Chronic Knee Pain Secondary to Biomechanical Changes in Young Adult with Pes Planus

Case at a Glance

A 21-year-old male presenting with chronic knee pain of several months duration, secondary to altered gait mechanics following longstanding foot pathology. Patient has significant pes planus and developmental coordination disorder affecting his biomechanics.

Patient's Story

The patient reports constant knee pain that developed following years of repetitive foot injury and has progressively worsened over the past two years. He describes how the chronic foot discomfort has altered his walking pattern, leading to compensatory knee pain. The pain is described as constant with exacerbation during daily activities and prolonged standing. Despite home physiotherapy exercises, ice therapy, and regular analgesics (paracetamol and ibuprofen), the pain continues to significantly impact his occupational activities and overall mobility. The patient has underlying severe pes planus (flat feet) and dyspraxia, which likely contribute to his altered biomechanics.

Initial Assessment

Physical examination revealed a young male with obvious bilateral pes planus. Gait analysis showed compensatory movement patterns. The patient reported taking prescribed vitamin D supplementation (1000 IU) and denied tobacco or recreational drug use, with minimal alcohol consumption. Multiple previous consultations with his general practitioner had provided limited therapeutic benefit.

The Diagnostic Journey

Initial imaging included plain radiographs of the foot, which ruled out fracture despite the patient's subjective sensation of the foot being 'broken.' The foot X-rays were reviewed and showed structural changes consistent with severe pes planus but no acute pathology. Following consultation feedback, the need for knee imaging was identified, with recommendations for MRI rather than plain films to better evaluate soft tissue structures and rule out internal derangement.

Final Diagnosis

Chronic knee pain secondary to biomechanical dysfunction and altered gait patterns related to severe bilateral pes planus and developmental coordination disorder. The case highlighted the need for comprehensive imaging workup before establishing a chronic pain diagnosis.

Treatment Plan

Continuation of conservative management including structured physiotherapy focusing on gait retraining and biomechanical correction. Referral to orthopedic specialist for comprehensive evaluation and consideration of advanced imaging (MRI). Discussion of multimodal pain management options including potential pharmacological interventions beyond basic analgesics and possible therapeutic injections pending imaging results.

Outcome and Follow-up

The case emphasized the importance of thorough investigation before labeling chronic pain conditions. Patient was advised that formal chronic pain documentation requires comprehensive evaluation and exploration of treatment options. Orthopedic referral was recommended to optimize management and explore specialized interventions for both the underlying biomechanical issues and resultant knee pathology.