Pain on the inside of the knee (patella problems)
The knee joint consists of the shinbone (tibia), the thighbone (femur) and the kneecap (patella). This is the small bone at the front of the knee, which is embedded in the tendon of the large quadriceps muscle (M. quadriceps). The M. quadriceps runs along the front of the thigh (femur) down to the lower leg (tibia).
This structure enables you to straighten your leg. The kneecap acts as a kind of lever, thereby increasing the force exerted by the quadriceps muscle.
What causes pain on the inside of the knee?
The kneecap acts as a kind of lever, enabling the leg to extend and bend. The underside and back of the kneecap are covered with cartilage. The cartilage ensures that the kneecap has a smooth surface, enabling it to glide easily into the special groove on the thighbone (femur) during movement.
Many knee problems arise when the cartilage of the kneecap becomes irritated or starts to wear away due to ageing. This is usually referred to as chondromalacia or chondropathy. A common condition affecting the kneecap in teenagers and young adults is the patellofemoral pain syndrome. The pain is often felt behind, below or around the kneecap, but the exact location is often difficult to pinpoint.
Causes of patella problems
The most common cause of patella problems stems from the way the patella moves within the groove of the thighbone. We can divide this into three groups:
- Imbalance in the muscles of the large quadriceps muscle
- Imbalance caused by bow legs and knock-knees
- Imbalance caused by abnormalities in the anatomical structure of the groove or patella; e.g. groove too shallow
In the first two cases, the kneecap will be subjected to an incorrect pulling force from the large quadriceps muscle. This causes the kneecap to be pulled more towards one of the two sides. This is usually towards the outside, where more pressure will be exerted on the cartilage. This can lead to pain on the inside of the knee, irritation and wear and tear.
Symptoms associated with patella problems
- Pain when walking downhill
- Pain when walking down stairs.
- Pain when the knee is kept bent for a long time, e.g. during long car journeys
- Sometimes you can hear your knee ‘creaking’ when climbing the stairs
- Sometimes you can hear that kneecap ‘click’ when it is bent
What can our podiatrists do to help with pain in the kneecap?
During the examination, a podiatrist can check the alignment and movement of the foot, ankle and knee. If the ankle rolls in too much (overpronates) whilst walking, this affects the knee. As a result, the knee will rotate further inwards (internal rotation), causing the kneecap to be pulled outwards and come into contact with the outer edge of the patellofemoral groove. This causes pain and, in the long term, may lead to wear and tear of the knee. Excessive outward rolling (supination) can also cause this type of problem.
The podiatrist can then correct the foot position or gait using podiatric insoles or if you have a correct shoe advice often. In cases of these complaints, the podiatrist often works alongside the physiotherapist, who will train the thigh muscles.
