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Knee PainThere are a variety of different types and causes of knee pain, and your treatment will vary depending on the cause.
Treating knee painIf you are suffering from knee pain and you also have flat feet (over pronate), it may be worth seeing a podiatrist to assess whether you may benefit from orthotic therapy to control your pronation.
Hip and lower back painThere are many and varied causes for hip and lower back pain and as with knee pain, the hip and lower back can also be affected by poor foot biomechanics, and over pronation in particular. When the positioning of any joint or structure in the body is put out of it’s normal alignment it can result in pain, discomfort or injury.
The ankle joint is formed where the bones of the lower leg, the tibia and the fibula, connect above the anklebone, called the talus. The ankle joint is a hinge that allows the foot to move up (dorsiflexion) and down (plantarflexion).
Irritation in the lower edge of the AITFL and the front of the ATFL can thicken these ligaments. Symptoms of posterior impingement include pain behind the heel or deep in the back of the ankle. The physical therapist's goal is to help you keep your pain under control, improve your range of motion, and maximize strength and control in your ankle. A marvel of bioengineering, the human foot combines the mechanical complexity of a Swiss watch with the structural strength of a cantilever bridge.
In some cases, knee pain can be exacerbated by poor foot biomechanics, most commonly over pronation (flat feet). Whilst you will likely need to seek trained advice from a therapist to assess and treat your hip or lower back pain, it is worth being aware that your foot biomechanics may be playing a part in your condition, and treating any abnormal biomechanics may assist in your recovery.
Impingement mainly happens when the ankle is fully bent up or down, leading to pain either in the front or back of the ankle joint.
The irritated ligaments become vulnerable to getting pinched between the tibia and talus as the foot is dorsiflexed.

It is most common in ballet dancers who must continually rise up on their toes, pointing their foot downward into extreme plantarflexion. In general, MRI scans are not helpful for impingement problems, but they may be ordered to check for other ankle problems that could be causing your pain. The way the lower back is positioned and moves can be connected to the positioning of the pelvis. This is especially true for athletes who repeatedly bend the ankle upward (dorsiflexion), such as baseball catchers, basketball and football players, and dancers.
When anterior impingement comes from ligament irritation, pain and tissue thickening are usually felt in front and slightly to the side of the ankle. If the pain doesn't change, the problem could be in the tendon that runs along the inside edge of the os trigonum. Mild pain medications and anti-inflammatory medicine, such as ibuprofen, may also be prescribed. Patients are placed in a special splint designed to protect the ankle and to keep the foot from pointing downward. The amount of weight put on the foot is gradually increased over a period of one to two weeks. The first few physical therapy treatments are also designed to help control pain and swelling from the surgery.
Dorsiflexing the ankle can trap the tissue between the edge of the ankle joint, causing pain, popping, and a feeling that the ankle will give out and not support your body weight.
To check for posterior impingement, the doctor may push your foot downward or have you rise up on your toes. Crutches are used during this time as the amount of weight borne on the foot is gradually increased.
The largest and strongest tendon of the foot is the Achilles tendon, which extends from the calf muscle of the leg to the heel.

As the foot points downward sharply, the os trigonum can get sandwiched between the bottom edge of the tibia and the top surface of the calcaneus (the heelbone).
Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.
The phalanges are connected to the metatarsals by five metatarsal phalangeal joints at the ball of the foot. Its strength and joint function facilitate running, jumping, walking up stairs or raising the body onto the toes.
If the ligaments have irritated the synovium of the ankle joint capsule, throbbing pain and swelling from inflammation (synovitis) may also be felt in this area. Collectively, the forefoot bears half the body's weight and balances pressure on the ball of the foot.
The midfoot, featuring five irregularly shaped tarsal bones, forms the foot's characteristic arch and serves as a shock absorber. The top of the talus is connected to the two long bones of the lower leg, the tibia and fibula, forming a hinge that allows the foot to move up and down. It joins the talus to form the subtalar joint, which enables the foot to rotate at the ankle. They give the foot its shape by holding the bones in position, and expand and contract to impart movement to the bones and joints.

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