Iliotibial band (ITB) syndrome

Condition

The iliotibial band is a structure known as fascia which arises from a small muscle at the hip and runs down the side of the leg to attach just below the outside of the knee. This is thought to help to stabilise the leg during walking and running. If this becomes tight or there is poor function then it can become irritated as it rubs over the outside of the knee and this is termed ITB syndrome.

What causes ITB syndrome?

This is generally caused by over use or poor biomechanical function during walking or, more commonly, running.

Specific gait patterns such as a cross over gait, poor hip control or foot function can predispose to the condition.

Will it get worse?

Left un-treated, most musculoskeletal problems deteriorate, eventually causing reduced activity.

What are the common symptoms?

• Pain / burning over the outside of the knee
• It will come on during a run and eventual cause the runner to rest.
• It may be more painful downhill

How is it recognised?

• Clinical examination and a detailed history allow diagnosis.
• A detailed 3D gait analysis can help to diagnose the contributing factors.
• When necessary an ultrasound scan or MRI scan can help diagnosis.

What can I do to reduce the pain?

There are several things that you can do to try and relieve your symptoms:

• Rest and local ice
• Specific stretching exercises or use of a foam roller
• Seek a professional opinion

What will Premier Podiatry do?

If simple measures do not reduce your symptoms, there are other options:

• Confirm the diagnosis / arrange any necessary investigations
• Perform a detail 3D gait analysis to diagnose the under lying factors that may contribute to injury.
• Advise appropriate shoes
• Advise exercises
• Consider prescribing orthotics
• Arrange a guided steroid injection if necessary.

The way in which your foot loads during walking can place increased stress on the foot and this can be controlled by special shoe inserts (orthotics). Whilst these do not correct the position of your foot, they guide motion to reduce symptoms and the risk of further injury.

In many cases orthotics are only required for a short period of time to help resolve symptoms whilst function is improved with an appropriate rehabilitation plan. Our sophisticated 3D gait analysis allows us to advise patients the length of time they will require orthotics.

Will this cure the problem?

In many cases, an appropriate exercise programme, footwear / orthotics and a suitable training programme are sufficient to resolve the problem.

In some patients a guided steroid injection (a steroid that is targeted to the precise point of injury) is required.

There have been some initial reports indicating that a botox injection to the small muscle at the hip can help to relieve symptoms by reducing muscle activity. If the benefits of this are short lived, then surgery to the ITB can be performed.

What will happen if I leave this alone?

It is likely to get worse and affect your ability to exercise.

How can I cure the deformity?

There are some promising early results from surgery but further evidence is required and, fortunately, this is rarely required.