How Foot Instability Contributes to IT Band Pain
What Is Iliotibial Band Friction Syndrome?
Iliotibial Band Syndrome (ITBS) is a common overuse injury affecting runners, walkers, and cyclists. It typically presents as sharp or aching pain on the outer side of the knee, caused by irritation of the distal iliotibial band as it moves over the lateral femoral condyle.
In some cases, irritation occurs higher up, leading to outer‑hip pain.
The iliotibial band (ITB) is a thickened strip of fascia running along the outside of the thigh. It originates near the anterior superior iliac spine and inserts into Gerdy’s tubercle on the tibia. It also blends with the tensor fascia lata, gluteus medius, gluteus maximus, and vastus lateralis muscles.
How Foot Instability Contributes to IT Band Pain
Foot mechanics play a major role in ITB irritation. When the foot collapses inward (excessive pronation), the knee rotates medially, increasing tension on the ITB. Over time, this repetitive strain leads to inflammation and pain.
Common Causes of IT Band Syndrome
Biomechanical Factors
- Weak hip abductors
- Muscle imbalance between gluteal and thigh muscles
- Excessive foot pronation
- Tight iliotibial band or tensor fascia lata
Training Errors
- Sudden increase in running mileage
- Increased interval or track training
- Running on crowned or uneven surfaces
- Overstriding or long stride length
Symptoms of IT Band Friction Syndrome
- Sharp or burning pain on the outer knee
- Pain that worsens with running, especially downhill
- Tenderness along the lateral thigh
Possible hip discomfort if proximal ITB is irritated
Evidence‑Based Treatment for IT Band Syndrome
ITBS can be stubborn and requires a combination of activity modification, strengthening, and biomechanical correction.
Activity Modification
- Reduce or temporarily stop running
- Avoid crowned roads and repetitive track running
- Shorten stride length to reduce ITB tension
Strengthening & Stretching
- Strengthen hip abductors (gluteus medius focus)
- Stretch the ITB, TFL, and gluteal muscles
- Incorporate the overhead arm extension to improve ITB lengthening
Footwear & Orthotics
- Motion‑control shoes to limit excessive pronation
- If already in motion‑control shoes, consider switching to a less controlling model
- Custom foot orthotics to stabilize foot mechanics and reduce knee rotation
Clinical Interventions
- Manual therapy
- Laser therapy
- Corticosteroid injection (for persistent inflammation)
- Surgical release (rare and only for chronic, non‑responsive cases)
When IT Band Pain Doesn’t Improve
If symptoms persist despite proper stretching and strengthening, another condition may be mimicking ITBS.
Differential diagnoses include:
- Lateral meniscal tear
- Lateral collateral ligament sprain
- Biceps femoris tendinopathy
- Patellofemoral pain syndrome
- Lateral patellar compression
- Popliteal tendinopathy
- Stress reaction or stress fracture
- Proximal tib‑fib joint sprain
- Referred pain from lumbar spine or peroneal nerve
When to Seek Professional Assessment
Persistent lateral knee or thigh pain should be evaluated by a Chiropodist. A biomechanical exam, gait analysis, and footwear assessment help identify the root cause and guide treatment.
References
- Conservative Rehabilitation Treatments of Iliotibial Band Syndrome: A Systematic Review. Muscles, Ligaments and Tendons Journal. 2021;11(1):29-40.
- Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Frontiers in Sports and Active Living. 2024;6:1386456.
- Gender Differences in the Kinetics and Kinematics of Distance Running: Implications for Footwear Design. International Journal of Sports Science and Engineering. 2012;6(2):118-128.
- The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion. JOSPT. 2016;46(9):749.
- Iliotibial Band Impingement Syndrome: An Evidence-Informed Clinical Paradigm Change. International Journal of Athletic Therapy & Training. 2017;22(3):1-11.
- The Top Five Running Injuries Seen in the Office. Podiatry Management. 2013; April & June issues.