chapter 12: Nonoperative Treatment


Kinetic Chain Mobilization and Alignment

Look at the patient standing, sitting, and moving. There are many variables from the ground up that will affect patellar tracking.

Starting at ground level, excessive pronation can lead to accentuation of valgus at the knee, external rotation of the foot and tibia, and resulting accentuation of lateral patellar alignment.

Simple, off‑the‑shelf orthotics can provide immediate reduction of this pronation and improvement of this component of the kinetic chain. Careful examination of the foot may reveal more pronation in the hindfoot or forefoot, so custom orthotics may be de­sirable in selected patients to address more severe functional deficits in these areas. One exception to medial posting or reduction of pronation is the patient with medial knee arthrosis (varus gonarthrosis). In such pronating patients, reduction of pronation may actually increase medial knee pain. Fortunately, such patients are relatively rare.

It is most helpful in the rehabilitation process to have a variety of antipronation or­thotics available on the shelf. Cork‑and‑leather arch supports are surprisingly comfort­able and may suffice for many patients at much less cost than custom molded orthotics.





Inside Chapter 12: