Iliotibial Band Syndrome

Iliotibial Band Syndrome or 'Ilitibial Band Friction Syndrome' is a common sports injury generally associated with running. This syndrome is bound to cause lateral knee pain in runners. This injury can also be caused by biking, hiking and weight lifting. This Iliotibial band is a thick fibrous tissue that runs from the outside of the pelvis, over the hip, knee and below the knee joint. The band stabilizes the knee during movements like running. The band coordinates with several other thigh muscles and moves from behind the femur in the thigh to the front during the gait cycle. The Iliotibial Band Syndrome refers to the superficial thickening of the tissue that is on the outside of the thigh. Continuous rubbing and flexing of the band causes irritation usually over the outside of the knee joint.

Common causes of the Iliotibial Band Syndrome among runners

• Iliotibial Band Syndrome occurs when the level of activity increases especially among runners who tend to increase their mileage. Increasing distance too quickly or excessive downhill running is a common cause among runners.
  
• Poor training habits in runners can cause this syndrome. While running on an indoor track, the leg bends slightly inwards and this causes extreme stretching of the Iliotibial band and the resultant injury.
  
• Inadequate warm up and cool down sessions among sports persons can cause this syndrome.
  
• While cycling, having the feet 'toed in' at an extreme and excessive angle can cause the Iliotibial band injury.

Individuals with anatomical abnormalities of the leg such as bow legs, high or low arches, overpronation of the foot and uneven leg length are prone to this condition. Muscle imbalance such as weak hip abductor muscles can lead to iliotibial band syndrome.

Symptoms of this syndrome include pain in the knee joint that worsens with continued movement and resolves on rest. There is persistent pain below the knees or stinging sensation just above the knee joint. Often swelling or thickening is noticed at the point of knee joint where the band moves over the femur. Persons suffering these symptoms must avoid running downhill or squatting, playing tennis or basketball and indulging in martial arts.

Treatment for Iliotibial Band Syndrome normally begins with applying ice the area of injury, selection of proper footwear and stretching routine. While icing, the injured part has to be kept elevated as this helps to reduce swelling. Anti-inflammatory medications and cortisone injections may be prescribed to reduce the inflammation. Surgery is rarely resorted to.

Chondromalacia

Chondromalacia can be defined as the degeneration of the cartilage in the knees. A chondromalacia patella is the softening of the cartilage underneath the patella or kneecap. Generally it is described as a pain beneath or the sides of the kneecap. Chondromalacia is often called Patellofemoral stress syndrome. When softening occurs, the cartilage breaks down causing irregularities along the under surface of the kneecap. Chondromalacia is caused by muscle imbalance like weak quadriceps and strong hamstrings. Excessive pronation as is the case when an arch collapses too much thereby causing the knee cap to twist sideways can also be a source for chondromalacia.

Chondromalacia occurs when the articular cartilage breaks down due to wear and tear process in the body. The patella cartilage is one of the earliest places in the body where cartilage breakdown can occur. This leads to degenerative arthritis or osteoarthritis in the knee joint. Chondromalacia also occurs frequently due to overuse and related trauma. Referred to as runner's knee, chondromalacia occurs in part time athletes and in professional sports person who trains more than usual. Due to overuse cartilage tear occurs and the knee starts giving way. Nagging injuries is also a common cause of chondromalacia in sports persons. Symptoms of Chondromalacia include pain in front of the knee around the kneecap as well as deep-seated pain in the back of the knee. There may be pain on squatting or kneeling. The knees might be tender and there may be swelling around the knee joints. In severe cases of chondromalacia a grating or grinding sensation of the bone are heard when the knee is extended.

After ascertaining the clinical history and a physical examination, the physician orders for x-ray of the knee. Even if the x rays are normal, a special x ray view of the patella view or 'sunrise' view shows the patella displacement or tilted laterally and the muscle (vastus lateralis) looks too tight or over powering.

In most cases of chondromalacia, exercises with or without formal physical therapy are enough to correct the problem. Physicians prescribe physical therapy if the pain persists. Icing an injured body part is an important part of the acute treatment process for Chondromalacia. A physician prescribes NSAID for chondromalacia to reduce pain and swelling. Sports medicine therapists often prescribe knee brace for patients who want to stay active in sports. This brace is known as a patella stabilizing brace. If the pain worsens, surgical treatment is suggested. Arthroscopy is a common orthopedic procedure for diagnosing and treating chondromalacia.

• Trauma and abnormal stress to the knee should be avoided.
  
• The leg muscles, especially the quadriceps and hamstrings should be maintained strong and flexible.
  
• Participation in sports and strenuous activities should be limited until the pain has gone away. Activities that increase the knee pain such as knee bends, should be avoided until the pain improves.
  
• Girls may develop this problem of Chondromalacia Patellae depending on the morphology. Tall and knock-kneed teenagers are more prone to develop chondromalacia especially if they have tightness of lateral muscles.
  

Blount Disease

Blount's disease or 'tibia vara,' is a growth disorder in the shin bone that affects the bones of the lower leg causing the lower leg to angle inward. This resembles a bow leg.

Named after the American orthopedic surgeon, Putnam Blount (1900 - 1992), Blount's disease is characterized by progressive lower limb deformity. Though Blount can affect people at any time during the growing process, it is more common in kids younger than four and in teens. A lot of pressure is put on the growth plate on the top of the tibia. This portion is called the physis - made out of cartilage, weaker than bone. The function of the physis is to allow the bone to lengthen and grow.

Due to excess pressure, the bone does not grow normally and instead the lateral outer side of the tibia keeps growing whereas the medial or inner side of the bone does not. Because of uneven bone growth, the tibia tends to bend outward instead of growing straight. Blount is not the same as naturally bowed legs that babies and toddlers have which usually straighten out when they start walking.

Blount is described as two distinct forms, early or infantile and late or adolescent Blount disease.

Infantile Blount disease is diagnosed between age one and three years. The disease presents when a child begins to ambulate. This disease is often bilateral and is less commonly associated with obesity.

Quite unlike the infantile Blount, late onset of Blount disease occurs in older children and is commonly associated with obesity and is often unilateral.

A combination of mechanical and biological factors influences Blount's disease to varying degrees. The mechanical forces contributing to the disease are weight of the child, age at walking, and varus deformity. The compressive forces across the medial femoral physis lead to growth retardation. Adolescent Blount does not appear to be progressive, or as common as the infantile form.

Causes

The cause of Blount disease remains controversial but it is mostly due to a combination of hereditary and developmental factors. There is increased incidence of the disease in overweight children who walk at an early age. Certain theories that mechanical overload of the proximal tibia contribute to Blount disease has been found. This mechanical overload is attributed to obesity and varus deformity. But this alone cannot be a cause as the disease is also noticed in children with normal weight.

Increasingly it is more common in people of African heritage, where kids start walking at an early age and whose family member might have had it. There is a genetic component to the disease as well, though a direct pattern of inheritance has not been clearly revealed. Hence, Blount is multifactorial and may differ in the early or late onset forms of the disease.

Symptoms

It is imperative to understand that Blount disease starts in early childhood or late teen years, the curve can get worse if not treated. Hence early diagnosis is important. The most obvious sign of Blount is bowing of the leg below the knee. While in young kids it is usually not painful, it teens it can be. It can feel like a growing pain in the knee area. The pain may come and go and many teens resort to over-the-counter pain relievers. As the lower leg bears the weight of the body, other problems such as rotation of the tibia are noticed. This causes a condition called in-toeing, wherein the feet point inward instead of straight out. Blount disease, over several years, can lead to arthritis of the knee joint and trouble walking. One leg may become slightly shorter than the other.

Diagnosis

If there is knee pain that seems to be getting worse and cannot be traced to an injury, then the doctor might possibly consider Blount. A complete physical examination will be done, and X-rays of legs taken. The doctor will look for any abnormal growth pattern at the top of the tibia - a tell tale sign of Blount. This will help the doctor measure how severe the bowing is.

Treatment

Treatment for Blount depends on the age of the patient and how far the disease has progressed. Young kids are advised braces, which are long-legged and lock the knee and need to be worn whilst weight bearing. But bracing is usually unsuccessful in girls and those with obesity. Older kids and teens will need surgery. There are different types of surgeries to correct Blount disease. These involve cutting the tibia, realigning it and holding it in place with plate and screws. This procedure is called Osteotomy. Sometimes, the damaged growth plate is removed and a device called external fixator is used to hold bones in place from the outside. In case of a twisted toe, surgeons correct the cause of it. Surgery is done under general anesthesia, and the patient might wear a cast and use crutches for a while. Physical therapy will be needed after surgery.