Patello-femoral tracking syndrome?

[swissiphic]

Data point:

Been dealing with low grade but persistent pfs for the past four years or so...mostly aggravated by my routine hiking sessions in the off season from skiing. It was never enough to seek pro help or change my routines but just a general pia. While ski touring in the winter it seems to disappear.

Recently replaced some old hiking boots that i've been using for the past three years. Replaced with same make/model/size. Figured since they're new, might as well try em without podiatrist made custom orthotics that i generally HAVE to use due to severe pronation and flat foot issues. For the first hike tried one and one...one boot with/one boot without custom orthotic. Noticed that there was an ever so slight positive change in that niggling pfs pain sensation in knee of legs with boot without custom orthotic. For the past three weeks been doing my 4/5 day a week 1200-1500 vert foot hiking routine without the custom orthotics. Knee pain has gone from a 3-4 to a 1-2.

Curious as to the mechanics behind this seemingly causal not corellatave positive development, i analysed my old boots, orthotics, new boots/sans orthotics. Old boots had excessive wear in forefoot caused by wear of regular quite steep up the fall line hiking. The orthotics have a pronounced heel shelf/arch support to post heel and provide arch support. This results in an inherent heel high/steep ramp angle. Combined with the excessive wear of the boots outsole forefoot, the combined ramp must have positioned my feet in an angle that i believe impacted the knees when compared to the new boots/stock flatish insoles. When downhilling, it was difficult to get my center of mass over the balls of my feet without substantial quad muscle flexion. For uphilling, either box stepping or french techniquing, the feet never felt 'natural'...just learned to live with it and compensate I guess.

Using this info, i did a test hike to compare contrast sensations of balance, gait and muscle engagement. I discovered that the old boots/custom orthotic combo encouraged a gait that encouraged a more upper body inclined towards the slope/butt out/quad muscles and suspect mid/upper glutes engaged focused stride. It felt a bit more un natural to remain more upright and engage the suspect lower glutes and hamstrings connection. With the new boot/flat insole test hike, i could more natural perform a 'rest step' stride, keep the upper body more upright and could feel more engagement of the a different zone of suspect lower glutes and somehow different sensation in hamstrings in my uphilling steps.

For downhilling, the resulting foot position promoted a better balance on ball of feet with less engagement and less fatiguing of the quad muscles.

All makes sense. Similar sensations felt on skis with boots/bindings with higher combo of ramp angle while downhilling, IIRC, imo.

Haven't read the entire thread...did u analyse footwear and how foot angle and/or foot issues/and/or shoe insoles for daily use/exercise use might be affecting things?

[galibier_numero_un]

That thread in Tech Talk I referenced above is still getting some action (https://www.tetongravity.com/forums/...Leg-(Quad)-Man).

With respect to foot and such, my PT did some pressure mapping - with two different pairs of orthodics as well as without. After a few ankle stretches/manipulations, my best stance was actually without orthodics. No doubt (without ongoing manipulation) I'll revert, but this was instructive, nevertheless.

Interestingly, I found myself leaning toward either my softer/less corrective orthodics or none at all. Some of the balance exercises I'm doing are intended to increase my awareness of the three key points of contact on my foot.

The quad-centric/dominant approach I've taken for years is going to take some time to roll back. As you mentioned, it feels a bit unnatural to engage my glutes and hamstrings more - almost as I I'm walking like Mr. Natural (for those of you old enough to remember him)



She's teaching me to feel my glutes when walking down stairs, for example, and all of the other exercises are geared toward learning how to fire my glutes as well.

Now that I'm back to long walks/easy hikes, I'm noticing the quad dominance on my left leg. As I focus on engaging my glutes, I'm noticing a weak left hamstring showing itself. Things to work on ;-)

... Thom