Pain Below the Knee: Causes and Treatment Options

Pain below the knee?

I would like to consult with the deputy director.
Two months ago, I started experiencing pain in the inner side of my right leg, just below the knee (in the bony area).
The pain is more pronounced when going up and down stairs or when bending my leg, and pressing on the painful spot increases the pain.
Occasionally, I feel a slight soreness, while at other times it feels somewhat better.
During this period, I have had an X-ray taken and have been taking pain relievers and applying anti-inflammatory ointment, but the effects have been minimal.
Could you please advise what the possible issue might be and whether further examinations are necessary? Thank you.

Zhi Ling, 40~49 year old female. Ask Date: 2009/12/29

Dr. Shi Qiming reply Orthopedics

The pain point located on the inner side of the lower left knee may be related to the attachment site of the thigh muscles.
Therefore, activities such as going up and down stairs or bending the knee can cause pain.
This may be due to tendonitis in that area.
If pain persists despite taking pain relievers and resting, it is advisable to visit an orthopedic clinic for further examination and diagnosis.

Reply Date: 2009/12/29

More Info

Understanding pain below the knee, particularly in the area just below the kneecap, can be quite complex as it may stem from various underlying conditions. Based on your description, it seems that you are experiencing pain on the inner side of your lower leg, particularly when going up and down stairs or bending your knee. This type of pain can often be associated with several issues, including patellar tendinopathy, bursitis, or even issues related to the meniscus or ligaments in the knee.

Possible Causes of Pain Below the Knee
1. Patellar Tendinopathy: This condition, often referred to as "jumper's knee," occurs due to overuse of the patellar tendon, which connects the kneecap to the shinbone. It is common in individuals who engage in activities that involve jumping or running, and it can cause pain below the kneecap, especially during movements that require bending the knee.

2. Bursitis: Inflammation of the bursa, a small fluid-filled sac that reduces friction between tissues, can lead to pain in the knee area. Prepatellar bursitis (inflammation of the bursa in front of the kneecap) can cause pain that worsens with movement.

3. Meniscus Tear: The meniscus is a cartilage that acts as a cushion between your thigh bone and shin bone. A tear can occur due to sudden twisting or turning movements, leading to pain, swelling, and difficulty bending the knee.

4. Ligament Injuries: Injuries to the ligaments, such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL), can also cause pain below the knee. These injuries often occur during sports or physical activities that involve sudden stops or changes in direction.

5. Osteoarthritis: As we age, the cartilage in our joints can wear down, leading to osteoarthritis, which can cause pain, stiffness, and swelling in the knee.

Treatment Options
Given that you have already undergone an X-ray and have taken pain medication with limited relief, it may be beneficial to explore further diagnostic options. Here are some recommendations:
1. Physical Therapy: Engaging in a physical therapy program can help strengthen the muscles around the knee, improve flexibility, and reduce pain. A physical therapist can design a personalized exercise regimen tailored to your specific condition.

2. MRI Scan: If the pain persists, an MRI may be warranted to provide a more detailed view of the soft tissues in the knee, including the cartilage, ligaments, and meniscus. This can help identify any tears or degenerative changes that may not be visible on an X-ray.

3. Rest and Activity Modification: It is essential to rest the affected knee and avoid activities that exacerbate the pain, such as climbing stairs or heavy lifting. Ice therapy can also help reduce inflammation and pain.

4. Medication: While you have already tried non-steroidal anti-inflammatory drugs (NSAIDs), discussing other options with your healthcare provider may be beneficial. In some cases, corticosteroid injections can provide temporary relief from inflammation.

5. Alternative Therapies: Some patients find relief through acupuncture, massage therapy, or chiropractic care. These methods can help alleviate pain and improve function.

6. Surgical Options: If conservative treatments fail and the pain significantly impacts your quality of life, surgical options may be considered, depending on the underlying cause.

Dietary Considerations
In addition to medical treatment, maintaining a healthy diet can support joint health. Consider incorporating anti-inflammatory foods such as fatty fish (rich in omega-3 fatty acids), nuts, seeds, fruits, and vegetables. Staying hydrated and maintaining a healthy weight can also reduce stress on the knees.

Conclusion
In summary, pain below the knee can arise from various causes, and a thorough evaluation is essential for accurate diagnosis and treatment. If your symptoms persist or worsen, I recommend consulting with an orthopedic specialist who can provide a comprehensive assessment and guide you through the appropriate next steps.

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