Lateral patellar maltracking, or kneecaps pointing outward, is a common biomechanical concern. This alignment issue means the kneecap (patella) is pulled toward the outside of the leg instead of gliding correctly within the groove of the thigh bone (femur). This deviation is rarely an isolated problem of the knee joint itself. It is usually a symptom of misalignment originating from the hip, lower leg, or foot. Understanding the contributing factors is the first step toward correcting this potentially painful condition.
Understanding Skeletal Alignment Factors
Outward-pointing kneecaps can stem from fixed, structural orientations of the leg bones that are present from birth. One primary structural cause is excessive femoral anteversion, which describes an increased twist in the thigh bone (femur) at the hip socket. This excessive inward rotation of the femur forces the lower leg to compensate by rotating outward, causing the kneecap to follow that external path.
The lower leg bone, the tibia, can also have a rotational twist, known as tibial torsion. Specifically, external tibial torsion involves an outward twist of the tibia relative to the knee joint. This fixed bony orientation also contributes to the kneecap pointing laterally, even if the upper leg alignment is normal.
These bony misalignments are considered structural issues because they are determined by the shape and orientation of the skeleton itself. While soft tissue can attempt to compensate, the underlying bone structure dictates the mechanical axis of the entire leg. This structural foundation is distinct from dynamic issues caused by muscle imbalances.
How Muscular Imbalances Influence Knee Tracking
While skeletal factors provide the foundation, muscular imbalances act as dynamic forces that pull the kneecap out of its correct path. A significant contributor to lateral maltracking is weakness in the gluteal muscles, particularly the gluteus medius and maximus. When these muscles are weak, the thigh bone tends to rotate excessively inward during activities like walking or running. The kneecap follows this rotational shift, which functionally directs it toward the outside of the knee.
Tightness in the soft tissues on the outer side of the leg also contributes to the outward pull on the kneecap. The iliotibial (IT) band, a thick band of fascia running down the outside of the thigh, can become tight and exert a lateral vector on the patella. Similarly, an overactive or tight vastus lateralis, the outermost quadriceps muscle, can overpower the inner quadriceps muscle, pulling the kneecap laterally along its groove.
Foot mechanics also play a role in the kinetic chain. Overpronation, where the arch collapses and the foot rolls excessively inward, can cause the lower leg to rotate internally. This inward rotation of the tibia sends a twisting force up the leg, which further destabilizes the knee and influences the kneecap to track improperly.
Associated Symptoms and Long-Term Risks
The outward tracking of the kneecap means the underside of the patella rubs unevenly against the femoral groove, leading to several uncomfortable symptoms. The most common consequence is Patellofemoral Pain Syndrome, often called runner’s knee, which presents as a dull, aching pain around or under the kneecap. This pain is typically aggravated by activities that increase pressure on the joint, such as climbing stairs, squatting, or sitting with bent knees for long periods.
Poor tracking can also create mechanical symptoms, including a feeling of instability where the knee seems to buckle or give way. Individuals may hear or feel clicking, popping, or a grating sensation, medically known as crepitus, as the kneecap moves.
If the uneven pressure continues over time, it can lead to chronic complications beyond simple pain. The constant friction causes the cartilage behind the kneecap to soften and break down, a condition called Chondromalacia Patella. Over many years, this uneven wear and tear can accelerate the degeneration of the joint surfaces, significantly increasing the risk of developing patellofemoral osteoarthritis.
Corrective Management and Next Steps
The first step in addressing an outward-pointing kneecap is to seek a professional diagnosis from an orthopedist or a physical therapist. A specialist can perform a detailed gait analysis and use imaging to determine whether the problem is rooted in fixed skeletal alignment or dynamic muscular factors. The specific treatment plan will be tailored to the root cause identified.
For muscular and functional issues, targeted physical therapy is the primary intervention. Strengthening exercises should focus on the hip abductors and external rotators, such as clamshells and hip bridges, to improve control over the thigh bone’s rotation. This work helps stabilize the limb and prevents the femur from rotating inward during movement.
Flexibility is also addressed by stretching tight structures that pull the kneecap laterally, specifically the iliotibial band and the lateral quadriceps muscles. If foot mechanics are a significant factor, a doctor may recommend custom orthotics to correct excessive overpronation and restore proper alignment from the ground up. Consistent and specific exercise is necessary to retrain the muscles and improve the kneecap’s gliding path.