So I finally started going to PT to try to fix my knee probelm I've been having for 3 years now. During my therapy doing knee to chest stretch we notice my tibia/foot internally rotates as my knee is in flexion/bent. What is odd though, is my foot while standing is somewhat externally rotated/duck foot. I dont know if I've compensated for my bow leg/internally rotated tibia through out the years or what but it goes from one end of the spectrum to the other in a full bend and its only one leg. The pain is in the upper/medial aspect of my pattella. I've been fitted about 6 times with no resolution but this discovery may help with solving my problem on my next fix. Has anyone had a similiar exp. like this and if so, how would you change your fit to fix it. It's kind of crazy how the biomechanics of your knee work but I hope I can fix this. Thanks

That is a different kind of knee question. Not that I have heard of everything, but that sounds unusual to me. Has your PT ever seen it before?

Sort of, I have to work on my hip flexor to allow for more of a lateral movement between my upper and lower leg and also i'm working on my vmo. I'm just trying to figure out cleat position and possible wedging that would alleviate my biomechanical problem and if my fore/aft position of my cleat would help with the rotated tibia.

Both of my legs do that, and my knee pain turned out to be due to an extremely tight IT band pulling the knee cap to the right (right knee). I was born with tibial torsion as well, so things don't quite fit together as they would in a normal knee. I went through just about every part on my bike I could before I turned to medicine to see how to fix my knee pain although I only endured it for a year before seeking help.

Right now what has worked for me is getting shorter crank arms (165mm, I am 5'8") to open up the knee and daily foam roller on my IT band to keep it loose after my PT beat the knots out of it You also need to make sure that your feet are under your knees as you pedal, and if spacers/extenders are needed to get your feet under your knees, it is worth a shot. My pedals I am still working with. I have Shimano 105's, and the return-to-center mechanism requires that you get your cleat rotation spot on as the pedal system will return you to that point repeatedly. I have the cleats as far back as they will go so that I don't end up being on my toes and causing my achilles to tighten up. If your knee is really sensitive at this time, I would not recommend a return-to-center style pedal, but something like a Speedplay system which gives you plenty of float while your knee recovers from the 3 years of abuse. The PT I saw works at a sports rehab facility, so it was some tough therapy. He would work over my IT band to the degree that I got bruises down the side of my right leg, and I had to do a lot of exercises to strengthen my glutes and hamstrings.

Thanks deep sky

Question, do you use extenders and still point your toe inward or do you try to get your q angle as close as possible?

I actually had 3mm of washers on my left pedal at one point, I am down to 2mm, and considering going to one. My fit and fitness has change quite a bit since I first started using the washers.

I started out with matching my stance on the bike to what I did when walking (toes pointed slightly outward on both). Currently I still maintain that on my left knee, but my right seems to want to actually go with straight or slightly pointed inward, and so I've rotated the cleat to match where the foot seems to go. I just pay attention to where my feet want to go, and let them I ride a triple, so my q-factor will always be wide, as I need those low low gears for spinning up hills. If I don't spin, my patellar tendon in the right knee is very mad at me, so a triple it is. I am going to try to move the cleat inward a bit as I've noticed that my knee wants to go inward a bit.

For me, I just follow what my body tells me and adjust my equipment accordingly. Having a fitter who gets your problem, and a PT who specializes in working with athletes also helps.