I wonder if you could give me some advice. I have a client with a running difficulty. When he runs, his right foot tends to point outwards and he feels pain in his right knee. Could you suggest to me what causes this and are there any solutions?
Yes. This is a common malalignment with many possible reasons. It sounds like your client is experiencing an abnormal valgus force, which is leading to a strain at the Pes anserine complex. If not taken care of, this abnormal stress can lead to ligamentous instability. Because the source of the problem could come from literally anywhere in the kinetic chain, it is close to impossible to give you an exact answer, but I will touch on a few and give some advice to point you in the right direction.
Start by assessing the function of the foot and hip. Search for the following answers (if beyond your expertise, refer out to someone that can help you - you will be the hero because you were smart enough to at least help!).
- Can they dorsiflex at least 15-20 degrees?
- Can they invert and evert their calcaneus?
- Does the tibia move well over the foot as the foot is in contact with the ground or is there abnormal movement when you place them in a controlled setting (you already said its abnormal when they run – but what if you control it)?
The key here is to see if your client has multi-planar ankle/foot mobility? If the answer is yes, then go to the hip complex and search for restrictions and/or abnormal movement that potentially is “driving” the increased valgus force. Be sure all planes are tested in attempts to determine the weak link. If the answer is no, then the first place to start is at the restricted ankle/foot complex. Use a slant board and improve the sagittal plane (forward-back), frontal (side-to-side) and transverse (turning) planes of motion followed by a dynamic foot/ankle stretch to prepare your client for running.
If the hip, foot and ankle checks out okay, then repeat the same tests on the left to see if the left side is “driving” the right malalignment. (Note: Often the opposite side foot-ankle and/or hip will drive the opposite side malalignment.)
I know this can be complex as I am just touching on a few things that can be causing what you’re observing, but at least this thorough process can steer you in the right direction. For more information on assessing runners and teaching runners (or clients) how to run efficiently, I would strongly recommend these two references.
- Gary Gray’s Functional Video Digest on Running
- The book Pose Method of Running by Dr. Romanov
These two references will thoroughly educate you on your client situation. If you have any further questions, feel free to contact me.
All the best.