Pes anserine bursitis/tendinopathy, also known as pes anserine tendinopathy is a less common overuse injury causing pain on the inside of the knee. A bursa is a small fluid sac which sits under the tendon. Either the tendon, bursa or both may become inflamed. Treatment includes rest, reducing symptoms and identifying possible causes.
On this page:
- Causes & anatomy
Symptoms of pes anserine bursitis/tendinopathy
Pes Anserine bursitis and pes anserine tendinopathy is often difficult to distinguish from a medial ligament injury because the symptoms are similar and both are likely to be painful when stressing the inside of the knee joint. Symptoms include pain over the inside of the knee, particularly the lower part. Specifically at a point three fingers below the joint line on the inside of the knee. Pain may be felt when climbing stairs or when contracting the hamstring muscles against resistance. Stretching the hamstring muscles may also cause pain.
Other injuries with similar symptoms include:
- Medial ligament sprain – this is a tear to the ligament on the inside of the knee.
- Medial cartilage meniscus injury – this is damage to the semi-circular shaped cartilage which provides support and cushioning to the knee joint.
- Stress fracture of the tibia – a hairline crack in the tibia bone at the knee caused by repetitive strain and overuse.
Pes anserine bursitis causes & anatomy
The Pes Anserine, also known as pes anserinus or the goose’s foot is the combined tendon of the semitendinosus muscle (one of the hamstrings), Sartorius (the strap-like muscle which crosses the front of the thigh) and gracilis muscle which is one of the long adductor muscles. Each of the three muscles is supplied by a different nerve (sartorius = femoral nerve, gracilis = obturator nerve, semitendinosus = tibial nerve). They all attach together to the tibia or shin bone on the inner part of the lower knee. The main function of the three muscles is to flex (bend) the knee, but the also help knee stability by helping the medical ligament resist valgus forces
In this area, there is also a bursa, called the anserine bursa which lies between this combined tendon and the Tibia bone underneath. This bursa may become inflamed due to repetitive friction in sports such as cycling, running and swimming, especially breaststroke. This results in bursitis and/or tendinopathy (sometimes called tendonitis). Any sport or activity which puts repeated stresses on the inside of the knee may put the athlete at risk of pes anserine bursitis or tendon injury.
The word tendinopathy is probably a more accurate term as it describes degeneration of the tendon rather than specific acute inflammation or tendonitis. With long term overuse injuries, it is more likely to be degeneration, without the presence of inflammatory cells.
Treatment of pes anserine tendinopathy
The aim of treatment is to treat the symptoms of pain and inflammation, as well as identifying and correcting any potential causes of the tendon or bursa inflammation.
What can the athlete do?
Rest and apply the PRICE principles of rest, ice, compression and elevation. Rest from any aggravating activities. Apply ice or cold therapy to reduce pain and inflammation. Ice can be applied for 10 minutes every hour initially for the first 24 to 48 hours reducing to 3 or 4 times a day as required.
What can a sports injury professional do?
A doctor may prescribe anti-inflammatory medication such as ibuprofen which may help reduce pain and inflammation. Stretching the surrounding muscles such as the quadriceps, hamstrings and adductor muscles may help.
Identifying causes of pes anserine bursitis
The second phase of treatment should be to consider what may have caused the injury and to correct the problem. It may be something as simple as having tight hamstring muscles and in which case these should be stretched regularly and sports massage applied to improve elasticity.
Other common causes include obesity, overpronation of the foot where the foot flattens or rolls in too much when running. This, in turn, causes the lower leg to rotate in which may also increase the valgus forces on the inside of the knee causing a valgus knee deformity where the knee falls or bows inwards. The Q angle if the knee is a measurement of vaglus knee deformity.
Wearing a knee brace or support with additional protection at the sides may help. A hinged knee brace has solid metal stays down the sides and provides the most support. A stabilized brace has flat springs inserted into the sides to provide additional support but may allow more movement than a hinged knee brace.
- Rennie WJ, Saifuddin A. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation. Skeletal Radiol 2005;34(7):395–8.
- Alvarez-Nemegyei J. Risk factors for pes anserinus tendinitis/ bursitis syndrome: a case control study. J Clin Rheumatol 2007;13(2):63-5.