Patellofemoral Pain Syndrome (Runner’s Knee)
at Foot Foundation

Patellofemoral Pain Syndrome (PFPS), often called runner’s knee, is pain felt around or behind the kneecap when it doesn’t track smoothly within its groove on the femur. While discomfort is centred at the knee, the root cause is often linked to the feet and lower limb mechanics.

Flat feet, excessive pronation, or poor footwear can increase inward rotation of the tibia and femur, altering kneecap alignment and increasing joint stress.

At Foot Foundation, we focus on correcting these biomechanical drivers with orthotics, footwear optimisation, and gait retraining, helping relieve pain and protect long-term knee health.

What is Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome (PFPS), commonly called runner’s knee, is pain felt around or behind the kneecap (patella). It occurs when the kneecap does not track smoothly within its groove on the femur, often due to abnormal lower limb mechanics.

While pain is experienced at the knee, the underlying cause is frequently found at the foot and ankle. Excessive pronation, flat feet, or poor footwear can increase inward rotation of the tibia and femur, altering patellar tracking and increasing joint stress.

At Foot Foundation, our podiatrists specialise in identifying these foot-driven causes and correcting them with targeted treatments to relieve pain and improve long-term knee health.

Causes & Risk Factors

Excessive foot pronation or flat feet – increasing tibial and femoral rotation, altering patella alignment
High arches – leading to poor shock absorption and increased force through the knee
Inappropriate footwear – worn-out shoes or unsupportive trainers
Muscle weakness/imbalance – particularly quadriceps, gluteals, and hip stabilisers
Overuse & training load – running, cycling, stair climbing, jumping sports
Sudden load changes – rapid increase in training volume or intensity
Previous injury – ankle sprains or hip weakness affecting gait mechanics

Treatment at Foot Foundation

Foot & Lower Limb Alignment
- Custom orthotics – to control excessive pronation, optimise tibial rotation, and improve knee alignment
- Footwear advice – recommending supportive shoes for running, sport, and daily wear
Load Management
- Activity modification to reduce painful loads while maintaining fitness
- Gradual, structured return to running or sport
Strengthening & Rehabilitation
- Referral to physiotherapy for quadriceps, gluteal, and hip strengthening
- Foot and ankle stability programs to reduce stress further up the chain
Gait Retraining
- Running technique modification – improving cadence, reducing overstride, and correcting hip-knee-foot mechanics
Pain Relief & Adjunct Therapies
- Shockwave therapy for chronic cases resistant to standard care
- Taping techniques to temporarily realign the patella and reduce pain

Symptoms

Pain around or behind the kneecap, often dull and aching
Symptoms aggravated by running, stairs, squatting, or prolonged sitting (“theatre sign”)
Grinding, popping, or clicking under the kneecap (crepitus)
Occasional swelling or feeling of instability
Pain worse after long periods of activity on hard surfaces

Diagnosis

At Foot Foundation, diagnosis includes:

Comprehensive biomechanical assessment – identifying foot posture, pronation, gait, and footwear factors contributing to patella maltracking
Video gait analysis – to observe lower limb alignment during walking and running
Functional testing – squats, step-downs, single-leg tasks to replicate pain
Referral for imaging (if indicated) – MRI or X-ray to rule out cartilage damage or arthritis