Knee & Leg

Conditions We Treat:

Fractures
Genu Valgum/Varum (Knock Knees/Bow Legged)
Osgood-Schlatter Disease (Knee Pain)
Runner’s Knee (Patellofemoral Pain)
Shin Splints
Strains/ Sprains
Tears: Meniscal, Patellar, Tendon, Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Quadriceps

Fractures

A fracture is a break in a bone. There are different types of fractures based on whether the bone is partially or completely broken, whether the bone breaks through the skin, the direction or shape of the break, the cause of the break, and the location of the break.

Causes:

Fractures commonly happen because of car accidents, falls, or sports injuries. Overuse and repetitive motions can also cause fractures. Low bone density and osteoporosis are conditions which cause weakening of your bones. Having one of these conditions makes you much more likely to break a bone.

Management:

Cast or splint: Wearing a cast or a splint will keep your bone from moving while it heals. How long you need to wear it will depend on the type of fracture and which bone is affected.
Recovering from fractures (Bone Health and Osteoporosis Foundation)

Patellofemoral Pain (Runner’s Knee)

Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is sometimes called "runner's knee" or "jumper's knee" because it is common in people who participate in sports — especially females and young adults — but PFPS can occur in nonathletes, as well.

Causes:

In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee — such as jogging, squatting, and climbing stairs.
It can also be caused by a sudden change in physical activity, which can be related to the frequency of activity (e.g., increasing the number of days you exercise each week) or to the duration or intensity of activity (e.g., running longer distances).
Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to one side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues.

Management:

Activity changes. Stop doing the activities that make your knee hurt until your pain goes away. This may mean:

Changing your training routine
Switching to low-impact activities — such as riding a stationary bike, using an elliptical machine, or swimming — that will place less stress on your knee joint
If you are overweight, losing weight, which will also help to reduce pressure on your knee

The RICE method:

Rest. Avoid putting weight on the painful knee.
Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on skin.
Compression. To prevent additional swelling, lightly wrap the knee in an elastic bandage, leaving a hole in the area of the kneecap. Make sure that the bandage fits snugly and does not cause additional pain.
Elevation. As often as possible, rest with your knee raised up higher than your heart.

Shin Splints

Shin splints occur when you have pain in the front of your lower leg. The pain of shin splints is from the inflammation of the muscles, tendons, and bone tissue around your shin. Shin splints are a common problem for runners, gymnasts, dancers, and military recruits.

Causes:

Shin splints are an overuse problem. You get shin splints from overloading your leg muscles, tendons or shin bone. Most often, the activity that causes the injury is high impact and repetitive exercise of your lower legs. This is why runners, dancers, and gymnasts often get shin splints.

Common situations that cause shin splints are:

Sudden change in activity level, whether it is in intensity or duration
Running, especially on hills. If you are a new runner, you are at greater risk for shin splints.
Increasing your days of training.
Increasing the intensity of training, or going a longer distance.
Doing exercise that has frequent stops and starts, such as dancing, basketball, or military training.

You are more at risk for shin splints if you:

Have flat feet or very rigid foot arches.
Work out on hard surfaces, such as running on the street or playing basketball or tennis on a hard court.
Do not wear the proper shoes.
Wear worn out shoes. Running shoes lose over half of their shock absorbing ability after 250 miles (400 kilometers) of use.

Management:

Avoid repetitive exercise of your lower leg for 1 to 2 weeks. Keep your activity to just the walking that you do during your regular day.
Try other low impact activities as long as you do not have pain, such as swimming, elliptical machines, or biking.

Expect that you need at least 2 to 4 weeks of rest from your sport or exercise. After 2 to 4 weeks, if the pain is gone, you can start your usual exercise activities. Increase your activity level slowly. If the pain returns, stop exercising right away.

Know that shin splints can take 3 to 6 months to heal completely. Do not rush back into your sport or exercise. You could injure yourself again.

In the meantime, some method you can try to reduce pain and swelling include:

Ice your shins. Ice several times a day for 3 days or until pain is gone.
Do stretching exercises, especially over the front part of the shin.
Use arch supports. Talk with your provider or physical therapist about wearing the proper shoes, and about special shock-absorbing insoles or orthotics to wear inside your shoes.
Work with a physical therapist. They can use therapies that may help with the pain. They can teach you exercises to strengthen your leg muscles.

Genu Valgum (Knock Knees)

Knock knees are a condition in which the knees touch, but the ankles do not touch. The legs turn inward.

Causes:

Infants start out with bowlegs because of their folded position while in their mother's womb. The legs begin to straighten once the child starts to walk (at about 12 to 18 months). By age 3, the child becomes knock-kneed. When the child stands, the knees touch but the ankles are apart.

By puberty, the legs straighten out and most children can stand with the knees and ankles touching (without forcing the position).

Knock knees can also develop as a result of a medical problem or disease, such as:

Injury of the shinbone (only one leg will be knock-kneed)
Osteomyelitis (bone infection)
Overweight or obesity
Rickets (a disease caused by a lack of vitamin D)

Management:

Knock knees are not treated in most cases. If the problem continues after age 7, the child may use a night brace. This brace is attached to a shoe. Surgery may be considered for knock knees that are severe and continue beyond late childhood.

Genu Varum (Bowed Leg)

Bowlegs is a condition in which the knees stay wide apart when a person stands with the feet and ankles together. It is considered normal in children under 18 months.

Causes:

Infants are born bowlegged because of their folded position in the mother's womb. Bowed legs begin to straighten once the child starts to walk and the legs begin to bear weight (about 12 to 18 months old).

By around age 3, the child can most often stand with the ankles apart and the knees just touching. If the bowed legs are still present, the child is called bowlegged.

Bowlegs may be caused by illnesses, such as:

Abnormal bone development
Blount disease
Fractures that do not heal correctly
Lead or fluoride poisoning
Rickets, which is caused by a lack of vitamin D

Management:

No treatment is recommended for bowlegs unless the condition is extreme. The child should be seen by the provider at least every 6 months.
Special shoes, braces, or casts can be tried if the condition is severe or the child also has another disease. It is unclear how well these work. At times, surgery is done to correct the deformity in an adolescent with severe bowlegs.

Strains/ Sprains

A sprain is a stretched or torn ligament. A strain is a stretched or torn muscle or tendon.

Causes:

Falling, twisting, pulling, or getting hit can all cause a sprain or a strain. Sprains most commonly occur at ankles and wrists. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common.

Management:

For the first 48 hours after the injury, follow the R.I.C.E. guideline:

Rest the injured part.
Ice the injured part to reduce swelling.
Compression also helps with reducing swelling.
Elevate the injured part above heart level to reduce swelling

Meniscal Tears

Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. However, anyone at any age can tear the meniscus.

Causes:

Acute meniscus tears often happen during sports. These can occur through either a contact or non-contact injury — for example, a pivoting or cutting injury.

As people age, they are more likely to have degenerative meniscus tears. Aged, worn tissue is more prone to tears. An awkward twist when getting up from a chair may be enough to cause a tear in an aging meniscus.

Management:

Many meniscus tears will not need immediate surgery. If your symptoms do not persist and you have no locking or swelling of the knee, your doctor may recommend nonsurgical treatment.

The RICE protocol is effective for most sports-related injuries.

Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.

You should not put all of your weight on your leg if it hurts or if your provider tells you not to. Rest and self-care may be enough to allow the tear to heal. You may need to use crutches.

Afterward, you will learn exercises to make the muscles, ligaments, and tendons around your knee stronger, more flexible, and more resistant to injury.

If you have surgery, you may need physical therapy to regain the full use of your knee. Recovery can take a few weeks to a few months. Under your provider's guidance, you should be able to do the same activities you did before.

Patellar Tendon Tears

Tendons are strong cords of fibrous tissue that attach muscles to bones. The patellar tendon works with the muscles in the front of your thigh to straighten your leg.

Small tendon tears can make it difficult to walk and participate in other daily activities. A large tear of the patellar tendon is a disabling injury. It usually requires surgery and physical therapy afterward to regain full knee function.

Causes:

Injury. It takes a very strong force to tear the patellar tendon.
- Falls. Direct impact to the front of the knee from a fall or other blow is a common cause of tears. Deep lacerations are often associated with this type of injury.
- Jumping. The patellar tendon may tear when the knee is bent and the foot planted, like when landing from a jump or jumping up.
Tendon weakness. A weakened patellar tendon is more likely to tear. Several things can lead to tendon weakness:
- Patellar tendinitis. Inflammation of the patellar tendon, called patellar tendinitis, weakens the tendon. It may also cause small tears.
- Chronic disease. Weakened tendons can also be caused by diseases that disrupt blood supply, including chronic kidney failure, high cholesterol, inflammatory diseases, diabetes, infection, and metabolic disease.
- Steroid use. Using medications like corticosteroids and anabolic steroids has been linked to increased muscle and tendon weakness.

Management:

Immobilization. Your doctor may recommend you wear a knee immobilizer or brace. This will keep your knee straight to help it heal. You will most likely need crutches to help you avoid putting all of your weight on your leg. You can expect to be in a knee immobilizer or brace for 3 to 6 weeks.
Physical therapy. Once the initial pain and swelling have settled down, you can begin physical therapy. Specific exercises can restore your strength and range of motion.
While you are wearing the brace, your doctor may recommend exercises to strengthen your quadriceps muscles, such as straight-leg raises. As time goes on, your doctor or therapist will unlock your brace, which will allow you to move more freely with a greater range of motion. You will be prescribed more strengthening exercises as you heal.

Anterior Cruciate Ligament (ACL) Injuries

One of the most common knee injuries is an anterior cruciate ligament (ACL) sprain, or tear. Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their ACL.

Causes:

The anterior cruciate ligament can be injured in several ways:

Changing direction rapidly
Stopping suddenly
Slowing down while running
Landing from a jump incorrectly
Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.

Management:

Treatment for an ACL tear will vary depending on the patient's individual needs. For example, a young athlete involved in agility sports will most likely require surgery to safely return to sports. A less active, older individual may be able to return to a quieter lifestyle without surgery.

Posterior Cruciate Ligament (PCL) Injuries

The posterior cruciate ligament (PCL) is located inside the knee, just behind the anterior cruciate ligament (ACL). It is one of several ligaments that connect the femur (thighbone) to the tibia (shinbone). The posterior cruciate ligament keeps the tibia from moving backward with relation to the thigh bone.

Causes:

An injury to the posterior cruciate ligament can happen many ways. It typically requires a powerful force.

A direct blow to the front of the knee (such as a bent knee hitting a dashboard in a car crash, or a fall onto a bent knee in sports)
Pulling or stretching the ligament (such as in a twisting or hyperextension injury)

Management:

Many posterior cruciate ligament tears are partial tears with the potential to heal on their own. People who have injured only their posterior cruciate ligaments may be able to return to sports without experiencing knee stability problems. Non-surgical treatment options include:

RICE: When you are first injured, the RICE method — rest, ice, gentle compression, and elevation — can help speed your recovery.
Immobilization: Your doctor may recommend a special brace to prevent the tibia bone from sagging backward (gravity tends to pull the bone backward when you are lying down). To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy: As the swelling goes down, you will start a careful rehabilitation program. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. Strengthening the muscles in the front of your thigh (quadriceps) has been shown to be a key factor in a successful recovery.

Your doctor may recommend surgery if you have combined injuries. For example, if you have dislocated your knee and torn multiple ligaments including the posterior cruciate ligament, surgery is almost always necessary. Additionally, patients with an isolated PCL tear may benefit from reconstruction if they have persistent instability or pain that is not improving with non-operative treatment.

Quadriceps Tendon Tear

The quadriceps tendon is the most important tendon involved in straightening the knee from a bent position. Small tears of this tendon cause pain or make it difficult to walk and participate in other daily activities. A complete tear of the quadriceps tendon is a disabling injury. It almost always requires surgery, followed by physical therapy to regain full knee motion and function.

Quadriceps tendon tears are not common. They most often occur among middle-aged people who play running or jumping sports.

Causes:

A quadriceps tear often occurs when there is a heavy load on the leg with the foot planted and the knee partially bent. Think of an awkward landing from a jump while playing basketball. The force of the landing is too much for the tendon and it tears. Tears can also be caused by falls, direct force to the front of the knee, and lacerations (cuts).

Another common cause for a tear is a weakened quadricep tendon. Several factors can lead to tendon weakness:

Tendinitis. Inflammation of the quadriceps tendon, called quadriceps tendinitis, weakens the tendon. It may also cause small tears. Quadriceps tendinitis is most common in people who run and participate in sports that involve jumping.
Chronic disease. Weakened tendons can also be caused by diseases that disrupt blood supply. Chronic diseases which may weaken the tendon include:
- Chronic renal (kidney) failure
- Other conditions associated with renal dialysis
- Hyperparathyroidism
- Gout
- Leukemia
- Rheumatoid arthritis
- Systemic lupus erythematosus (SLE)
- Diabetes mellitus
- Infection
- Metabolic disease
Steroid use. Using corticosteroids has been linked to increased muscle and tendon weakness.
Fluoroquinolones. This special type of antibiotic has been associated with quadriceps tendon tears.
Immobilization. When you are off your feet for a prolonged period of time, the muscles and tendons supporting your knees lose strength and flexibility.

Management:

Most small, partial tears respond well to nonsurgical treatment:

Immobilization: Your doctor may recommend you wear a knee immobilizer or brace. This will keep your knee straight to help it heal. You will most likely need crutches to help you avoid putting all of your weight on your leg. You can expect to be in a knee immobilizer or brace for 3 to 6 weeks.
Physical therapy: Once the initial pain and swelling has settled down, you can begin physical therapy. Specific exercises can restore the strength and range of motion in your leg.

Most people with complete tears will require surgery to repair the torn tendon. Your doctor may recommend surgery if you have a large partial tear or a partial tear associated with tendon degeneration. This will likely depend upon your age, your activities, and your previous level of function.