The Pes Anserine complex consists of the Gracillis, Sartorious and Semitendinosis muscles. These three muscles merge to create a conjoined tendon which inserts at the inner aspect of the knee just to the side of the tibial tuberosity (as pictures). This shared tendon complex is often referred to the ‘Goose’s foot’ owing to the Latin origin of the anatomical structure. Pes Anserine bursitis is an inflammatory condition of the bursa -which is small structure containing fluid serving to reduce friction, situated below the Pes Anserinus tendon complex.
Pes Anserine bursitis will cause discomfort on the inner, upper aspect of the knee on your shin bone (Tibia). This area will be particularly tender to touch and you may find there is localised swelling, redness and warmth in comparison to the unaffected leg. You may find symptoms becoming exacerbated with increases in certain activities such as climbing or descending stairs or anything that involves the knee moving under load.
This pathology often occurs as a result of overuse, when the related muscles and tendons are repeatedly loaded with bending and straightening movements of the knee i.e. running. This can increase the amount of friction and pressure that the underlying bursa experiences, leading to an inflammatory response. Additionally, this form of bursitis can occur from direct trauma to the Pes Anserine region. Other causes involve biomechanical abnormalities.
Conservative management initially involves the RICE protocol: rest, ice compression and elevation, is commonly utilised over the first 72 hours to reduce inflammation. Within this, regime it is worth noting that a brief period of ‘relative rest’ (2-4 days) is recommended to allow symptoms and irritation to settle further.
This period of rest if usually employed in conjunction with nonsteroidal anti-inflammatory drugs which can be taken to alleviate the pain and support inflammation reduction. These can be prescribed by your GP or a topical gel can be applied to the symptomatic region. Ice can also be applied for 15-20 minutes every 4-7 hours during the inflammatory phase. Compression and elevation will assist with swelling reduction.
In cases of considerable swelling with function being significantly reduced, the input of a GP may be necessary to drain the fluid in order to not only test the fluid for signs of infection, but also to reduce pressure and decrease pain. If an infection is present antibiotics may be considered. If an infection is not present, in those patients that require it (due to considerable pain and dysfunction) a steroid injection may be applied to reduce inflammation.
Once the inflammation and swelling has reduced, restoring normal soft tissue flexibility and increasing strength can begin which is key for this condition. This is important so that you can return to your normal activities and will help to reduce friction on the affected structures and mitigate the likelihood of re-occurrence. Your Specialist Physiotherapist will help create a bespoke and progressive self-management and rehabilitation programme to help manage your symptoms and improve strength and function. An emphasis should be placed on increasing quadriceps and hamstring strength using progressive, functional exercises. Activity modification recommendations may also be offered to help prevent further issues and support your graded return to normal function.