Pes Anserine Bursitis (goose foot)

Pes Anserine Bursitis (goose foot)

Pes anserine bursitis is a condition that happens when this bursa gets swollen and irritated.

The pes anserine is an area on the inside of your knee, just below the joint, which is cushioned by a fluid-filled sac (bursa). The condition causes knee pain.

Inflammation of the pes anserine (“goose’s foot”) bursa located at the medial aspect of the knee approximately 6 cm below the anteromedial joint line.

The bursa lies between the conjoined tendons of the sartorius/gracilis/semitendinosus muscles and the medial collateral ligament. It is frequently described as knee pain, but it is typically noticed when lying on one’s side in bed when the knees are opposed. 

Pain is worsened by going up stairs. It is more common in obese individuals, patients with valgus knee deformity, and patients with pes planus. Pain is elicited by palpating the bursa and may have associated warmth.

Pes anserinus literally means “goose foot” and is composed of, from anterior to posterior in the medial aspect of the knee, tendons of the sartorius gracilis, and semitendinosus muscles.

A common mnemonic for this is “Say grace before tea.” There are many small bursae around its insertion which can become inflamed with overuse, resulting in pes anserine bursitis.

What are the causes?

This condition may be caused by:

  • Making the same movement over and over.
  • A hit to the inside of the leg.

What increases the risk?

This injury is most likely to develop in:

  • Runners.
  • Athletes who play sports that involve a lot of running and quick side-to-side movements (cutting).
  • Athletes who play contact sports.
  • People who swim using an inward angle of the knee, such as with the breaststroke.
  • People with tight hamstring muscles.
  • Females.
  • People who are overweight.
  • People with flat feet.
  • People who have diabetes or osteoarthritis.

What are the symptoms?

Symptoms of this condition include:

  • Knee pain that gets better with rest and worse with activities like climbing stairs, walking, running, or getting in and out of a chair (common).
  • Swelling.
  • Warmth.
  • Tenderness when pressing at the inside of the lower leg, just below the knee.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms.
  • Your medical history.
  • A physical exam.
  • Tests, such as:
    • X-rays.
    • MRI and ultrasound. These tests are done to check for swelling and fluid buildup in the bursa and to look at muscles and tendons.

During your physical exam, your health care provider will press on the tendon attachment to see if you feel pain. He or she may also check your hip and knee motion and strength.

How is this treated?

This condition may be treated by:

  • Resting your knee.
  • Avoiding activities that cause pain.
  • Icing the inside of your knee.
  • Raising (elevating) your knee while resting.
  • Sleeping with a pillow between your knees. This will cushion your injured knee.
  • Taking medicine to reduce pain and swelling.
  • Having medicines injected into your knee.
  • Doing strengthening and stretching exercises (physical therapy).

If these treatments do not work or if the condition keeps coming back, you may need to have surgery to remove the bursa.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • If directed, apply ice to your knee.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • While you are sitting, elevate your knee.
  • While you are lying down, elevate your knee above the level of your heart.
  • Take over-the-counter and prescription medicines only as told by your health care provider.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do exercises as told by your health care provider.

General instructions

  • Sleep with a pillow between your knees.
  • Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure to use equipment that fits you.
  • Be safe and responsible while being active to avoid falls.
  • Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.

Contact a health care provider if:

  • Your symptoms do not improve.
  • Your symptoms get worse.

Pes Anserine Bursitis Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain and stiffness.

Exercise A: Hamstring, doorway

  1. Lie on your back in front of a doorway with your left / right leg resting against the wall and your other leg flat on the floor in the doorway. There should be a slight bend in your left / right knee.
  2. Straighten your left / right knee. You should feel a stretch behind your knee or thigh. If you do not, scoot your buttocks closer to the door.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: V-sit (hamstrings and adductors)

  1. Sit on the floor with your legs extended in a large “V” shape. Keep your knees straight during this exercise.
  2. Keeping your head and back in a straight line, bend at your waist to reach for your left foot (position A). You should feel a stretch in your right inner thigh.
  3. Hold for __________ seconds. Then slowly return to the upright position.
  4. Keeping your head and back in a straight line, bend at your waist to reach forward (position B). You should feel a stretch behind both of your thighs or knees.
  5. Hold for __________ seconds. Then slowly return to the upright position.
  6. Keeping your head and back in a straight line, bend at your waist to reach for your right foot (position C). You should feel a stretch in your left inner thigh.
  7. Hold for __________ seconds. Then slowly return to the upright position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Quadriceps, prone

  1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
  2. Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
  3. Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.
  4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee and hip. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Terminal knee extension, quadriceps

  1. Secure a long loop of rubber exercise band around a sturdy object like a table leg.
  2. Put the band behind your left / right knee. Step back from where the band is secured to put tension on the band.
  3. Slowly bend your left / right knee. Keep your left / right foot flat on the floor.
  4. Tighten the muscle in the front of your thigh and push back against the band to straighten your knee.
  5. Hold this position for __________ seconds.
  6. Return to having your left / right knee bent.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise E: Straight leg raises (hip abductors)

  1. Lie on your side with your left / right leg in the top position. Your head, shoulder, knee, and hip should line up. You may bend your bottom knee to help you balance.
  2. Lift your top leg 4–6 inches (10–15 cm) while keeping your toes pointed straight ahead.
  3. Hold this position for __________ seconds.
  4. Slowly lower your leg to the starting position.
  5. Allow your muscles to relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

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