Patients who do not respond to an initial corticoid steroid injection will not likely benefit from subsequent shots (32). Non-responding cases may benefit from intrabursal injection of local anesthestic or corticosteroids (11,32). What other treatment options are available? Strengthening exercises should be directed at the hip abductors for hip stability and control of femoral internal rotation. Stretching exercises should focus on the hamstrings, adductors, quadriceps, and calves (4,21). Patients with pes anserine bursitis will benefit from stretching and strengthening exercises (1). Custom orthotics have been shown to improve outcomes at both two months and four months (31). Patients with fallen arches (flat feet) will benefit from arch supports or custom orthotics. Manipulation is appropriate for restrictions in the lumbosacral spine or lower extremity.
Myofascial release & stretching may be utilized to help release adhesions and restore flexibility to the muscles of the leg. Treatment of pes anserine bursitis includes anti-inflammatory measures, activity modification, stretching, strengthening, and correction of biomechanical deficits (2,4).Įarly on in treatment symptoms may be eased by using modalities including: ice, ultrasound, e-stim and NSAIDS.
What are the best treatment options for pes anserine bursitis? After a failed trail of treatment, MRI may be used to confirm the diagnosis and differentiate from concurrent knee pathology (28). Diagnosistic ultrasound may help identify bursal swelling (26,27). X-rays provide little value in the assessment of pes anserine buritis but may help identify osteoarthritis or other bony pathology. 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).ĭo I need X-rays or other imaging for pes anserine bursitis? Up to 75% of patients with knee osteoarthritis may suffer from pes anserine bursitis (18). 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). The increased incidence in women is thought to result from an anatomically wider pelvis and increased Q-angles amplifying valgus stress (10,11). Females within that subgroup often suffer bilateral complaints and are 10 times more likely than males to be affected (12). Pes anserine bursitis is present in up to 1/3 of diabetics with symptomatic knees (12,13). Risk factors include obesity, knee osteoarthritis, diabetes, and being female (1,3,10-13). What are the risk factors for pos anserine bursitis? Because the bursae of the knee are inter connected, irritation to one bursa may cause diffuse swelling in others (7). 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). The pes anserine bursa functions to reduce friction between the tendons and the tibia. The pes anserine bursa is usually sandwiched between the tendons and the tibia, although its location is variable (34). The term describes the appearance of the conjoined tendons of three muscles as they converge and insert on the tibia. “Pes anserinus” is latin for “goose’s foot”. 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).