22 Jun 2022

When a knee injury is like an innocent bystander to a foot injury

Many people that I see in my practice have pain in one or both knees. A problem in the foot can cause knee pain. The most common cause is a stiffness of the Big toe. The toe problem is an inability to lift up the Big toe up toward the ankle, as far as it should go. This movement, which we call an extension, should normally be about 50-60 D.

The specific cause is a lack of enough pull on this toe by the Posterior Tibialis tendon.  This tendon winds around the inside side of the ankle (the medial ankle). It can get stuck inside the sheath that surrounds it at ankle level.  Think of this sticking as friction, not a permanent blockage.

So when the posterior tibialis tendon fails to do its work, the weight from the body above cannot travel directly through the foot to the big toe. Normally 65%  of the weight down through the foot goes into the Big toe. But the sticking of the posterior tibialis tendon prevents some of the 65%  from going through the big toe. So maybe only 30-50 % now travels correctly. The other % now travels into the 2nd, 3rd, 4th, and 5th toes, since this weight has to travel somewhere. This shift of direction for the body's weight now travels more to the 2nd through 5 toes. So, this changes one's walking to more of a sideways movement. This shift then affects the knee above. Now the leg and knee have to accommodate the change of force distribution in the front of the foot. This results in some of the body weight traveling down more into the outside of the knee. This excess pressure results in increased stress on the outer side of the knee. Over months to years,  this stress can result in more stress and damage on the outside part of the knee and on the knee cap and the tendons traveling through it.

Pain may result around the knee cap, in these tendons. Sometimes this pain is called jumper's knee. or patellar -femoral pain. The ultimate cause is in the big toe.

My treatment is in 2 steps. First I fix the Big toe's abnormal movement by a simple, gentle, and brief manipulation at the heel. This manipulation now loosens the posterior tibialis tendon from the sheath around it, so it can move more easily and allow proper elevation of the  BIg toe. I have developed an easy foot exercise to continue the progress made.

Second,  we work on the knee, on the tendons around the knee caps., and on tiny nerves carrying the message of pain. Most often I use Perineural injection Thera, using tiny needles as described in the main section of this website. Treatment can be done as often as 1 or 2 times a week, for 2 to 4 weeks, for speedy and permanent recovery.