Chondromalacia Patellae refers to a condition that involves the softening and fissuring of the hyaline cartilage that underlies the patella.
While considering the mechanics of the patellofemoral joint, it is important to note the alignment of the patella which should remain planted in the trochlear groove of the femur; during flexion of the knee in gait, the patella glides back and forth in this groove because of the lubricating effect of the articular cartilage, which primarily helps to reduce friction in the joint.
The onset of biomechanical imbalances triggered by an unhealthy foot posture, such as an increased Q-angle, causes a misalignment in the patellofemoral joint leading to abnormal tracking of the patella.
This pushes the patella to either side of the trochlear groove, thereby increasing the friction between the patella and femur on movement and leading to a gradual deterioration of the hyaline cartilage and the articular surface of the knee.
The clinical presentation of the condition would be anterior knee pain, which could either be local or diffused; this pain exacerbates upon motions that load the patellofemoral joint such as walking up the stairs or standing after prolonged periods of rest.
The patient will also complain of instability in the knee and a painful crackling sensation (crepitus) when the knee is flexed.
Treatment modalities for the condition would focus on strengthening exercises of the quadricep muscles such as vastus lateralis and vastus medialis, which are significant for the optimal movement of the patella.
The effectiveness of an orthotic intervention in treating Chondromalacia Patellae would involve supporting the foot in a functionally corrected posture to decrease compensatory movements of the lower limbs.
This optimal posture would provide adequate supination at heel strike with the forefoot making full contact on the ground at mid-stance and the majority of the forefoot load being on the first metatarsal joint at heel lift.
This would help in regulating hyperpronation whilst decreasing internal tibial and femoral rotation and reducing torsional stresses to the quadriceps. This would lead to a decreased Q-angle and curb the lateral tracking of the patella.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.