KneeŞişli, Istanbul
Pes anserine tendinobursitis treatment
The pes anserine is where three muscle tendons join on the inner side of the shin bone. Irritation of these tendons and the bursa beneath them causes pain located just below the inner knee.
Also known as: Pes anserine bursitis, goose foot bursitis
What is it?
The tendons of sartorius, gracilis and semitendinosus come together on the upper inner shin; the arrangement resembles a goose's foot, hence pes anserine. A small bursa between the tendons and bone reduces friction.
When this area is overloaded both the tendons and the bursa become irritated. Pain is felt as a point about four to five centimetres below the joint line on the inner side. Climbing stairs, getting out of bed and lying on your side with the knees touching all increase it.
The most common background is knee osteoarthritis and excess weight, and it also appears in runners and people new to exercise. Hip weakness with the knee collapsing inward increases load on the area, so treatment includes the hip.
Symptoms
- Point pain on the inner side about four to five centimetres below the joint line
- Symptoms worse going up and down stairs
- Difficulty rising from bed and from a chair
- Pain when lying on your side with the knees touching
- Marked tenderness on pressing the area
- Sometimes mild swelling and warmth
- Stiffness in the morning and after long periods sitting
Causes and risk factors
- Knee osteoarthritis — the most common associated condition
- Excess weight
- A sudden increase in training volume
- Hip abductor weakness with the knee collapsing inward
- Excessive hamstring tightness
- Abnormalities in walking mechanics
The assessment
The exact location of pain is established; point tenderness at the pes anserine region largely makes the diagnosis. It is distinguished from joint line tenderness, as it is frequently confused with a meniscal problem.
Hip abductor strength, hamstring flexibility and the degree of inward knee collapse during walking are assessed. Any accompanying osteoarthritis is included in the programme.
Course of treatment
Weeks 0–2
Reducing irritation
Provoking activities are reduced and a pillow between the knees when lying on your side is advised. Soft tissue work is applied.
Weeks 2–8
Hip strengthening
Strengthening the glutes reduces inward knee collapse and directly lowers load on the area.
Weeks 8–12
Functional loading
Stair, sit-to-stand and walking capacity are progressively increased.
Maintenance
Load balance
Strength work continues, with weight management added where needed.
How long does it take?
Clear relief is usually seen within four to eight weeks, with a programme of 8–12 sessions. Where osteoarthritis coexists the process can take longer and the goal is bringing pain to a manageable level.
When to see a doctor
The findings below fall outside the scope of physiotherapy and require medical assessment.
- Fever, marked redness and warmth — possible infection
- Rapidly enlarging swelling
- Inability to bear weight on the knee
- Pain not relieved by rest at night and steadily increasing
- Sudden calf pain and swelling
Frequently asked questions
Is it a meniscal problem?
They are often confused, but the location differs: meniscal pain is on the joint line while pes anserine pain is a few centimetres below it. The two are easily distinguished on examination.
Is an injection needed?
In most cases no. Load management and hip strengthening give good results; an injection may be considered by a physician in stubborn cases.
Why is side-lying painful?
When the knees touch, the irritated area comes under direct pressure. A pillow between the knees removes that pressure and markedly improves comfort at night.
Is it possible to keep walking?
Yes, adjusting distance to a level where pain stays acceptable. Stopping entirely leads to muscle loss and delays recovery.
Methods used
Related conditions
The content on this page is for information only and does not replace medical diagnosis or treatment. Always consult a healthcare professional about your symptoms.
Assessment appointment
No referral is required for assessment. Enquiries regarding Pes anserine tendinobursitis treatment may be submitted via WhatsApp; available dates and times will be provided in response.