Male, 29 years old, volleyball player, 267 lbs.
Increasing pain and swelling in both knees over a six year period. Pain and stiffness in lower back and morning stiffness in feet and ankles.
He has had multiple and often conflicting diagnoses and treatment, all directed at his knees. Arthtoscopic surgery on the right knee produced no definitive diagnosis or change in symptoms. He has had a succession of soft “orthotics” that were basically arch supports.
Static Stance Position shows a high degree of tibial varum with subtalar compensation. The head of the talus and navicular hypertrophy create a large prominence on the medial aspect of each foot.
Subtalar varus with forefoot valgus. Hip rotation in both flexed and extended position was more internal than external indicating bilateral femoral torsion and anteversion. All other joint ranges of motion were within normal limits.
Patient had a pronounced “bounce” in his gait with complete collapse of the medial longitudinal arch. There is a marked medial rotation of both knees as the forefoot contacts the ground.
Rearfoot varus, forefoot valgus with compensated equinus gait.
This is another case of years of treatment aimed at the symptoms while the biomechanics are ignored. In addition to the primary structural problems, lack of proper stretching has led to a severe posterior muscle group imbalance, causing changes in the postural complex and further knee stress and damage.
Semi-rigid sport orthotics posted with 5 deg rearfoot varus posts bilaterally, 3 deg forefoot valgus posts bilaterally, and a 1/8″ poron forefoot extension to the sulcus. Stretching exercises were prescribed for the posterior muscle groups.