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Bursitis is usually caused by overuse, or constant friction and stress on the bursa.

Pes anserine bursitis is common in athletes who:

• Put extra strain on their hamstrings or inner knee through repetitive motion, such as runners, swimmers, or cyclists
• Play sports with lateral (side-to-side) movements or sudden changes in direction, such as soccer, tennis, or basketball

People with osteoarthritis of the knee are also at risk.

Several factors can contribute to the development of pes anserine bursitis, including:

• Incorrect training techniques, such as not stretching, doing a lot of running on hills, and suddenly increasing mileage
• Tight hamstring muscles
• Obesity
• Being duck-footed, being flat-footed, or having knock knees
• Osteoarthritis in the knee

The symptoms of pes anserine bursitis include:

• Pain slowly developing on the inner/medial side of your knee and/or in the center of your shinbone, about 2 to 3 inches below your knee joint
• Pain increasing with exercise or climbing stairs
• Puffiness or tenderness to the touch in this area
• Stiffness or pain after sitting with your knees bent for a long period of time

Pain from pes anserine bursitis is located on the inner (medial) side of the knee, just below the joint.

Symptoms of pes anserine bursitis may mimic those of a stress fracture, medial meniscus tear, and/or medial collateral ligament sprain.

To see whether you have pes anserine bursitis or a different condition, your doctor will examine your knee and talk to you about your symptoms.

Treatment of pes anserine bursitis is almost entirely non-operative.

Athletes with pes anserine bursitis should take steps to modify their workout program to allow healing and prevent the inflammation from coming back.

Other treatments include:

• Rest. Stop doing the activity or substitute a different activity until the bursitis clears up.
• Ice. Apply ice at regular intervals 3 or 4 times a day for 20 minutes at a time. Do not apply ice directly to the skin.
• Anti-inflammatory medication. Non-steroidal anti-inflammatory medication (such as aspirin, ibuprofen, and naproxen) may ease the pain and reduce the inflammation. You can also use topical NSAIDs, like over-the-counter diclofenac gel.
• Injection. Your doctor may inject a solution of local anesthetic and a potent steroidal anti-inflammatory agent into the bursa, which often provides prompt relief.
• Physical therapy. Your doctor may recommend physical therapy for specific stretching exercises, as well as ice and ultrasound treatments.