Osgood-Schlatter Disease

Paediatric Foot Conditions· Also known as: Osgood-Schlatter's, Osgood-Schlatter syndrome, tibial tubercle apophysitisUpdated Nov 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, November 2026

At a Glance

Osgood-Schlatter disease is a common cause of knee pain in active young people who are still growing. The tendon below the kneecap pulls on the growth area at the top of the shin bone, causing pain, tenderness and often a bony bump. About 10 per cent of 12 to 15 year olds have it at any one time. Pain is usually worse during or after sport. It settles on its own once growth finishes, and care aims to keep pain manageable in the meantime. The bump usually stays.

What is it?

Osgood-Schlatter disease is a growth-related cause of knee pain. It affects the bony bump just below the kneecap, at the top of the shin bone (called the tibial tubercle). The patellar tendon, which runs from the kneecap to the shin, attaches there. While bones are still growing, the pull of this tendon can irritate the growth area, which leads to pain, swelling and inflammation.

It is called an overuse injury. Despite the word "disease" in the name, it is not a serious illness. It is described as self-limiting, which means it settles by itself, and full recovery is expected. It is the leading cause of knee pain in active teenagers.

Who does it affect?

It is common. About 10 per cent of children aged 12 to 15 have it at any one time, and about 13 per cent have it at some point in their lives. Another estimate puts it at 3.8 new cases per 1000 people each year, so figures vary depending on who is counted.

It is more common in boys and in children who play sport. Figures of about 21 per cent in athletes and 4.5 per cent in non-athletes have been reported. It usually starts at 11 to 13 years in girls and 12 to 15 years in boys.

Signs and symptoms

The main symptom is pain just below the kneecap. There can also be swelling and tenderness at the bump, and a small, hard, sore lump may form as it heals. The pain is usually worse during or just after activity such as running, jumping, kicking, kneeling or climbing stairs. How bad it is can vary a lot from person to person. It often affects one knee, but it can affect both.

Some signs don't fit Osgood-Schlatter disease and can point to something else. These include:

Swelling or bruising that doesn't improve with rest or raising the leg.
Pain that is regular or constant at night, or that wakes a child from sleep. This can be linked to a tumour.
A joint or limb that is red, hot, swollen or stiff, with or without fever. This can mean an infection or an inflammatory joint disease. Septic arthritis (an infection inside the joint) can damage a child's joint within 24 to 48 hours.
Weight loss, fever, night sweats or tiredness, which can be linked to a tumour, infection or inflammation.
Numbness or pins and needles that don't go away.
A sudden limp with no clear cause, or not being able to walk on the leg.
Large, tense swelling soon after an injury, with the hamstring (the muscle at the back of the thigh) tightening up. This can mean bleeding into the knee joint.
A sudden injury to the bump, which can be a broken tibial tubercle. This is a separate injury, and it carries a considerable risk of complications and repeat operations.
The knee locking, giving way or clicking painfully. Clicking that doesn't hurt is normal.

What causes it?

The thigh muscles at the front of the thigh (the quadriceps) pull on the shin bone through the patellar tendon. Running, jumping and bending repeat this pull many times, and the growth area at the top of the shin bone becomes irritated. Kneeling can make it worse.

Growth spurts add to this. Bones grow first, and the thigh muscles have to stretch to catch up, so they can become tight. Tight muscles pull harder on the bump, which is why pain is often worse with exercise. Sport is linked to higher rates of the condition, but this shows a link, not that sport on its own causes it.

How is it diagnosed?

It is usually diagnosed from your symptoms and an examination. Your podiatrist will ask where the pain is, what brings it on (running, jumping, kneeling or stairs) and whether one or both knees are sore. They will press on the bump to check for tenderness and may ask you to straighten your knee against resistance, which often hurts. They may also check for tight thigh muscles at the front and back.

As part of this, features that don't fit the usual picture are looked for, such as those listed under signs and symptoms. Infection and tumour need to be ruled out in any knee pain in young people.

Treatment

Treatment is non-surgical. The aim is to keep pain manageable while growth finishes. Most of the steps below are widely used, but how well each one works isn't yet clear.

Looking after it at home

Adjusting activity. Advice varies. Some advise limiting jumping, running and kicking until they are pain-free, sometimes for several months. Others say sport can continue as tolerated, and that over-treating should be avoided. Lower-stress options include a cross trainer, swimming and gentle cycling. School PE may need to be less vigorous for a while.
Stopping what hurts. Any exercise that increases knee pain is best stopped.
Ice. Ice for 10 to 15 minutes after activity, wrapped in a towel or cloth so it isn't on the skin.
Stretching. Gentle stretches for the front and back of the thigh, held for 20 to 30 seconds, if pain allows.
Pain relief. Simple medicines such as ibuprofen and paracetamol are sometimes used.

Knee immobilisation (keeping the knee still in a brace or cast) is not recommended.

Treatment from your podiatrist

Your podiatrist will usually explain that the condition is self-limiting and that it improves once growth has stopped. They may help you plan changes to activity and show you stretches for the thigh muscles. Stretching appears helpful, though exact exercises, how often and for how long haven't been settled.

Some programmes combine activity changes with knee-strengthening exercises. With one, about 80 per cent of teenagers reported a good outcome by 12 weeks and 90 per cent by 12 months. Some of that improvement may simply be the condition settling over time. It isn't yet clear whether shoe inserts, heel lifts, straps or taping help Osgood-Schlatter disease.

Other options

Physiotherapy and exercises to stretch tight muscles and tendons are often part of care. When pain and loss of function carry on despite this care, a referral to an orthopaedic specialist (a bone and joint doctor) may be considered.

Non-surgical treatments have been reported to bring full recovery of daily activities in anywhere from 14.3 per cent to 100 per cent of cases. Complications ranged from 0 to 66.7 per cent, most often thigh muscle wasting (quadriceps atrophy) and skin irritation.

Surgery

Surgery is uncommon. It seems to be kept for people whose growth has finished and whose symptoms continue. In some athletes, a small loose piece of bone (an ossicle) sits within the patellar tendon and causes long-lasting pain. Taking it out may be appropriate.

Recovery

Osgood-Schlatter disease should settle once growth finishes, though the bump below the kneecap usually stays. Until then, discomfort can last weeks to months, and it may come and go.

Return to sport is often slower than pain relief. With activity changes and knee strengthening, about 16 per cent of teenagers were back playing sport by 12 weeks and 69 per cent by 12 months. Which factors lead to faster or slower recovery isn't clear yet.

Preventing it

How to stop Osgood-Schlatter disease coming back isn't clear yet, and no programme has been shown to prevent it. Gentle stretching of the thigh muscles is a commonly advised simple measure. Pain that returns during a growth spurt is common, and it tends to ease again as growth slows.

Frequently asked questions

Can my child keep playing sport?

Sport is not likely to cause permanent damage, but it may make the pain worse. Stopping any exercise that increases knee pain is advised. Some advice is to cut back on running, jumping and kicking until pain-free.

Do I need an X-ray or scan?

Usually not. When the symptoms and examination point clearly to Osgood-Schlatter disease, X-rays or scans aren't normally needed. They may be used if an injury, infection or something else is suspected.

Can it affect both knees?

Yes. It usually affects one knee, but about 20 to 30 per cent of people have pain in both. It can start in one knee and later appear in the other.

Does the knee need a brace or cast?

Knee immobilisation, where the knee is kept still in a brace or cast, is not recommended for Osgood-Schlatter disease. Care focuses on adjusting activity, ice, gentle stretching and sometimes simple pain relief.