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Old 05-08-2012, 06:48 PM   #1
Joe Bernard
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Patella Femoral Syndrome and Orthotics

I have flat feet and was diagnosed with patella femoral syndrome in my left knee, had two PRP shots to help it heal, and currently wear custom orthotics with really supportive running shoes. The orthotics have made my knee much better, but I still feel unstable because I'm wearing pretty squishy shoes and still feel some pain if I squat all the way down (third world squat). Has anyone managed to transition from orthotics + squishy shoes to no orthotics and minimalist shoes? How did you do it?

I got a pair of F-lite 230s for my birthday LAST July and they are still in the box because that was when I was diagnosed with PFS and my PT said minimalist shoes are not good. I read Steve Low's article on feet and plan on doing the appropriate exercises to help my knee, but can I really rebuild my arch as a 22 year old guy? And should I return the shoes or keep them with hopes of eventually wearing them (zappos 1 year returns)? I'd like to wear the shoes with my orthotics but I'm not sure if the lack of ankle support would allow the orthotics to shift around in the shoe too much to be effective. I have not deadlifted or squatted close to a year now, and would love to be able to return to both if possible. Any anecdotal stories are welcome.
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Old 05-09-2012, 06:49 AM   #2
Liz Hyde
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Re: Patella Femoral Syndrome and Orthotics

Well, I'm going through the same thing right now, and some of my questions are the same as yours.

I don't have custom orthotics, but bought 3 pairs of superfeet that I have in my soccer cleats (which I think triggered this), running shoes, and a pair of NB mx10s I just bought for everyday wear. I bought the NBs because I'm used to minimalist shoes (I wear sandals all the time) and if my feet are going to be in jail, they should at least be in lightweight jail. My doc seems to have no problem with them as long as I have the arch supports.

Have you done any PT yet? It sounds like you've just been resting up until now. I've been doing PT for about 6 weeks now, and I'm better in someways and worse in others. No shots yet but doc says we can do either cortisone or lubricant shots.... I'm trying to avoid it if I can. Having cortisone shots at 25 don't leave me feeling all that confident in my future knee health.
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Old 05-09-2012, 08:17 AM   #3
Steven Low
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Re: Patella Femoral Syndrome and Orthotics

The obligatory

wfs
http://www.eatmoveimprove.com/2009/1...-dysfunctions/
http://www.eatmoveimprove.com/2010/1...g-on-the-feet/

Theoretically, it's possible to "rebuild the arch" in some capacity, even if it's just strengthening the muscles to make the foot work as it's supposed to.

And yes, there's quite a few people on here who have made it to barefoot/minimalist shoe running. Don't know if they're going to chime in or not though.
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Old 05-09-2012, 05:00 PM   #4
Joe Bernard
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Re: Patella Femoral Syndrome and Orthotics

Quote:
Originally Posted by Liz Hyde View Post
Well, I'm going through the same thing right now, and some of my questions are the same as yours.

I don't have custom orthotics, but bought 3 pairs of superfeet that I have in my soccer cleats (which I think triggered this), running shoes, and a pair of NB mx10s I just bought for everyday wear. I bought the NBs because I'm used to minimalist shoes (I wear sandals all the time) and if my feet are going to be in jail, they should at least be in lightweight jail. My doc seems to have no problem with them as long as I have the arch supports.

Have you done any PT yet? It sounds like you've just been resting up until now. I've been doing PT for about 6 weeks now, and I'm better in someways and worse in others. No shots yet but doc says we can do either cortisone or lubricant shots.... I'm trying to avoid it if I can. Having cortisone shots at 25 don't leave me feeling all that confident in my future knee health.
I originally tried regular orthotics and noticed that it made my knee feel worse, which is why I bought custom ones. I did PT for 12 sessions, 3x/week for one month, and it definitely helped but I still have some issues when I squat all the way down. Don't get a cortisone shot, it only masks the pain. Ask your doc about a PRP shot (platlet-rich plasma), it is much better for you and actually promotes healing. Although it does come with a steep price tag (mine was $500 not covered), it was worth it for me.

I feel the same way as you, I'm a young guy, why do I have this problem? Oh well, only thing we can do is keep at it.

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Originally Posted by Steven Low View Post
The obligatory

wfs
http://www.eatmoveimprove.com/2009/1...-dysfunctions/
http://www.eatmoveimprove.com/2010/1...g-on-the-feet/

Theoretically, it's possible to "rebuild the arch" in some capacity, even if it's just strengthening the muscles to make the foot work as it's supposed to.

And yes, there's quite a few people on here who have made it to barefoot/minimalist shoe running. Don't know if they're going to chime in or not though.
I've read the whole feet article but only the 4th and 5th section of the first article, I'll read the first three sections when I have time in the next couple days. Good to know my arches can benefit in some ways even if they can't be rebuilt. Hopefully the people you are referring to comment, I would love to be able to wear my inovs, they look awesome.

BTW, Steve, all the stuff on your site and in your book is worth its weight in gold. I've learned so much from both of them, as I'm sure a good amount of people have here too. Thanks for all the work you do.
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Old 05-13-2012, 08:46 PM   #5
Steven Low
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Re: Patella Femoral Syndrome and Orthotics

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Originally Posted by Joe Bernard View Post
I've read the whole feet article but only the 4th and 5th section of the first article, I'll read the first three sections when I have time in the next couple days. Good to know my arches can benefit in some ways even if they can't be rebuilt. Hopefully the people you are referring to comment, I would love to be able to wear my inovs, they look awesome.

BTW, Steve, all the stuff on your site and in your book is worth its weight in gold. I've learned so much from both of them, as I'm sure a good amount of people have here too. Thanks for all the work you do.
You might want to see if you can get hooked in with Shon Grosse... I believe he's up near the Philly area and by googling your location you look to be decently close by.

wfs
http://shongrosse.com/

He's one of the PTs that other PTs send patients to when they can't figure them out, and he's worked with UPenn track team IIRC. Very highly regarded and can probably help you sort out what seems like multiple issues.


Also, thanks on the book side of things. Let me know if you have questions or want a routine critique. And don't forget to submit an Amazon review.
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Old 05-15-2012, 01:28 PM   #6
Daniel Pope
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Re: Patella Femoral Syndrome and Orthotics

Hey Steven, just curious if you mentioned the short foot position popularized by Janda? Strengthening the short foot position and working hip external rotation strength as well as promoting ankle mobility come to mind right off the bat in this case. Thanks for the post by the way!
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Old 05-19-2012, 04:46 PM   #7
Steven Low
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Re: Patella Femoral Syndrome and Orthotics

I don't think I did... good call.

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http://www.youtube.com/watch?v=qDitRaQRxs4
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Old 05-21-2012, 06:12 PM   #8
Joe Bernard
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Re: Patella Femoral Syndrome and Orthotics

Quote:
Originally Posted by Steven Low View Post
You might want to see if you can get hooked in with Shon Grosse... I believe he's up near the Philly area and by googling your location you look to be decently close by.

wfs
http://shongrosse.com/

He's one of the PTs that other PTs send patients to when they can't figure them out, and he's worked with UPenn track team IIRC. Very highly regarded and can probably help you sort out what seems like multiple issues.


Also, thanks on the book side of things. Let me know if you have questions or want a routine critique. And don't forget to submit an Amazon review.
I'll check him out, thanks for the link. Thanks for the offer, I'll be sure to give a review.

Quote:
Originally Posted by Daniel Pope View Post
Hey Steven, just curious if you mentioned the short foot position popularized by Janda? Strengthening the short foot position and working hip external rotation strength as well as promoting ankle mobility come to mind right off the bat in this case. Thanks for the post by the way!
Thanks for the suggestions, looks like I have some things to keep me busy during the slow times at work.
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Old 05-22-2012, 07:19 PM   #9
Joe Bernard
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Re: Patella Femoral Syndrome and Orthotics

As far as my knee goes, my PT recommend that I do leg press negatives with my left knee and don't go to parallel, plus some leg lifts with weight around my ankles. I did the leg press negatives for a bit and initially it felt betterm but after a month I stopped because it began to feel worse. I know that there is a greater shearing force on your knee when you don't go to at least parallel because you are not recruiting the hamstrings and glutes, which is probably why my knee felt worse. Google only turned up the single leg stuff that I mentioned, plus leg curls and leg extensions. What would be the better rehabilitative exercises to do, unilateral or compound movements?
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Old 05-22-2012, 08:35 PM   #10
Liz Hyde
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Re: Patella Femoral Syndrome and Orthotics

Well, some of the stuff my PT is having me do:

Almost parallel wall squats (though I usually end up going parallel,) with a small swiss ball or other squishy thing between my legs. So basically, you're leaning back against the wall (or against a swiss ball against a wall), isolating your glutes/hammies. Then you squeeze the ball between your knees (which zaps the VMO/inner thigh muscles)

Some single-leg balancing drills... One I do is balancing on a upside down bosu, throwing a med. ball against the wall. Weight doesn't really matter, its more the change of direction (tennis ball would work). Doing any balancing with your eyes closed is fun too.

Also a bunch of lunges... though your ROM may make that hard (personally side lunges tweak my knee enough to hurt)

Bridges... part of my weak chain is hip flexors so these are hard for me (so I must work on them). Bonus points for doing them with a small swiss ball/other squishy thing (I've used a pillow) between your knees.

What she's really having me do is overemphasize the inner part of my quads. I'm pidgin toed, so one of the things I have to focus on is keeping my feet straight, or overcompensate by rotation them out. Don't know if that's a problem for you though.

I just went back today after a 2 week break from check ups... been doing the PT stuff (at the expense of my usual workouts, plus replacing running with swimming, recumbent biking for warmups). I've been doing better, but there's still pain going on. Now I have a referral for a MRI. Fun.
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