Knee pain is common in runners. If your pain is on the inside of the knee, you might have pes anserine bursitis or lower hamstring tendonitis. So what does pes anserine tendinitis mean, and how do you manage it?
This is one cause of inner knee pain — see that hub for the full list of causes.
What is the pes anserine bursitis?
Pes anserine means ‘goose’s foot’ — the point on the inside of the knee where three tendons attach to the lower leg in a shape resembling a goose’s foot. These three tendons are the sartorius, gracilis, and semitendinosus. Bursitis is another term for paratendonitis, so we treat this condition as tendon swelling, or pes anserine tendinitis.
How does pes anserine tendinitis present?
Pes anserine pain is felt on the inside, lower part of the knee, just below the inner (medial) joint. Sometimes it moves up towards the lower hamstring muscles. The pain typically worsens with activity, and often more so afterwards. Occasionally, people notice localised swelling on the inside of the knee.
When assessing the knee, it’s essential to rule out other causes of medial knee pain — a stress fracture, torn meniscus, patellofemoral arthritis, fat pad impingement, and pain referred from the hip or spine. Not all inner knee pain is pes bursitis. Pain can also come from a nearby tendon, the semimembranosus. We usually confirm the diagnosis and exclude other causes with an MRI.
Pes anserine tendinitis vs medial meniscal tear
Both cause inner knee pain, but there are key differences. Pes bursitis usually comes on gradually from overload, whereas a medial meniscal tear often follows a twisting injury. Pes bursitis pain sits lower in the knee, while meniscal pain is higher at the medial joint line. A meniscal tear can also cause swelling, locking, or giving way. Most experienced doctors can distinguish the two.
What causes pes anserine bursitis?
It’s typically caused by repetitive overload of the tendons, leading to swelling and pain. People often report a change in the usual intensity or frequency of running or sport. Sometimes a fall onto the inside of the knee triggers swelling and pain in the pes anserinus.
How to treat pes anserine bursitis
Physiotherapy is the mainstay of treatment. Exercise therapy combines flexibility, strength, and balance work. Stretches target the hamstrings, hips, and thighs; strengthening focuses on the knee and hip; and balance work on a wobble board or uneven surfaces helps. Correcting lifting and squatting patterns matters too.
Activity modification is also crucial — as symptoms improve, you gradually resume running and sports. Anti-inflammatory measures such as ibuprofen and ice ease inflammation. If simple treatments don’t work, shockwave therapy may help.
Is an injection for pes bursitis helpful?
Yes, if simple treatments haven’t worked. A cortisone injection can ease pain so you can continue rehab and sports. We consider an ultrasound-guided pes bursal injection for:
- Pain not improving with physiotherapy or rehab
- Severe night pain
- Pain with low-load activity, such as walking or stair climbing
- Pain is stopping you from training for an upcoming event
The key is to place the cortisone deep into the pes bursa, between the tendons and the tibia. The injection should be done under ultrasound guidance to improve accuracy and reduce side effects. Afterwards, rest for about a week, restart rehab after a week, and run after roughly ten days. For more on the pros and cons of cortisone, see our cortisone guide.
How long does pes anserine bursitis take to heal?
Like most tendon problems, it can be slow, often 3–6 months to fully resolve. In some cases, early recovery within six weeks is possible.
Pes anserine pain after a total knee replacement (TKR)
Lower hamstring and pes anserine pain is sometimes seen after a total knee replacement. It can be hard to tell whether pain after a TKR is due to the implant, infection, or tendon swelling — so see your surgeon before assuming a tendon is the cause.
Frequently asked questions about pes anserine bursitis
Can I run with pes anserine bursitis?
Yes, provided you do your rehab exercises alongside. Build the load gradually rather than pushing through sharp pain.
Will a kneecap brace help pes anserine tendinitis?
It can. A kneecap brace supports the knee and may ease pes bursitis pain — worth trying alongside rehab.
Is swimming good for pes anserine tendinitis?
Yes — any aerobic activity that conditions the pelvis and lower-limb muscles helps. Avoid breaststroke, though, as it loads the pes anserine tendons more.
Do PRP injections help pes anserine bursitis?
PRP is a standard option for joints and tendons. There’s no specific evidence for it in pes anserine bursitis, but we’d consider it for cases that fail other treatments, including cortisone.
How do I tell pes anserine bursitis from lower hamstring tendonitis?
They overlap and can coexist. Pes anserine pain is located on the inner shin just below the joint; low hamstring tendonitis is felt more on the back or inner-back of the knee and worsens with hamstring loading. An ultrasound or MRI settles it.
Final word from Sport Doctor London about the pes anserine bursitis
Pes anserine bursitis causes pain on the inside of the knee. It’s essential to rule out other causes, such as a meniscal tear or stress fracture. Start with simple treatments, then move to an ultrasound-guided cortisone injection if there’s no improvement — and always choose a doctor experienced in ultrasound and injections.
To book a one-stop knee assessment and injection with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
Great information on a non biased platform with no agenda to sell you anything. really good and trustworthy advice from someone who clearly has our best interest at heart.
thanks Doc.
Thanks Lorenzo
Great post, we share this with our patients all the time, would be even better if you could include some stretching and exerceses for them to do ;)
Thanks for the feedback. Yes I agree – more practical exercise points and fewer medical interventions. I’ll make these changes soon. Thanks Lorenzo