Lateral Knee Pain

Dorsiflexion vs Plantarflexion

 

It seems to me that, if my foot was in dorsiflexion, the tibialis anterior muscle may well be working, and may not be high on the 'to do' list for an EMG... whereas the tibialis posterior muscle may have been a better candidate as it may be responsible for the fact that I cannot stand on tiptoes alone with my right leg. 

 

Also the gastrocnemius, soleus and plantaris muscles may need investigation, bearing in mind that I can hardly lift up my right leg, neither in front (knee to chin), nor behind (heel to bum). I was, and still am, catching my foot / toes on things like uneven paving stones and my thin kitchen mat (now binned!) My shoes would wear down at the toes where I had scraped them on the ground. The nail on my big toe has been 'pushed' away so that there is a greater expanse of nail that is not attached to the toe.

 

The latest letter I received stated that '... her quadriceps muscles and gluteus medius...' are weaker on the right. They suggest continuing with physiotherapy exercises... but I have been doing mainly the same physiotherapy exercises for the past 6 or 7 years, on and off, and they have made no difference at all.

 

Is it possible that my foot is in dorsiflexion, not because that is the problem, but rather because it cannot plantarflex properly...? Perhaps when weight-bearing...?

 

But this, however, seems to be a common occurrence with lower leg dysfunction as discussed by: 

http://brentbrookbush.com/lower-leg-dysfunction/

 

Common compensation patterns leading to LLD have been previously described as “pronation, pronation dysfunction, and/or foot/ankle impairment”2-4.  However, these terms may be misleading. For example, pronation implies dorsiflexion, abduction, and eversion of the tibiotalar and subtalar joints respectively, but this does not accurately describe the compensation pattern of the ankle joint in LLD. Dorsiflexion is often limited and the foot becomes relatively plantar flexed during daily activity. 

 

 

https://aclandanatomy.com/abstract/4010439

 

Dorsiflexion involves just lifting the foot. Plantar flexion involves lifting the whole body...

There’s one muscle on the front of the leg for dorsiflexion, tibialis anterior. There are three on the back of the leg for plantar flexion, gastrocnemius, soleus, and plantaris...

... tibialis anterior... also has a role in producing inversion... dorsiflexion... assisted... by the long extensor muscles for the toes...

The action of soleus, gastrocnemius, and plantaris is to produce plantar flexion at the ankle joint. Their action lifts us up off the ground when we stand on tip-toe. When balanced against gravity, the same action controls our rate of descent. In addition, these muscles provide an important part of the propulsive force in normal walking, in going uphill, in running, and in jumping.

 

This tends to suggest that it is more likely to be weak plantarflexion because I cannot stand on my tiptoes with my bad, right foot, and nor can I support my body weight in that position nor stand on the one leg.

 

The two most common deviations found in the foot and ankle are discussed by:

http://www.ideafit.com/fitness-library/foot-ankle-and-knee-0

 

Common Deviations of the Foot and Ankle

The two most common deviations found in the foot and ankle are overpronation and lack of dorsiflexion.

Pronation, a function of the foot wherein the foot collapses and the heel rolls inward, is necessary to help transfer forces forward and toward the midline of the body. Overpronation, however—wherein the tibia, femur and knee rotate inward along with the heel—causes a disruption in the transfer of force.

Dorsiflexion is also a normal function of the foot and ankle. It involves flexing, or pulling the foot and toes up and back toward the shin to maintain alignment throughout the body. Overpronation limits dorsiflexion, causing the foot to push down and forward (plantarflex) rather than up and back. Limited dorsiflexion impairs all weight-bearing activities from standing to squatting, walking and running.

 

 

And I think that that's it... Overpronation...!

 

Overpronation (the tibia, femur and knee rotate inward along with the heel)

• limits dorsiflexion,

• causes plantarflexion,

• causes the foot to push down and forward... SLAP on the ground,

• impairs all weight-bearing activities from standing to squatting, walking and running,

• causes a disruption in the transfer of force...

 

 

Ummm... 'causes a disruption in the transfer of force'... so is it possible that this transfer of force acted upon the fibular such that the fibular caused movement within the knee...???

 

 

http://olc.metrohealth.org/SubSpecialties/Trauma/Media/SkeletalTrauma/ch60.pdf

(2003)

(Page 2427)

Anterior Process Calcaneal Fractures

All but the smallest anterior process or ‘‘beak’’ fractures of the calcaneus involve the calcaneocuboid joint. Symptoms of this injury may be identical to those of a chronic ankle sprain, and the mechanism of injury can be identical.224

Typically, the bifurcate ligament or, on occasion, the extensor digitorum brevis pulls off a fragment of bone during a plantar flexion inversion moment. Remember that

one cannot sprain the ankle without twisting the (hind) foot. The presence of an anterior beak fracture must always be suspected if after an injury a patient complains of persisting pain or swelling in the region of the calcaneocuboid joint or the sinus tarsi. This diagnosis is commonly missed because the fracture fragments can be quite small and identification can be hindered by talocalcaneal overlap on routine plain films. Their small size and location also usually result in little functional disability aside from chronic pain, although the pain itself can be quite limiting. It is usually located in the sinus tarsi or directly over the anterior process, a superficial and usually easily identifi-able anatomic structure. Often, this pain is very reproducible on repetitive examination, and careful attention during palpation with the foot inverted and plantar flexed can aid in transposing the area of interest away from the lateral ankle ligament complex to facilitate the differential diagnosis. Thus, any patient with persistent pain in this region attributed to an ‘‘ankle sprain’’ or otherwise should have a set of standard foot films taken in addition to typical ankle films. If the diagnosis remains difficult but a high index of suspicion remains, bone scan and CT evaluation are both fairly sensitive and specific tests that may demonstrate the fracture (Fig. 60–37).

 

I have selected this reference for no other reason than it contains so many of frequently applicable words/phrases, but I am totally lost within it:

ankle sprain

extensor digitorum brevis

plantar flexion inversion

twisting

chronic pain

foot inverted and plantar flexed

lateral ankle.

 

Maybe further x-rays of foot and ankle or maybe bone scan and CT evaluation are required...