We tend to see Osgood-Schlatter in super active sporty kids who are engaged in activities where their quadriceps muscles are contracted repetitively. Osgood-Schlatter is relatively common especially in boys and is a quite debilitating knee injury in adolescent children aged between 8 to 13 in girls and 11-15 in boys usually triggered during active growth spurts. Osgood-Schlatter is a self-limiting syndrome recovering completely with the closure of the tibial growth plate.
The quadriceps muscles (all 4 of them) are powerful thigh muscles that straighten the knee when contracted (knee extension). As the Quads head towards the knee, they converge encompassing the knee cap (patella) and once they’ve done that, they attach to the strong patella tendon anchoring the whole lot to the shin bone (tibia). The attachment (anchor) site is called the tibial tuberosity and in young children, its a growth plate that hasn’t yet fused to the main bone (tibia) unable to withstand prolonged high tensile forces.
So, having active kids continuously yanking and damaging the little growth plate (the size of your pinky) that hasn’t yet fused to the tibia (because it’s still in its growing phase) with robust and repetitive muscle contractions will end in pain, inflammation and in more severe cases micro-fractures, growth plate damage, bone separation and an enlarged deformity of the tibial tuberosity. In chronic cases, this can severely affect your child’s ability to walk or run.
As you can see none of these are desirable outcomes, which brings me to my first point…. get in early and manage quickly with professional guidance!
I should also mention a much less common cause of Osgood Schlatter ‘s Disease is the inconsistent growth of the quadriceps muscles in comparison to the thigh bone (femur). During a growth spurt, the lengthening of the Quad’s may not be unable to keep up with the lengthening of the femur, resulting in an increased tensile force at the attachment site of the Quads (tibial tuberosity).
How can you tell your child has Osgood-Schlatter’s disease? (AKA tibial tubercle apophysitis)
If your child has pain below the knee cap near the top of their shinbone and you notice it causes pain and discomfort on touch, chances are your child may have Osgood-Schlatter’s disease given it’s the most likely cause of knee pain in children. You may also notice inflammation (redness and swelling) as well as a rather large bump. Compare the bump to the other leg if the knee pain is only on one side and see if you can notice any variations. Keep in mind one leg is never identical to the other but in some cases, the bump can be twice the size in one-sided cases of Osgood-Schlatter’s disease. If your child is complaining of bilateral knee pain then comparing won’t be much help as your child may have Osgood-Schlatter’s on both sides as seen in 20-30% of cases.
Other things to look out for is increased knee pain during (or after) activities especially running, jumping, playing up/down stairs, repetitive knee bending, squatting and direct kneeling contact. In more severe cases your child may start to limp and avoid all forms of activity which is generally out of character for sporty kids. Rest will help but not for long and if your child has flat feet (poor foot biomechanics), poor footwear and tight leg muscles it compounds the problem.
Our Podiatrist Dr Ella often finds in a lot of Osgood-Schlatter cases, flat feet and poor lower leg mechanics are often overlooked. People are so fixated on the site of pain they don’t consider how the knee could be influenced by a flat foot. If the inside of the foot drops then the inside of the knee will drop and torsion. Having the tibial torsion thrown in the mix will strain the patella tendon and the tibial tubercle growth plate exacerbating Osgood-Schlatter.
How is Osgood Schlatter’s disease diagnosed?
Our Podiatrist Dr Ella treats a lot of children’s lower leg and foot problems and generally, Osgood-Schlatter’s disease is easily diagnosed. Dr Ella may refer your child for an x-ray (bulk billed) if a more severe injury or disease is suspected such as fractures, malignancy, or infection.
The word “disease ” used to describe Osgood-Schlatter is a little misleading as it’s really an overuse injury rather than an actual disease.
How does a Podiatrist treat Osgood Schlatter’s disease?
Because Osgood-Schlatter will resolve completely once the tibia stops growing and the growth plate fuse, it’s really a matter of stabilising the condition and giving the body the opportunity to heal the damage. In the initial stages, rest is important and the use of kinesio tape or a simple infrapatellar knee strap that easily valcrosses on and off anchoring the patella tendon is a good start along with a thorough biomechanical assessment to check if foot orthotics are needed. If the foot mechanics are normal then only the knee needs attention but if its a combination of both, then both need professional attention. Footwear advice, addressing postural issues and strengthening/stretching exercise along with learning to use a foam roller to massage the quadriceps muscles, ITB, hamstrings, hip flexors and calf muscles are usually prescribed. Very rarely will a child be prescribed complete rest or need the use of crutches.
Although symptoms of Osgood Schlatter’s Disease may linger for months, few children have poor outcomes with conservative Podiatry treatment, and surgical intervention is seldom necessary.
Dr Ella understands how important sport and activity is to your child so she will do everything possible to restore normal activity levels but not at the expense of having this condition continuously re-aggravated leaving your child with an unsightly deformity. A large bump may not seem much but we have found it can cause distress to some children due to its permanent nature and especially knowing, it could have been avoided with the right intervention early in the peace,