What is pes anserine bursitis?

Pes anserine bursitis is irritation of a small bursa on the inner side of the upper shin. It sits beneath three tendons where they join the tibia, or shin bone.

The name pes anserinus means “goose foot”. It describes the fan-shaped attachment of three tendons:

• Sartorius
• Gracilis
• Semitendinosus, one of the hamstring muscles

These muscles help bend the knee and support the leg during walking, stairs, running and sport. The nearby tendons can also become sore. For this reason, clinicians may use the term pes anserine syndrome when the exact pain source is uncertain.

What does pes anserine bursitis feel like?

The main feature is pain or tenderness below the inner knee joint line. Symptoms may begin after more walking, running, hills, stairs or kneeling than usual.

• A tender spot on the inner upper shin
• Pain with stairs or hills
• Pain when rising from a chair
• Pain with squats, kneeling or running
• Mild swelling or fullness
• Stiffness after rest

Does the pain location fit?

What can contribute to pes anserine pain?

Symptoms often begin when activity rises faster than the knee can adapt. Several health and activity factors may also increase load around the inner knee.

• A quick increase in walking, running, hills, stairs or gym exercise
• Repeated kneeling at work, home or during sport
• Knee osteoarthritis
• Higher body weight, which can increase knee loading
• Reduced strength or control around the hip, thigh or calf
• A recent change in shoes, training surface or exercise type

No single movement pattern, muscle weakness or shoe type confirms the cause. A physiotherapist can assess which factors appear relevant for you. Our exercise load management guide explains how to adjust training without changing everything at once.

How is pes anserine bursitis assessed?

A clinician will ask where the pain sits, what brings it on and how it responds after activity. The physical assessment then checks the painful area and nearby parts of the leg.

Your assessment may include:

• Checking the tender area below the inner knee
• Testing knee, hip, ankle and foot movement
• Checking thigh, hamstring, calf and hip strength
• Watching a squat, step, walk or run
• Screening for other causes of inner knee pain

What else can cause inner knee pain?

Scans are not always needed. Ultrasound or MRI may help when symptoms are unusual, severe or slow to improve. However, imaging can show bursal or tendon changes in people without pain, so findings need to be considered alongside your symptoms and physical assessment.

Physiotherapy for pes anserine pain

Management aims to settle the current flare, reduce the most relevant aggravating load and rebuild the knee’s capacity. Most people begin with non-surgical care.

1. Settle the flare

   Temporarily reduce the activity producing the largest pain increase. Shorter or flatter walks may be easier, while deep squats, hills, repeated stairs or kneeling can be reduced if they aggravate symptoms.

   A wrapped cold pack may provide short-term relief if it feels helpful. Discuss suitable medicines with your GP or pharmacist when required.

2. Rebuild strength and control

   Your program should match your symptoms, goals and current fitness. It may include knee exercises, hip strengthening, hamstring work, calf strengthening and step practice.

3. Return to activity gradually

   Increase one part of your activity at a time. For example, increase walking distance before adding more hills or speed. This makes it easier to identify a useful training level without creating a large flare.

Rehabilitation may include:

• Sit-to-stand or squat practice
• Step-ups and step-downs
• Hip and thigh strengthening
• Hamstring and calf strengthening
• A gradual return to walking, running, gym exercise or sport

A biomechanical assessment may help when walking or running repeatedly aggravates symptoms. Some people may also benefit from exercise physiology for longer-term strength, fitness or health support. If knee osteoarthritis contributes to the problem, the GLA:D Australia program may suit some people.

Can you keep walking or running?

Many people can continue walking if pain stays mild, their walking pattern remains normal and symptoms return towards their usual level by the following day. Short, flat walks are often easier than hills, stairs or long uneven routes during a flare.

Simple activity-load guide

This is a general guide rather than a strict rule. Age, general health, knee osteoarthritis and the type of activity can change what is appropriate. See our walking tips for knee pain for further practical advice.

What if the pain does not settle?

Persistent pain deserves a fresh assessment. Your physiotherapist or GP may reconsider the diagnosis, review your activity plan and decide whether imaging or another management option could help.

Research has examined corticosteroid injections, platelet-rich plasma and shockwave therapy for pes anserine bursitis. Results vary, and current studies do not establish one best option for everyone. A GP or specialist can discuss potential benefits, limitations and risks when usual care has not helped.

Home management tips

• Reduce the one or two activities producing the largest flare
• Keep comfortable movement that does not change your walking pattern
• Begin exercise at a level you can repeat with good control
• Increase one factor at a time, such as repetitions, depth, speed or distance
• Review recent changes in training, work tasks or footwear
• Avoid pushing through sharp or steadily worsening pain

When should you seek help?

Consider a physiotherapy assessment if pain lasts more than one to two weeks, limits walking or stairs, keeps returning or occurs alongside knee osteoarthritis.

Arrange an earlier assessment after a twist, fall, sudden swelling or clear loss of knee function.

Pes anserine bursitis FAQs

What to do next

Start by reducing the activity that causes the largest flare. Keep comfortable movement, then rebuild strength and activity in small steps.

If symptoms persist or the diagnosis remains unclear, a physiotherapy assessment can help identify the likely pain source and guide a plan for walking, stairs, work, gym exercise, running or sport.

Related knee information

Knee pain

Explore common knee conditions, symptoms and treatment information.

Knee bursitis

Learn about other bursae around the knee and how bursitis can present.

Knee osteoarthritis

Understand common osteoarthritis symptoms and management options.

Knee exercises

Review exercise and rehabilitation principles used for knee strength and function.

Sports injury physiotherapy

Find information about physiotherapy assessment, rehabilitation and return to activity.

References

1. Mohseni M, Mabrouk A, Li D. Pes Anserine Bursitis. StatPearls. Updated January 29, 2024.
2. Hasan M, Berkovich Y, Khatib M, et al. Knee bursae: a comprehensive review of clinical evaluation, imaging differentiation, and the expanding role of biologic therapies. Cartilage. Published online November 15, 2025.
3. Majidi L, Saeb F, Alaei B, et al. Comparison of local corticosteroid injection and extracorporeal shockwave therapy in pes anserine bursitis. Med J Islam Repub Iran. 2023;37:10.
4. Gouda W, Abbas AS, Abdel-Aziz TM, et al. Corticosteroid injection, platelet-rich plasma and shockwave therapy for pes anserine bursitis. Adv Orthop. 2023;2023:5545520.