The Pes Anserine Insertion

The pes anserine insertion is an anatomical location where three tendons attach to your shin bone near you knee.  The insertion is special because the three tendons that make up the pes anserine arise from three different muscles with three different functions.

Pes anserine translates to "goose foot," and the three tendons that make up the pes anserine insertion form the shape as a goose's foot as they attach to the bone.

The three tendons that comprise the pes anserine include the sartorius tendon, the gracilis tendon, and the semi-tendonosis tendon, which is one of your hamstrings.  These three muscles arise from different areas of your hip and thigh and all attach on the medial, or inside, part of your knee in a area called the medial tibial plateau.

There is a small bursa, or fluid filled sac, underneath the pes anserine insertion.  This bursa helps the tendons glide and slide properly.

Problems with the Pes Anserine

If you have pain on the inner, or medial, side of your knee, you may have a problem with your pes anserine.  Common conditions of the pes anserine include:

  • Pes anserine bursitis
  • Pes anserine tendonitis or tendonosis
  • Strain of the sartorius, semi-tendonosis, or gracilis tendon

Symptoms of Arising from the Pes Anserine

If you are having pain on the medial side of your knee, you may have a problem with your pes anserine.

 Usually the pain is on the inner and front part of the top of your shin bone.  Other conditions, such as a medial meniscus injury, medial collateral ligament sprain, or knee joint arthritis may cause pain there as well.  Therefore, it is recommended you see a doctor or physical therapist whenever medial knee pain strikes.

If you have medial knee pain, your physical therapist should perform a thorough knee assessment to determine the cause of your pain.  He or she may perform knee special tests and palpate the pes anserine to determine if that structure may be causing your pain.  Once you have an accurate diagnosis, you may benefit from PT for pes anserine bursitis or tendonitis.

One of the challenges of assessing and treating a problem with the pes anserine is that the three tendons that make up the insertion arise from different areas of your hip and perform different functions.  Therefore, a focused evaluation and assessment of your knees, ankles, hips, and low back are necessary to determine the cause of your problem.  That way, a specific treatment plan tailored to your condition can be prescribed.

There are many causes of knee pain, and a problem with the pes anserine, or goose's foot, is one condition that your physical therapist can help treat so you can remain pain free and enjoy your normal activities.

Source: Source: Moore, K. L., & Dalley, A. F. (1999). Clinically oriented anatomy. (4th edition ed.). Williams & Wilkins.

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