Knee instability doing box step ups, foot issue

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  • #33666
    christine-7855
    Participant

    I’ve noticed that when I do box step ups, my right leg is very solid but I have stability problems with my left leg. I can stand up on it, but I have to put a LOT more effort into balancing and holding the leg steady. I’ve also been fighting with a strange foot issue on my left side where I have a spot at the base of one of my outer toes on my forefoot that gets tender after long hikes or hiking with weight, and I wonder if the lack of leg stability is related.

    Any tips for how I can figure this out? I have been to a podiatrist about the foot but they were just confused. It’s something that is more of a niggle than something that prevents me from getting out, but it is starting to hold me back and I don’t want to ignore it. I wonder if I need to do some sort of PT on my left leg to strengthen stabilizers.

Posted In: Injury & Rehab

  • Participant
    alisonG on #33668

    That sounds like a really good observation- that you note instability on one leg and also some odd foot function. It’s definitely worth a check – but make sure to find a PT that has specific focus with this – not all are created equal. Where do you live, generally? Might be able to recommend someone to you!

    If you want to do a little more self-assessement or background reading, a PT wrote a book that can be quite useful for this- check out Jay DiCharry’s “Running Rewired”, specifically pg 77-88 that talks about foot function and single leg control. (I’m a PT too, disclaimer). Info in there translates nicely to mountain sports and compliments much of the strength and movement patterning work that Uphill Athlete folks have put together here.

    Participant
    christine-7855 on #33697

    I am in the San Francisco Bay Area, Alison G. I can ask my doctor for a PT recommendation… is it normal to go straight to a PT? Do PTs have specialties, or are they usual generalists?

    Participant
    christine-7855 on #33698

    I will check out the book too!

    Keymaster
    Scott Semple on #33732

    I’ve moved this over to our injury forum. If you revisit this page, you’ll see a blue bubble chat thingy in the lower right-hand corner of the screen. Click that to start a dialog with our PT, Pete Dickinson.

    Leg/knee instability is often a hip issue, but Pete will be better able to address the issue.

    Participant
    derekosborne22 on #33739

    Not sure whether PT is short for Personal Trainer or Physiotherapist – hope it’s the latter as in my experience Personal Trainers have very limited training in diagnosing injuries and developing recovery programs. That’s certainly the case in UK – maybe different in US.

    From my experience, I’d tend to agree with Scott that this is most likely to be a hip issue; maybe knee, but suspect hip. I’ve known several people with a variety of stability issues fixed by very specific hip/glut focused exercise programs. I think the foot issue is either something completely separate or is compensation issue, but very unlikely it’s the source of the instability. A good Physio should be able to diagnose and come up with a recovery program.

    Hope this helps, and hope you get it fixed – sounds very frustrating.

    Participant
    christine-7855 on #33744

    Physical Therapist, Derek. My hunch is that the foot could be a compensation issue. I’m kind of grasping at straws here. It’s been something that’s been in and out for the better part of a year, since I was doing weighted hill training, sometimes on foot and sometimes on skis, for an expedition to Mount Kenya last February. The podiatrist gave me some foot pads but it’s still been in and out depending on what activity I’ve been engaging in. A few long approaches to alpine walls this summer had me limping on the left side at the end, though it always recovered by the next morning with rest.

    Makes sense to move this to the injury forum. I don’t feel injured, but perhaps that’s denial. 😉 It’s affecting me enough that I’ve backed off on doing much aerobic / ME training for ski touring this winter, and am focusing on rock climbing instead. I recently reintroduced box step ups as a part of a general strength circuit, and that definitely makes my left foot feel weird after.

    Sometimes rock climbing does aggravate the left foot also, particularly some torquing motions. Sometimes I can trigger acute pain that then quickly subsides.

    I’m requesting a referral from my primary care doctor and also trying to get in touch with someone through the Uphill Athlete PT program, which I did not know about previously!

    Moderator
    Pete Dickinson MS,PT on #33804

    Christine,
    Pete the physiotherapist here. Some different factors come in to play with single leg stance instability, especially when its one sided. You were right to check with your podiatrist to see if you have different foot structure from one side to the other. It’s not uncommon to have more forefoot ‘varus’ (upward cant of the front of the foot) on one side causing more pronation and instability. This type of structure can also stress the outside of the foot. Metatarsal pads can aide in providing some support to your forefoot.
    The ligaments holding your ankle together can also make balancing more difficult. Recommendations for this type of issue is to make sure you wear good stability oriented trainers, as this will help your stability.
    Of course, there are other factors. Your hip strength is a key factor in foot stability. the good news is that this can be trained! Starting off with weight bearing exercise into both legs such as deadlifts is a good start. Progress into front and side lunges. The key is making sure your knee stays stacked on top of the foot,and doesn’t collapse in. Monster walks with bands around the knee or ankles are also a good activity.
    Hope this gives you some direction to pursue. Best of luck and keep in touch!
    Pete

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