Patella maltracking, or patellofemoral pain syndrome, is an imbalance in the gliding of the kneecap that aggravates cartilage behind the knee. Rather than gliding vertically as the knee bends, a maltracking patella is pulled to the outward side as it moves upward in the groove. This may result in pain on the outward and front sides of the knee, clicking sounds, swelling, and pain from both activity and long bouts of sitting. Multiple treatments are available, with varying degrees of success.
Common causes of patella maltracking include problems with foot alignment and muscle strength. Muscle imbalances in the quadriceps (front thigh) or gluteus maximus (rear) may create gait conditions that aggravate this affliction. Other causes include malrotation of the upper leg bone, or femur, and foot pathology. Treatments include physiotherapy, the use of insoles, and even reconstructive surgery.
Specifically, patella maltracking is contrasted to patellar tilt, in which the kneecap usually points toward the outer or lateral side; and patellar misalignment, when the kneecap rests too far to the side. Patella maltracking occurs during bending and straightening movements, transitioning outside of its intended groove. The fact that this is a movement condition means that treatment often consists of movement therapies. These might include strengthening of the quadriceps and hamstrings, or using tape or bandages to train the movement of the patella. In some cases, orthotics may be employed to control foot hyperpronation, the inward rotation of foot movement that overextends kneecap movement, to equalize the forces that act upon the knee.
This affliction often strikes people who have a history of patella dislocation, or those who have suffered an injury. Common among adolescent females, it also afflicts those suffering from flat feet or genu velum, knock knees. It may result from ankles turned inward or outward, or even improper footwear. Specialists such as medical professionals, sports physical therapists, or chiropractors assist in proper treatment of this condition.
A common cause of patella maltracking lies with the mechanics of the feet. Improper foot placement rotates the leg inward, which tightens the iliotibial band on the outside of the thigh, drawing the patella outward. With increased pressure at the bottom of the kneecap, friction wears the cartilage down and generates pain behind the knee. Muscle weakness in the gluteus maximus can create overcontraction of the quadriceps, which may also heighten pressure on the kneecap.
Immediate treatments include stretching, or rest, ice, compression, and elevation (RICE), to reduce swelling and inflammation. Exercise techniques such as side-lying abductions, clamshells, hip rotations, or donkey kicks are sometimes employed in retraining the movement of the legs and feet. Gait correction with orthotics, or braces and insoles, reduces weight-bearing forces and guides movement. Other treatments might include surgery, injections, anti-inflammatory agents, and medications.