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Author Topic: Pain in medial lower femur, increases with weight on heel  (Read 381 times)

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Offline sashko

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Pain in medial lower femur, increases with weight on heel
« on: January 05, 2016, 05:48:32 AM »
Hi everyone,

I'm 26, and for the past year and a half, I have had knee pain which seems to be centered in the medial femoral condyle or epicondyle area. Through some PT but mostly just lots of time, I have gotten to the point where the pain is mild-moderate most of the time. Curiously, I tend to do better as long as I keep my weight on the balls of my feet; however, if I strike my heel (walking) just little harder than normal, or even just shift my weight to my heel when standing still, I immediately feel a much stronger pain in my knee, which tends to remain for extended periods of time. When sitting in a chair with my leg out, if my leg rests on the heel (or even foot flat on the floor), my knee starts to hurt a lot; but with my feet curled up under the chair and weight not on the heel, I can sit fine.

This also has made wearing or trying on most footwear extremely painful. I've noticed I do best barefoot, or in some specific pairs footwear that seem like they place most of my weight on the balls of my feet when standing or walking. (This tends to be footwear that has a lot of arch support and fairly neutral heel-to-toe drop. Shoes with low toes and even slightly lifted heels immediately cause pain in my knee which can last for weeks.)

The pain started quite suddenly (though without obvious injury) in summer 2014, on the tail of a several-month stint of walking around with shoe inserts that specifically lifted my heels. (I was doing this to help ease pressure on my calf and achilles, which I had badly strained several months prior.) I notice now that if I place those same heel-inserts in my shoes (even shoes that are bearably comfortable for me), I immediately get sharp pain - which is why I think those heel inserts contributed to the initial cause. Almost seems like anything pushing my heel up is pushing up into my femur via my tibia.

Just wondering if anyone else has experienced sharp pain in the same lower femur area which gets worse with weight placed on the heel. It has been a rough couple years (been to 3 orthopedists), and at this point, while I am able to bike and jog short distances with only minor discomfort, I can't squat or do much else without very strong pain that then lasts days or sometimes weeks. (Used to ski, mountain bike, backpack etc., etc.) Considering trying cortisone, but not quite sure that inflammation is at the root of my problem. Thanks for any input.

Best,
Sasha

Offline dal_knee

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Re: Pain in medial lower femur, increases with weight on heel
« Reply #1 on: January 05, 2016, 04:14:35 PM »

Sounds like bone marrow edema.  Check for it on T2 sequencing of your MRI.   Another term the radiologist may use would be subchondral edema.  I can write additionally if that's what's noted in your MRI.
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline sashko

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Re: Pain in medial lower femur, increases with weight on heel
« Reply #2 on: January 05, 2016, 04:40:14 PM »
Thanks a lot for your reply. I had an MRI about a month after the initial pain started, and then another one this past spring (about 6 months later). None of the three orthopedists that looked at the MRIs and accompanying reports ever mentioned edema, but I'll take another look at the reports at least.

Last orthopedist suggested that it might be neuroma (femoral or saphenous nerve) and suggested another MRI w/ contrast and also possibly a nuclear bone scan. Thinking about giving cortisone a try still before doing all that. I might also be better off seeing a Physiatrist/PM&R or Neurologist in addition to the orthos.
« Last Edit: January 05, 2016, 04:43:18 PM by sashko »

Offline dal_knee

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Re: Pain in medial lower femur, increases with weight on heel
« Reply #3 on: January 05, 2016, 05:07:31 PM »
Yes, please look at MRI report.   I would not be surprised if the ortho simply ignored this finding on MRI.  It's happened to me over and over again.    If there is no annotation on MRI, I recommend that you pop in your disk and make sure that they included a T2 sequence in the scan.    If they did, than you can probably cross off bone marrow edema as culprit and move forward with getting nerve conduction scan with physiatrist.
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.















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