Pes Anserine Bursitis and Inner Knee Pain

Physiotherapist assessing the inner knee during an examination — An assessment can help separate pes anserine pain from other causes of inner knee pain.

Pes anserine bursitis can cause a tender spot on the inner upper shin, a few centimetres below the knee joint. Stairs, hills, squats, kneeling, walking or running may make it sore.

The pes anserine area contains three joined tendons and a small fluid-filled sac called a bursa. The bursa helps the tendons move over the shin bone. Pain may come from the bursa, the nearby tendons or both.

Other knee problems can feel similar. Our knee pain guide and knee bursitis guide explain other common causes.

Quick answer: Pes anserine bursitis often causes a tender area below the inner knee joint line.

Care usually starts with short-term load changes, pain relief and a gradual strength program.

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What is pes anserine bursitis?

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

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

Sartorius
Gracilis
Semitendinosus, which is 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 unclear.

What does pes anserine bursitis feel like?

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

A sore 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?

Location: the tender area is below the inner knee joint line.
Load: stairs, hills, squats, kneeling or running make it sore.
Touch: gentle pressure over the area brings on familiar pain.

This is not a diagnosis. Joint, ligament, meniscus, bone, hip or back problems can cause pain in a similar area.

What can contribute to pes anserine pain?

Symptoms often start when activity rises faster than the knee can adapt. Several health and movement factors may also add stress around the inner knee.

A quick rise in walking, running, hills, stairs or gym work
Repeated kneeling at work, home or sport
Knee osteoarthritis
Higher body weight, which can increase knee load
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 matter for you. Our exercise load management guide explains how to change one training factor at a time.

How is pes anserine bursitis diagnosed?

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 point 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?

Knee osteoarthritis	May cause joint ache, stiffness, swelling and pain with load.
Medial meniscus injury	May follow a twist and cause joint-line pain, swelling, catching or locking.
Medial collateral ligament injury	Often follows a side force or twist and may feel unstable.
Patellofemoral pain	Patellofemoral pain usually sits around or behind the kneecap.
Bone stress injury	Can cause a very local sore spot that worsens with repeated impact.
Referred pain	The hip, lower back or nerves can sometimes send pain towards the knee.

Scans are not always needed. Ultrasound or MRI may help when symptoms are unusual, severe or slow to improve. However, a scan can show bursal or tendon changes in people without pain. Your clinician should compare the scan with your symptoms and physical assessment.

Physio treatment for pes anserine bursitis

Treatment aims to calm pain, reduce the main trigger and rebuild the knee’s capacity. Most people start with non-surgical care.

1. Settle the flare

Reduce the activity that causes the biggest pain increase
Choose shorter or flatter walks for a short time
Limit deep squats, hills, stairs or kneeling if needed
Use a wrapped cold pack for short-term relief if it feels helpful
Discuss medicine with your GP or pharmacist if required

2. Rebuild strength and control

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

Step-up exercise used to rebuild knee strength and control — Step exercises can build strength for walking, stairs and hills.

Rehabilitation may include:

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

A biomechanical assessment may help when walking or running load keeps bringing the pain back. Some people may also benefit from exercise physiology for longer-term strength, fitness or health support. If knee arthritis is part of the problem, the GLA:D Australia program may suit some people.

3. Return to activity in stages

Increase one part of your activity at a time. For example, add distance before hills or speed. This makes it easier to find a useful level without causing a large flare.

Can you keep walking or running?

Many people can keep walking if pain stays mild and returns to its usual level by the next day. Short, flat walks are often easier than hills, stairs or long uneven routes.

Simple load guide

Green: mild pain settles soon and is no worse the next morning.
Yellow: pain rises and takes longer to settle. Reduce one load factor.
Red: you limp, swelling grows, pain becomes sharp or symptoms worsen each day. Stop and arrange an assessment.

This guide is not a strict rule. Age, health, knee arthritis and the type of activity can change what is safe. See our walking tips for knee pain for more ideas.

What if the pain does not settle?

Persistent pain needs a fresh assessment. Your physiotherapist or GP may review the diagnosis, your activity plan and whether imaging would help.

Research has examined corticosteroid injections, platelet-rich plasma and shockwave therapy for pes anserine bursitis. Results vary, and the studies do not show one clear best choice for every person. A GP or specialist can discuss the possible benefits and risks when usual care has not helped.

Home management tips

Reduce the one or two activities that cause the largest flare
Keep useful movement that does not change your walking pattern
Start with a level of exercise you can repeat well
Increase one factor at a time, such as reps, 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 the pain lasts more than one to two weeks, limits walking or stairs, keeps returning or occurs with knee arthritis.

Arrange an earlier assessment after a twist, fall, sudden swelling or clear loss of knee function. Seek urgent medical care if you cannot put weight through the leg, feel unwell with a hot swollen joint, or develop calf swelling, redness, chest pain or shortness of breath.

Pes anserine bursitis FAQs

What is pes anserine bursitis?

Pes anserine bursitis is irritation of a small bursa below the inner knee. It sits under three joined tendons where they attach to the upper shin.

What does pes anserine bursitis feel like?

It often feels like a tender spot below the inner knee joint line. Stairs, hills, squats, kneeling, walking or running may make it sore.

Can I keep walking with pes anserine bursitis?

Many people can keep walking if pain stays mild and settles by the next day. Short, flat walks are often easier during a flare.

How long can pes anserine bursitis take to settle?

Recovery varies. Mild cases may improve within several weeks. Longer-lasting pain may need a review of the diagnosis, activity load and exercise plan.

Do I need a scan for pes anserine bursitis?

Not always. A clinician may suggest ultrasound or MRI when symptoms are unusual, severe or slow to improve, or when another injury may be present.

When should I seek professional help?

Seek help if pain limits walking or stairs, keeps returning, follows an injury or does not improve. Seek urgent care for a hot swollen joint, inability to put weight through the leg, calf swelling, chest pain or shortness of breath.

What to do next

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

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