Foot anserine bursitis, also known as anserine bursitis, is an inflammatory disease of the bursa of the joint tendon of the gracilis, sartorius, and semitendinosus muscles. We can find it on the inside of the middle part of the knee joint, 5 cm below the projection of the medial part of the joint space between the pes anserine tendons.
What is pes anserine bursitis of the knee joint?
When crow's foot bursitis develops, it is difficult to understand what it is. The articular bursa (joint bursa) is located between the collateral-medial ligament and the tendon junction on the inside of the knee joint. Often, inflammation of this articular bursa is confused with a sprain or rupture of the collateral-medial ligament due to the similarity of symptoms.
Another name for this disease is anserine bursitis (BA). The development of the inflammatory process of the bursa can be caused by trauma directly in the area where it is located, increased friction caused by a number of reasons (osteoarthritis, infectious arthritis). Bursitis of the anserine bursa is considered a secondary form of the disease.
The disease is an inflammation of the knee joint
Diagnostics
Lateral radiographs of the patient's knee help rule out stress fracture, arthritis, and osteochondritis dissecans. MRI is necessary when it is necessary to clarify whether there are other damage to the medial surface of the knee joint. Also, MRI will allow you to do without arthroscopy. The MRI image must be compared with the data obtained as a result of the physical examination. Sinusography (radiography of the sinus after administration of a contrast agent) is the best assistant for making a diagnosis if other imaging methods, including MRI and CT, are not feasible for some reason. Injections of lidocaine/corticosteroids into the bursa area are possible, which will help assess the contribution of this pathology to the overall structure of the pain syndrome of the knee joint.
Rating scales
Lower Extremity Functional Scale (LEFS)
Physical examination
The pes anserine bursa can be palpated at a point slightly above the tibial tuberosity and 3-4 cm medially (about two finger widths).
Palpation of the crow's foot bursa
Examination of hamstrings should be carried out in the supine position. Flex the patient's hip 90° and then extend the knee as far as possible. The degree of knee extension will be an indicator of the length and tone of the hamstrings. If the patient's knee straightens completely, the hamstring is not constrained.
Estimating the length of hamstrings
If bursitis occurs due to sports activities, symptoms can be reproduced by resisting internal rotation and flexion of the knee. In the chronic version in older people, bending or straightening the knee usually does not cause pain.
The main reasons for the development of anserine bursitis
The “crow's foot” on the leg carries shock-absorbing and stabilizing functional loads. Prevents joint instability and prevents excessive rotational movements of the joint. Direct injury to the anserine bursa is difficult.
The causes of the development of the disease are previous diseases of various etiologies and localizations:
- infectious, purulent arthritis;
- DOA (deforming osteoarthritis);
- consequences of knee joint injuries;
- dysfunction of the tendon-ligamentous apparatus;
- autoimmune diseases (lupus erythematosus, rheumatoid arthritis);
- endocrine diseases (diabetes);
- excessive body weight;
- acquired or congenital flatfoot;
- pathological disorders of the development of the muscular and bone structure of the skeleton;
- penetration of pathogenic flora from a nearby inflammation site by hematogenous route.
What to pay attention to so as not to miss the disease
The problem is that Koenig's disease has no specific symptoms. The signs are quite general and duplicate other pathologies of the musculoskeletal system, but the danger is much higher. Therefore, you should not ignore the following signs that your body gives you:
- knee discomfort;
- aching pain of varying intensity;
- increased discomfort when moving;
- pain without a good reason;
- tissue redness, local swelling;
- a crunch in the knee, which also occurs when cartilage is depleted;
- feeling of stiffness;
- inflammation in the joint;
- gait disturbance;
- visually noticeable changes in gait, lameness.
Forms and types of disease
The form of the disease “crow's foot” of the knee joint is determined by the anatomy of the localization of the affected bursa - the anserine bursa.
The disease is divided into two types - deep and superficial
Such bursitis is classified according to the factors of its development into four types:
- Aseptic, in which inflammation is caused by excessive mechanical stress or friction. Causes excessive production of synovial fluid and its accumulation in the cavity of the articular bursa. This type of disease has the most favorable prognosis.
- Infectious (purulent), caused by the invasion of virulent flora into the anserine bursa by blood flow or by an open wound. Without proper treatment it leads to sepsis. Requires treatment in a medical facility under the supervision of a physician.
- Post-traumatic, developed through injury to tendons, ligaments, articular surfaces, muscle fibers of varying severity.
- Caused by the appearance of osteophytes or the accumulation of calcium salts. It is a complication of chronic arthrosis.
Main risk factors
The presence of risk factors in everyday life may contribute to the appearance of inflammation of the anserine bursa:
- Professional affiliation - the work of workers, construction workers, agricultural workers, associated with prolonged kneeling positions.
- Belonging to professional sports. The disease affects weightlifters, wrestlers, weightlifters, football players, and skiers. There is a direct correlation between the appearance of bursitis and excessive physical activity.
- Hereditary predisposition.
- Congenital pathologies and developmental anomalies of the musculoskeletal skeleton and tendon apparatus.
- History of autoimmune disorders.
- Hormonal imbalance. In women during menopause, as well as during long-term treatment with steroid hormones.
- Sudden and prolonged hypothermia of the lower extremities or the body as a whole.
Risk factors include: occupation, congenital pathologies
Symptoms
The disease has a characteristic clinical picture, which includes the following symptomatic manifestations:
- pain in the inner part of the knee joint, which increases when climbing up a hill or up steps;
- swelling localized below the knee fossa;
- increased sensitivity of the knee;
- sensation of a foreign body inside the joint;
- hyperemia of the skin at the site of inflammation;
- deterioration of general condition;
- decreased range of motion or limited joint mobility;
- the development of muscle atrophy caused by sparing the diseased joint.
Manifestations of the disease depend on the reasons that caused its appearance. A differentiated diagnosis is established taking into account diseases with a similar clinical picture.
Symptoms vary from the causes of the disease
Why is it developing?
Doctors do not have a definite answer. The reasons can be very different:
- inflammatory processes;
- traumatism of cartilaginous tissues, which is difficult to diagnose, which contributes to the development of tissue necrosis and separation of the osteochondral fragment;
- systematic microtraumas;
- hereditary predisposition;
- ischemia – decreased vascular nutrition;
- concomitant diseases of a degenerative-dystrophic nature, for example, knee arthrosis;
- diseases of the cardiovascular system;
- congenital anomalies of osteochondral tissue.
Koenig's disease is often classified as a disease of unknown origin.
Diagnosis of anserine bursitis
It is important to correctly differentiate the diagnosis. When establishing it, a qualified orthopedist-traumatologist relies on an objective clinical picture, palpations and complaints of the patient.
To clarify the diagnosis, laboratory and instrumental studies are prescribed:
- physical examination - stress test;
- blood test with leukocyte formula;
- test for rheumatic factor;
- blood test for uric acid levels;
- X-ray of the knee joint;
- Ultrasound of periarticular tissues;
- MRI;
- puncture and culture of synovial fluid.
Diagnosis at the initial stage of the disease allows you to reduce the duration and intensity of treatment and speed up the recovery process.
X-ray of the knee joint
How does Koenig's disease develop?
By analogy with arthrosis, this disease also has several stages.
In the first stage, minor discomfort appears, the pain is localized in the knee, the cartilage is not yet deformed, but damage to the bone marrow has already begun.
On the second, more areas with dead tissue are formed, and the symptoms intensify. The synovial membrane becomes inflamed, and the destruction of cartilage begins.
In the third, the dead area of tissue is separated from the bone, the symptoms intensify even more, and mobility is limited due to severe pain.
In the fourth stage, the affected tissues form a separate substance in the synovial bursa and cause a strong inflammatory process.
Koenig's disease develops over many years
First aid
When you are concerned about pes anserine bursitis, you need to know the rules of first aid:
- Complete immobilization (ensuring immobility) of the knee joint. The maximum period if it is not possible to go to a medical institution is no more than 10 days.
- Cold compress. It is necessary to apply ice packs and apply cooling ointments.
- The use of pharmaceutical or self-made compression products (elastic bandages, tight bandages from improvised means, compression stockings, knee pads). Allows you to reduce pain.
- Ensuring that the limb is elevated to reduce swelling.
How to get rid of the disease?
An inflamed crow's foot in the knee joint causes suffering to the patient, causes lameness, and reduces ability to work. To get rid of the disease, you need to contact a specialist in the field of orthopedics and traumatology.
Once a crow's foot joint has been diagnosed, treatment consists of a set of measures:
- Elimination of the causes that caused the appearance of the disease - treatment of achillobursitis, diseases of the bone joints of infectious etiology.
- Conservative methods of influence. It includes medication, physiotherapy (magnetic, shock wave, UHF, cryotherapy, kinesitherapy, mud therapy, electrophoresis with novocaine, therapeutic gymnastics).
- Surgical treatment – puncture, bursa aspiration, excision. The indication for surgical intervention is the absence of positive dynamics after conservative therapy and the development of complications of the disease.
- Non-traditional treatment as an auxiliary method of influence.
Physiotherapy is part of the treatment of bursitis
Medications
Drug therapy can reduce pain, swelling, stop the process of inflammation at the initial stage of development, and prevent the development of a chronic form of the disease and the appearance of complications.
For these purposes, the following is used in medical practice:
- NSAIDs have the ability to relieve pain, fever and slow down the progression of inflammation (Ibuprofen, Nimid, Ketoprofen, Movalis, Meloxicam).
- Steroid hormones relieve acute pain and stop inflammation (Kenalog, Diprospan, Depo-Medrol).
- Antibacterial drugs - antibiotics, are prescribed depending on the pathogen and resistance.
- Muscle relaxants that reduce muscle tension (Mydocalm, Mefedol).
- Anesthetics, by blocking the affected area (Novocaine, Lidocaine).
Before using medications, it is necessary to consult a doctor to clarify the dosage of the drugs and the duration of therapy.
Medicines are the main method of treating pes anserine of the knee joint
Unconventional treatment
Methods, remedies, recipes of traditional medicine are not an independent therapeutic method. This type of therapy is used as an auxiliary therapy at the initial stage of the disease or in the absence of the opportunity to visit a doctor.
The active ingredients used in alternative medicine are:
- plant materials – fresh and dried parts of plants (leaves, inflorescences, fruits, bark, needles, rhizomes, stems);
- raw materials of animal origin (butter, lard, goat fat);
- bee products (propolis, honey, wax, dead wood);
- healing mud.
Based on the above active ingredients, the following is prepared:
- decoctions, infusions;
- tinctures, rubbing;
- compresses, applications, wraps;
- baths, lotions;
- creams and ointments.
Alternative treatments are:
- hirudotherapy (treatment using medical leeches);
- treatment with bee stings (apitherapy);
- manual, reflex therapy;
- acupuncture.
Before using alternative medicine methods, you need to make sure that there is no allergic reaction to the components included in the folk remedies.
Prevention of pathology
Following a set of simple rules will help prevent the occurrence of this disease:
- Avoid overloading the knee joint, ligaments and tendons.
- Treat infectious and viral diseases in a timely manner.
- Prevent lower extremity injuries.
- When playing sports, increase the load gradually, and before training, do a warm-up to warm up the muscles.
- Purchase and use shoes with low heels.
- If symptoms characteristic of this disease appear, immediately visit a doctor.
- Maintain constant control of body weight.