Pes Anserine Bursitis (also known as pes anserinus or anserine bursitis) is a painful irritation of the bursa on the inside of the knee (1-3). “Pes anserinus” is latin for “goose’s foot”. The term describes the appearance of the conjoined tendons of three muscles as they converge and insert on the tibia. The pes anserine bursa is usually sandwiched between the tendons and the tibia, although its location is variable (34).
What does the pes anserine bursa do?
The pes anserine bursa functions to reduce friction between the tendons and the tibia. Trauma, degeneration, or overuse – especially repetitive inward knee bending (valgus or "knock knee") or rotational stress may trigger the bursa to produce excessive fluid, resulting in a painful inflammation (1,2,6). Because the bursae of the knee are inter connected, irritation to one bursa may cause diffuse swelling in others (7).
What are the risk factors for pos anserine bursitis?
Risk factors include obesity, knee osteoarthritis, diabetes, and being female (1,3,10-13). Pes anserine bursitis is present in up to 1/3 of diabetics with symptomatic knees (12,13). Females within that subgroup often suffer bilateral complaints and are 10 times more likely than males to be affected (12). The increased incidence in women is thought to result from an anatomically wider pelvis and increased Q-angles amplifying valgus stress (10,11). Functional risk factors for the development of pes anserine bursitis include hamstring tightness, lack of knee extension, and improper or rapid changes in training (2,20,21).
Can I have arthritis and bursitis?
Up to 75% of patients with knee osteoarthritis may suffer from pes anserine bursitis (18).
Who is most likely to get bursitis?
The prevalence of pes anserine bursitis is increased in distance runners, breaststroke swimmers (kick), and athletes participating in sports that require cutting or rapid side-to-side movement such as football, baseball, soccer, and racquet sports (2,19,35,36).
Do I need X-rays or other imaging for pes anserine bursitis?
X-rays provide little value in the assessment of pes anserine buritis but may help identify osteoarthritis or other bony pathology. Diagnosistic ultrasound may help identify bursal swelling (26,27). After a failed trail of treatment, MRI may be used to confirm the diagnosis and differentiate from concurrent knee pathology (28).
What are the best treatment options for pes anserine bursitis?
Treatment of pes anserine bursitis includes anti-inflammatory measures, activity modification, stretching, strengthening, and correction of biomechanical deficits (2,4).
Early on in treatment symptoms may be eased by using modalities including: ice, ultrasound, e-stim and NSAIDS.
Myofascial release & stretching may be utilized to help release adhesions and restore flexibility to the muscles of the leg.
Manipulation is appropriate for restrictions in the lumbosacral spine or lower extremity.
Patients with fallen arches (flat feet) will benefit from arch supports or custom orthotics. Custom orthotics have been shown to improve outcomes at both two months and four months (31).
Patients with pes anserine bursitis will benefit from stretching and strengthening exercises (1). Stretching exercises should focus on the hamstrings, adductors, quadriceps, and calves (4,21). Strengthening exercises should be directed at the hip abductors for hip stability and control of femoral internal rotation.
What other treatment options are available?
Non-responding cases may benefit from intrabursal injection of local anesthestic or corticosteroids (11,32). Patients who do not respond to an initial corticoid steroid injection will not likely benefit from subsequent shots (32). Surgery for pes anserine bursitis is rarely needed (4).
At Creekside Chiropractic & Performance Center, we are highly trained to treat pes anserine bursitis. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
Sources:
1. Butcher JD, Salzman KL, Lillegard WA. Lower extremity bursitis. Am Fam Physician. May 15 1996;53(7):2317-24.
2. Rennie WJ, Saifuddin, A. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation. Skeletal Radiology. 2005; 34: 395-398.
3. Wood LR, Peat G, Thomas E, et al. The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults. Osteoarthritis Cartilage. Jun 2008;16(6):647-53.
4. Glencross PM, Pes Anserine Bursitis http://emedicine.medscape.com/... accessed
5. Saidoff DC, McDonough AL. Knee and shin. In: Critical Pathways in Therapeutic Intervention. Extremities and Spine. 1st ed. St. Louis: Mosby; 2002:546. 6. Kang I, Han SW. Anserine bursitis in patients with osteoarthritis of the knee. South Med J. Feb 2000;93(2):207-9
7. Jensen LK, Eenberg W. Occupation as a risk factor for knee disorders. Scand J Work Environ Health. 1996;22:165–175
10. Helfenstein M Jr, Kuromoto J. Anserine syndrome. Rev Bras Reumatol. May-Jun 2010;50(3):313-27
11. Alvarez-Nemegyei J, Canoso JJ. Evidence-Based Soft Tissue Rheumatology IV: Anserine Bursitis. J Clin Rheumatol. Aug 2004;10(4):205-6.
12. Cohen SE, Mahul O, Meir R, et al. Anserine bursitis and non-insulin dependent diabetes mellitus. J Rheumatol. Nov 1997;24(11):2162-5.
13. Unlu Z, Ozmen B, Tarhan S, et al. Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitus. J Rheumatol. Feb 2003;30(2):352-4.
18. Larsson L, Baum J. The syndrome of anserine bursitis: an overlooked diagnosis. Arthritis Rheum. 1985;28:1062–1065.
19. Glencross PM, Pes Anserine Bursitis http://emedicine.medscape.com/... accessed
20. American Academy of Orthopaedic Surgeons. Goosefoot (Pes Anserine) Bursitis of the Knee. Available at: www.aaos.org. Accessed 04/10/2014
21. Chmielewsk R, Case Report: Osteopathic Manipulative Treatment of Pes Anserine Bursitis Using The Triple Technique. Rhematology IV: Anserine Bursitis. Journal of Clinical Rheumatology. August 2004,10 (4): 205 - 206.
22. Alvarez-Nemegyei J. Risk factors for pes anserinus tendinitis/bursitis syndrome: a case control study. J Clin Rheumatol. Apr 2007;13(2):63-5.
23. Chatra PS. Bursae around the knee joints. Indian J Radiol Imaging. 2012;22:27–30.
24. Mochizuki T, Akita K, Muneta T, Sato T. Pes anserinus: layered supportive structure on the medial side of the knee. Clin Anat. 2004;17:50–54.
26. Voorneveld C, Arenson AM, Fam AG. Anserine bursal distention: diagnosis by ultrasonography and computed tomography. Arthritis Rheum. Oct 1989;32(10):1335-8.
27. Yoon HS, Kim SE, Suh YR, et al. Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci. Feb 2005;20(1):109-12.
28. Zeiss J, Coombs RJ, Booth RL Jr, et al. Chronic bursitis presenting as a mass in the pes anserine bursa: MR diagnosis. J Comput Assist Tomogr. Jan-Feb 1993;17(1):137-40.
31. Ferrari, Robert, A Cohort-Controlled Trial of Custom-Made Foot Orthoses in Anserine Bursitis JPO Journal of Prosthetics & Orthotics: January 2014 - Volume 26 - Issue 1 - p 33-37
32. Helfenstein M Jr, Kuromoto J. Anserine syndrome. Rev Bras Reumatol. May-Jun 2010;50(3):313-27.
33. Imani F, Rahimzadeh P, Abolhasan Gharehdag F, Faiz SH. Sonoanatomic variation of pes anserine bursa. Korean J Pain. Jul 2013;26(3):249- 54.
34. Hammer WI. Functional Soft-tissue Examination and Treatment by Manual Methods. 3rd ED. p. 360. 2007 Jones and Bartlett Publishers
35. Rouzier P. The Sportsmedicine Patient Advisor. 3rd Ed. 2010 McKesson Corporation