Pain and inflammation involving the tendons connecting three thigh muscles to the lower leg near the knee is known as bursitis of the pes anserine. It is common among athletes and middle aged obese women and is often mistaken for arthritis. Learn about the treatment for pes anserine bursitis.
What is Pes Anserine Bursitis?
The pes anserine tendon is the structure with the shape of a goose foot attached to the lower leg in the inner side of the knee. The tendon connects the thigh muscles (hamstrings) to the shin bone and is involved in flexing the knee. Between the bone and the tendon is a lubricating structure, the bursa, which may be injured or inflamed due to overuse of the muscles and tendons near the knee. For this reason pes anserine bursitis may be mistaken for knee arthritis.
Pes anserine bursitis is often found in:
- Athletes involved in swimming, running, basketball, football, and soccer
- Middle aged obese women
- Patients aged 50-80 years who have osteoarthritis of the knees
- Middle aged women with a valgus knee deformity
- Patients with diabetes
- Flat footed patients
- Patients who suffered from injury such as a direct blow to the inner area of the knee
Symptoms consist of pain and inflammation over the inner side of the knee. Diagnosis is by history, physical examination and by exclusion of other disorders like osteoarthritis of the knee. Radiologic imaging studies are not absolutely necessary except to consider other such diseases.
Treatment Options for Pes Anserine Bursitis
The first line of treatment for pain and inflammation over the bursa is rest from activities and the use of pain or anti-inflammatory medications. Examples of nonsteroidal anti-inflammatory drugs (NSAIDs) are ibuprofen (Motrin, Ibuprin), naproxen (Naprosyn, Naprelan), and indomethacin (Indocin, Indochron E-R).
Aside from oral medications, treatment for pes anserine bursitis also includes:
- Ice packs may be applied over the inflamed area. This may be done for 20 to 30 minutes every 3-4 hours for 2 days.
- Wrapping an elastic bandage over the area around the knee helps to decrease swelling. Elevation of the leg and using a small pillow between the thighs during sleeping also relieve inflammation.
- If the bursa is severely swollen, needle aspiration of fluid in it may reduce the inflammation. Injection of a corticosteroid and/or local anesthetic in the space may also be helpful.
- Physical therapy may be done with the help of physiotherapists. The goals of physiotherapy are to mobilize the muscles and joints, strengthen muscles and to reduce tension over the bursa. Stretching the leg muscles are the main exercise movements for rehabilitation.
- Surgery is rarely indicated. For athletes who are suffering from severe limitation of motion for several weeks, bony growths may have formed, causing irritation. Surgical excision may be performed to remove the bursa and the bony growths.
- After surgery immobilization for one to two weeks is advised, followed by active range of motion exercises for 3 weeks. Progressive resistive exercises are later started to increase muscle strength.
- In patients with concomitant osteoarthritis, treatment for the latter may be indicated to decrease the pain and inflammation over the joint, too. Principles of physiotherapy also apply.
- For women who are obese and suffering from diabetes, weight loss is advised by dieting and exercise.
The prognosis of treatment for pes anserine bursitis is good especially for athletes. Losing weight for those who are overweight also yield positive results. Education of patients in the proper treatment of the condition is important to avoid disuse atrophy (shrinking) of leg muscles and to enable return to normal activities.
eMedicine, “Pes Anserinus Bursitis: Treatment & Medication" accessed 1/24/11
University Sports Medicine, "What Is Pes Anserine Bursitis?" accessed 1/24/11