the lead leg, bringing the trailing leg through and standing upright. Alternate between legs. This shows a walking lunge with dumbbells . I was advised to do these frequently during the day without any extra weight. They seemed to have the added benefit of improving balance.
- Straight leg raises: These are performed sitting down and simply require one leg to be held straight, raised up and then lowered. As with the walking lunges, these were to be done frequently during the course of the day.
- Bodyweight squats: These relied on the assistance of a sofa! The exercise involves standing with feet shoulder width apart and then squatting down to just touch the sofa (in a normal sitting motion) and then pushing up again. There were 15 repetitions performed three times. They were performed daily.
- Step downs (AKA Reverse step ups): The step down requires a stable platform, low enough to step down from without too much imbalance or general wobbling around. I used a telephone directory to begin with. Standing with both feet on the step, step down with one leg and then return by pushing with the leg that is still on the step. This should be repeated with both legs. As strength increased the step height was increased.
- Leg extension: As gym was nearby I was told to include four sets of twelve repetitions on the leg extension machine. Only a light weight was used.
- Cross trainer: Since running was out of the question the cross trainer was used to maintain aerobic fitness.
The strengthening program seems to have worked well. I returned to running again after eight weeks and rarely suffer any knee pain. This really highlighted the importance getting the expert advice of a physiotherapist as soon as pains or problems starts to occur. Unfortunately I still have skinny legs and flat feet.