LEG EXOSTOSIS |
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General Information
DEFINITION--An overgrowth of bone in the tibia (the larger bone in the lower leg). It extends out from the bone like a spur and is visible on X-rays. An exostosis occurs at the site of repeated injury, usually from direct blows. This benign overgrowth of bone can be mistaken for a bone tumor.
BODY PARTS INVOLVED
Tibia.
Knee joint (sometimes).
Ankle joint (sometimes).
Soft tissue surrounding the exostosis, including nerves, lymph vessels, blood vessels and periosteum (covering of bone).
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SIGNS & SYMPTOMS
No symptoms for mild cases.
Pain and tenderness in the lower leg at the site of the exostosis.
Extreme sensitivity to pressure or even minor injury.
Change in contour of the tibia, ranging from a slight lump to the appearance of a large calcified spur (1cm or more in length). In the worst cases, the exostosis may break away and feel like a distinct foreign body. An X-ray will show it to be loose in the tissues of the lower leg.
"Locking" of the lower leg, if a tendon catches on the exostosis during exercise.
CAUSES
Repeated injury (contusions, sprains or strains) that involve the periosteum--the covering to bone (tibia) in the lower leg.
Chronic irritation to an already damaged area.
RISK INCREASES WITH
Participation in contact sports such as football, basketball or soccer.
History of bone or joint disease, such as osteomyelitis, osteomalacia or osteoporosis.
Vitamin or mineral deficiency.
Poor muscle strength or conditioning, which makes injury more likely.
If surgery or anesthesia are needed, surgical risk increases with smoking, use of mind-altering drugs, muscle relaxants, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Engage in vigorous muscle strengthening and conditioning prior to beginning regular sports participation.
Warm up adequately before competition or workouts to decrease the risk of injury.
Allow adequate recovery time for any leg, ankle or knee injury.
Wear protective equipment, such as shin guards and knee pads, for participation in contact sports.
Practice and learn the proper moves and techniques for your sport to decrease the risk of injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care.
Surgery (sometimes) to remove the exostosis.
Self-care during rehabilitation.
Physical therapy.
DIAGNOSTIC MEASURES
Your own observation of signs and symptoms.
Medical history and physical exam by a doctor.
X-rays of the lower leg, ankle and knee.
POSSIBLE COMPLICATIONS
Overlooking a mild exostosis that produces no symptoms, despite signs of diminished performance. Athletes and coaches frequently assume that decreased performance is from loss of competitive drive or emotional causes, rather than from the physical disability that actually exists.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic knee or ankle following repeated injury.
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissue.
Impaired blood supply to the injured area.
PROBABLE OUTCOMELower-leg exostosis usually causes no disability if it is treated properly. Treatment usually involves resting the injured leg for 2 to 4 weeks, heat treatments, corticosteroid injections and protection against additional injury. In a few cases, surgery is necessary to remove the exostosis.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This condition develops gradually.
CONTINUING CARE
Rest the injured area. Use splints or crutches if needed.
Apply heat frequently. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Follow instructions under How to Prevent to avoid a recurrence of the injury.
MEDICATION
Medicine usually is not necessary for this disorder. For minor pain, you may use non-prescription drugs such as aspirin.
If surgery is necessary, your doctor may prescribe:
Non-steroidal anti-inflammatory drugs to help control swelling.
Stronger pain relievers.
Antibiotics to fight infection.
ACTIVITYDecrease activity for 2 to 4 weeks. If surgery is necessary, resume normal activity gradually.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity. Your doctor may suggest vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when movement is comfortable.
Use ice massage for 10 minutes before and 10 minutes after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of lower-leg exostosis.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage, or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms. Drugs used in treatment may cause side effects.
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