What Is Pes Anserinus?
Pes anserinus or pes anserine, also known as “goose’s foot,” is a webbed, foot-like structure located in the front and inner side of the shin bone below the knee joint.
It is composed of the conjoined ends of the tendons of three thigh muscles: sartorius, gracilis, and semitendinosus, which are collectively called “guy ropes.” These muscles help in flexing or bending the knee.
Sandwiched between the pes anserine and the shin bone is a small, fluid-filled sac called the pes anserine bursa. Bursae can be found all over the body, especially in bony areas such as the elbows, hips, knees and heels. They protect the tissues and bones by preventing friction between them during movement.
What Does Pes Anserine Bursitis Feel Like?
Too much friction could result in the inflammation of the bursa. When this occurs, the bursa produces excessive fluid that can compress the surrounding tissues, resulting in pain.
When you have pes anserine bursitis, you will feel pain in the inner side of your knee, about two to three inches below the knee joint. You might especially feel this pain during running, going up or down the stairs, or getting up from a chair.
In severe inflammation, the pain may spread in front of the knee and even on the lower leg. This area will also be tender when touched, and there may be visible swelling.
What Are The Symptoms Of Pes Anserine Bursitis?
If you have pes anserine bursitis, you may observe the following:
- Pain that gradually develops in the inner side of the knee, about two to three inches below the joint.
- Pain in the pes anserine area that increases during repetitive activities such as going up the stairs, running and cycling.
- Tenderness or pain when touched.
Severe cases of pes anserine bursitis may also result in the knee having a limited range of motion, weak thigh muscles, changes in one’s walking pattern and difficulty in performing knee movements.
What Causes Pes Anserine Bursitis And Why Is It Painful?
Repetitive movements of the knee produce too much friction in the bursa causing inflammation and swelling. As the fluid increases inside the bursa, pressure builds up and compresses the surrounding tissues resulting in pain.
A direct force or trauma to the pes anserine could also result in bursitis. Individuals with osteoarthritis, a condition in which cartilage degenerates, resulting in bones rubbing against each other and causing swelling in the knee joint, are also susceptible to pes anserine bursitis.
The factors that increase the risk of an individual for developing pes anserine bursitis are as follows:
- Out-turning of the knee or out-toeing of the feet
- Out-turning of the knee in females due to a wide pelvis
- Tightness of hamstring muscles
- Poor body mechanics during training
- A sudden increase in the intensity of exercise of training
- A sudden and excessive increase in uphill and downhill walking, jogging or running
- Medial meniscal tear
How Long Is The Recovery Time For Pes Anserine Bursitis?
Physicians usually recommend a conservative treatment program consisting of rest, pain medication and physical therapy rehabilitation for individuals with pes anserine bursitis.
Individuals heal at different rates depending on the severity of bursitis, the cause of injury and the individual’s adherence to recommended treatment. A mild injury usually heals in a few weeks, and you can usually go back to normal daily activities within three weeks of treatment.
Some individuals only need about 3 weeks of treatment before they can return to their usual activities. However, others, including athletes, may need approximately six to eight weeks of recovery time before they can return to previous activities.
Will Pes Anserine Bursitis Go Away On Its Own?
Pes anserine bursitis may heal on its own provided that you take time for adequate rest so the inflammation can subside and the injury can heal. If you continue with activities that cause or worsen the pain, it may result in further injury and extended healing time.
Although pes anserine bursitis is a common injury, it is still best to consult an expert to diagnose the condition correctly and receive advice on the correct course of treatment. A proper treatment will speed up the healing time and allow you to go back to your previous activities earlier than without adequate treatment.
How Do You Treat Pes Anserine Bursitis?
Doctors usually recommend conventional treatment to treat pes anserine bursitis. Surgery is generally not required as long as other knee injuries do not accompany bursitis.
If you have been diagnosed with pes anserine bursitis, the first thing that you should do is rest the affected knee and avoid repetitive movements. Rest will provide enough time for the inflammation and swelling to resolve and for the injury to heal. In some instances, a physician may prescribe a crutch to avoid moving the affected leg.
The doctor may also prescribe anti-inflammatory medication such as ibuprofen to help reduce the pain and swelling. For extremely painful bursitis that does not resolve with over-the-counter medications, a physician may give intrabursal corticosteroid injection for immediate relief.
Some doctors may also use a needle or cannula to remove or drain the excess fluid. However, this procedure poses a risk for bacterial infection if done incorrectly. There is also a chance that the fluid may fill up the bursa again even if the procedure is done several times.
During the first 24 to 48 hours after injury, a doctor may advise you to apply a cold compress for 20 minutes at a time to reduce the pain and swelling. Once you have reduced the pain and swelling, you may place a hot compress before exercising to aid in muscle flexibility and improve healing.
Heat produces vasodilation or widening of the blood vessels, which will help deliver needed nutrients for faster recovery. Elevating the affected leg above the heart and using a compression bandage may also reduce swelling.
Once pain and swelling are minimal, you can pursue physical therapy intervention, focusing on stretching and strengthening the muscles around the knee.
Your physical therapist will also help you regain your balance, especially if you were asked to avoid placing weight on the injured leg. Your physical therapist will also train you in proper body posture and mechanics so you can avoid reinjury.
Can You Exercise With Knee Bursitis?
Bursitis occurs because of inflammation due to overuse and repetitive movements. Activities or exercises that do not exert too much impact on the knee, such as swimming, can still be done, provided that they don’t cause pain in the knee.
You should avoid activities where repetitive knee movements are required, such as running, cycling, stair negotiation and walking for long distances on uneven surfaces. These activities will further cause inflammation in the bursa.
In general, avoid any activity that causes or aggravates the pain to prevent further injury and damage to surrounding tissues. Continuing the repetitive exercises that produce pain may result in a longer healing time.
Is Walking Good For Knee Bursitis?
Walking causes repetitive motion in the knee, which you should avoid when you have pes anserine bursitis. Walking can be done on level surfaces and only for short distances as long as it will not cause or worsen the pain.
It is best to avoid uphill and downhill walking as walking on uneven surfaces can exert significant force on the knees.
How Do You Sleep With Pes Anserine Bursitis?
You are recommended to sleep on the side of your uninjured knee, such that the affected side is on top. You may also place a pillow between your legs to cushion the bursa on the knees.
What Should You Not Eat When You Have Bursitis?
Since bursitis involves inflammation, you should avoid foods that increase inflammation. These include sugary food, artificial sweeteners, processed food such as hotdogs, soda, or other sweetened drinks. Avoid excessive alcohol consumption.
Acids also accumulate in joints and bind to important alkaline minerals such as calcium and magnesium, which are important for bones and cartilages; try to limit your intake of acidic foods such as coffee, carbonated drinks and citrus fruits.
Stay hydrated! You should increase your water intake if you have bursitis. The body is made up mostly of water, and it is essential for transporting the acids outside the body. Drinking plenty of water ensures that the bones, joints and other body tissues remain hydrated.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.