Dear Dr. Caraotta
I have had knee problems on and off for some time and was told that this could be due to being overweight and not having good arch supports. I saw an advertisement on television that showed how getting an insert in the shoe could help knee problems. Do you think this could help, or what do you recommend?

Answer:
Knee pain could be caused by many different conditions. In order to understand this, it is important to have a general working knowledge of the architecture of the knee. The main supportive structure of the knee are ligaments. Ligaments are non-elastic bands which connect bone to bone. The knee has four major ligaments that are intimately related to function. There is one on the inside of the knee, one on the outside, and two in the center. The knee also has cartilage which serves as a shock absorber to the joint. Surrounding the joint, there is a fluid sac called bursa. This serves to help lubricate the joint. If a person has foot problem which causes them to walk antalgic, this could put excessive stress on the knee and result in a pain syndrome.

Since the knee is a dependent joint, it could also be affected by a persons weight. Excessive weight and undue stress could cause the cartilage to wear down and result in degenerative joint disease or osteoarthritis.

There are however many other conditions that could cause knee pain. The knee is susceptible to torsional stresses which is often encountered in sporting activities. Other common conditions involving the knee include knee bursitis, quadriceps weakening and imbalance, ligamentous sprain, and cartilaginous tears and Osgood Schlautters disease.

Foot othotics could be beneficial in some cases in which the patient is over pronating. When a patient looses the integrity of their arch, or if they have flat feet, the ankle will evert and cause a biomechanical shift in the ankle joint which could affect the knee, hip and low back. Orthotics in this case could be beneficial, if they are fitted properly. The best orthotic for a foot is a custom orthotic, in which an impression is taken of the foot and sent to a qualified laboratory to have the prescription filled.

In order for us to determine whether or not a foot orthodics could be beneficial in your case, It would be necessary for us to examine your foot and knee joint to see if there is a need or any correlation.