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Hello everyone.
If I have a runner with definitely normal or high arch, whose feets are beeing judged as normal or supinating but his knees are X shape (sorry, don't know correcr english description for it) and this runner have a tendency to roll his knees inward in a dynamis test (like light squad repeated many times) - what would you say?
Does this knee behaviour could or should have any impact on a shoe reccomendation or not?

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Fred, I assume by X shape, you mean internally rotating? So you are asking about a case that the foot is supinating and the knees are internally rotating? If that is the case, I would follow CP's standard advice for these sorts of patients and refer them to your enemies

Seriously though, its a difficult one and unusal situation, but does happen. As the shoe recommendation for a supinating foot is different to an internally rotating knee (which is usually associated with a pronated foot).

Compromise will be the only way to go. Maybe a motion control shoe aimed at knee with lateral wedging/orthotic aimed to foot

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DaVinci, thanks, yes this is the case.
My question is caused by a suggestion form a friend that according to her internally rotating knee should't have any impact on a type of shoe we are recommending to a runner.
That the key thing is a foot - its's arch and heel tendency to pronate or not to.

You (all podiatrists) would probabbly suggest proper orthosis but a runner wants to run when he comes to a shop - so sending him to a podiatrist to get some special orthosis may be often discurraging for him to get engaged in running (I am not selling shoes, I am running website for runners and also trying to give some reliable information to shoe sellers).

Hi,

30-odd years ago (and trailing the USA) the "running boom" hit the UK.

UK Podiatrists became very excited!

Running Clubs who previously had a hard-core membership of perhaps 70 individuals suddenly showed 200 or 300 members on their books.

Even with podiatric and other interventions and improved shoe technology a high % of the newer runners injured themsleves, and stayed injured. A multitude of reasons were suggested (I remember overtraining being a popular one). However, the sad fact is that some people have lower limb geometry which can take running without injuring, and some have lower limb geometry which will tend to injure if pushed (as in running). I suggest your pt falls into this category.

So - motion-control footwear may help, but some kind of orthosis may help evem more. And even then, I'd not guarantee your pt trouble-free running.

Hope this helps.

Regards,

David

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I would have guessed "x" shaped would have meant genu valgum (latin) or Knock-kneed (english). If the knee is significantly medial to the center of pressure under the foot there will be an abduction moment on the tibia. This can be decreased by using a shoe with a dual density midsole that is firmer medially. (That shoe will tend to shift the center of pressure more medially, at heel contact.

If someone is developing knee pain in type of shoe, by all means try anothere type of shoe. It could prevent the knee pain or the knee pain could develop faster. Either way you get some information.

Regards,

Eric

Hi Fredzio

Yes you are correct podiatrists as a rule do suggest a proper functional orthoses to give the patient the best chance of continuing their sport.

I am finding it increasingly frustrating where patients have come to me AFTER visiting a running shop having a video gait analysis ( in many instances I assume viewed by a member of staff with little or no knowledge of biomx) and then sold a pair of anti this or anti that VERY expensive trainers which have little or no effect on the patients condition.

This is very common with the advent of charity runs/walks where the entrants are actively encouraged to go to a particular running shop for a particular pair of trainers to sort out any problems they have when training for the event.

They then arrive with us bemoaning the fact they have to pay for proper treatment after the expense they have previously had.

Perhaps a rethink on your part may be in order to get the proper treatment to start with ??

Just my thoughts

cheers
Derek

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In the case of a internally rotated knee, but with a supinated foot beneath it, I would usually suspect poor proximal rotation control (Glut. med)

Just my thoughts

Fredzio:

I have been a runner for the past 35 years, treat many runners in my practice and have worked closely with one of the premier running shoe stores here in Northern California for the past 20 years. I have great empathy for you and for other honest and ethical running shoe store staff and their owners. Your problem is quite difficult: you are often expected to make medical diagnoses and offer therapeutic shoe options with little to no medical training.

Unfortunately, sending a runner with a running injury from the shoe store straight out to a podiatrist or other sports doctor is not always the best advice for that runner, unless that podiatrist or sports doctor is ethical, intelligent and truly interested in the diagnosis and treatment of running injuries. Mediocre clinicians may do more harm than good for these runners, by overprescribing foot orthoses or telling the runner that they should stop running permanently. On the other hand, mediocre shoe salesmen or unethical shoe store owners may misdiagnose the runner's condition, give the wrong training advice, or oversell expensive running shoes when a less expensive and equally effective running shoe may perfectly suit the runner's needs.

I would be interested in learning your real name, your country of origin and the link to your website in order to see if I can offer more suggestions that may help you better educate runners when making decisions regarding running shoes and their injuries.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
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Department of Applied Biomechanics
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