Anatomy
Three of the thigh muscles (Sartorius, Gracilis and Semitendinosus) attach together on the upper, inner (medial) part of the tibia just below the knee. The tendon attachment of the three tendons is called the Goosefoot (Pes Anserinus). Between the three tendons and the tibia is a bursa to reduce tendon pressure on the tibia.
Cause
With repeated strain or impact, the bursa and tendons can become ‘inflamed’ (inflamed), swollen and painful.
This can cause the bursa to become irritated and produce too much fluid, causing it to swell and put pressure on the neighbouring parts of the knee (Curtis BR, et al. 2019).
Symptoms
Pain on the inside of the shin just below the knee. The pain gets worse when running, jumping, climbing stairs, squatting etc. but usually subsides at rest.
Examination
In mild cases, the diagnosis is usually made by clinical examination alone, where pressure on the pes anserinus brings out the known pain. If there is any doubt about the diagnosis, ultrasound scanning can be performed, which is suitable for visualising the tendons and bursa.
Treatment
Treatment primarily includes relief from pain-inducing activity, stretching and graduated rehabilitation within the pain threshold. If there is no improvement despite regular physiotherapy, treatment may be supplemented with anti-inflammatory tablets (NSAID) or an injection of corticosteroids into the bursa between the tendons as part of a long-term physiotherapy programme to reduce the risk of recurrence.
Surgery is usually not indicated.
Complications
If the progress is not smooth, you should consider whether the diagnosis is correct or if there are complications.
In particular, the following should be considered: