Pes Anserine Bursae / Irritation

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I was hoping to get some thoughts on Pes Anserine Bursitis / Irritation.

Are there any specific underlying Biomechanical factors which may contribute to this problem, I cant seem to find much out there.

I have a female runner and apart from the other treatments - The Physiotherapy side and steroid injection etc.. i was wandering how much of an impact orthoses may play?

Is it just a case of reducing the pronatory moments around the sub-talar joint in order to impact on tibial rotation?

Any thoughts would be appreciated.

Matthew

 

Hi Matthew,

I have just been reading about this in Michaud's textbook " Foot Orthoses and other forms of conservative foot care". (Fantastic book by the way).

Michaud indictaes that pes anserine bursitis may be caused by rearfoot varus deformity (on page 61). "The excessive subtalar joint pronation ....causes excessive internal tibial rotation... which is responsible for medial knee injury, as the medial tibial plateau is forced into rapid posterior glide beneath the medial femoral condyle. This movement strains the medial meniscus and the medial joint capsule and may produce chronic pes anserine bursistis."

There are many pages discussing Rearfoot Varus Deformity and the best approach in terms of orthoses. Certainly worth a look if you can get it.

Briefly Michaud recommends "placing a varus wedge or post under the medial foot. The post basically acts to bring the surface to the patient's medial foot, rather than forcing the patient to pronate in order to bring the medial foot to the surface."

Hope this helps. Again, worth reading the few pages in the book if you can.

Let us know how you go with the patient

Gen

 

The sartorius causes hip and knee flexion; and external rotation of the hip. The sartorius gets stretched with hip and knee extension; and internal rotation of the hip. This occurs with pronation at propulsion. If you stop the pronation at propulsion, this condition resolves.

Stanley

 

Matthew,

Here is a more recent bit of literature regarding Pes Anserinus and knee/rearfoot alignment

Ian

 

thanks for the info guys, im trying to source the Michaud's textbook so will hopefully get some good reading from that.

 

Hi Matthew
I've seen a few of these and although there is almost invariably a degree of instability, the cause is usually multifactorial (as is so often the case with what we do), be vary of looking at this as a matter of STJ pronation, specifically look at her propulsive phase mechanics and the metatarsal axis she propels though (ie: oblique or transverse/high or low gear ala Bösjen-Moller, 1979). I would not be surprised if she propels from the lateral forefoot (callus to the plantar aspect of the 5th met head is a give away but not always present) through the oblique axis and in such cases, try a lateral forefoot wedge; think of this in the same way as lateral forefoot wedging to reduce medial compartment knee pain ie: reducing the adductory moment. If this works, I would suggest a lateral correction (eg: cuboid skive) to a device with possibly a lateral forefoot extension/reverse morton extension (PPT).
Drop me a line if you want any further info.
http://www.latrobe.edu.au/podiatry/documents/podbiopdfs/SagittalPlaneBiomech.pdf
http://www.latrobe.edu.au/podiatry/sagittal.html
Glenn

 

During the running boom here in the States, I was in charge of the sports medicine clinic at the Ohio College of Podiatric medicine. We saw 40 runners a day, and I had the opportunity to see several patients with Pes anserine bursitis. At the time, I was using Schuster orthoses with medial wedging of the forefoot. These devices would put the patient into low gear, which caused supination of the subtalar joint (by avoiding the FnHL which can occur in high gear). The results were almost immediate.
Currently, I do make this device, but the mechanics is the same which is propulsive phase pronation due to FnHL, which what I stated above.

Respectfully,

Stanley