Pes Anserine Bursitis of the Hind Leg

The serpentine pouch of the glenohumeral foot is located on the medial side of the knee below the level of the joint. Serous sinuses are small 'sacs' with gelatinous contents found in many parts of the body. They contain a small amount of fluid and help to reduce friction between tissues. The hamstring is a strong tendon complex formed by the degeneration of three tendons on the medial surface of the upper third of the tibia.

Tendinopathy, or serous tendinitis, of the glenohumeral foot refers to an inflammation of this tendon which results from irritation of the bursa and the production of extra fluid causing swelling and pressure on the adjacent parts of the knee. Two pathological conditions can develop in the area where the hammertoe is located. Either tendinitis of the tendons of the hammock tendon, or inflammation of the serous follicle in the area (serous folliculitis of the hammock: distension of the follicle due to overfilling with fluid as a result of the inflammatory process following irritation of the follicle by friction), or a combination of the two.

It is the result of overgrowth of the tendons of the goose foot and the continuous friction of the homonymous follicle. It occurs mainly in athletes but in various cases with the existence of factors such as:

• Osteoarthritis of the knee.

• Rheumatoid arthritis.

• Obesity.

• Diabetes mellitus.

• Incorrect training techniques, e.g. no stretching or no warm-up.

• Knee rotation.

• Tight muscles.

• Inner meniscus tear.

• Flatfoot, Knee pain.

• Direct injury to the area.

Symptoms of serous sinusitis of the crow's feet include:

• Gradually increasing pain on the medial side of the shin, two to three centimeters below the knee.

• Pain when exercising or climbing stairs.

In the correct diagnosis it is necessary to take a good history and a physical examination of the patient, with attention to the existence of other pathogens because the detection of the disease brings symptoms caused by other diseases and the real cause must be found for the most correct and permanent treatment and not only symptomatic.

As far as the tests are concerned, X-Rays have no diagnostic value in chickenpox, but they give us information to exclude other conditions.

Magnetic Resonance Imaging - MRI shows a swelling of the jejunal follicle which is consistent with bursitis. With ultrasound scan we can easily and directly distinguish chickenpocket bursitis from other painful diseases of the area.

Conservative Treatment

The treatment of tendinitis / ulceritis of the plantar fascia should follow the basic principles of the therapeutic approach to the treatment of overuse injuries.

• Rest of the affected area.

• Cryotherapy, immobile position, bandaging and abstinence from vigorous activities.

• Use of oral non-steroidal anti-inflammatory preparations for a short period of time. If a person cannot take an anti-inflammatory, then they may use a topical anti-inflammatory preparation (ointment, solution).

• Physiotherapy (electrotherapy, ultrasound, laser, etc.).

• If required, a local injection of a cortisone preparation (cortisone injection).

• Local injection of platelet-rich plasma (PRP).

Surgical Treatment

A very small percentage of patients do not respond to the above therapeutic interventions. In these patients, the surgical treatment of tendinitis / thylakitis of the hindfoot involves surgical removal of the serous follicle. This procedure is performed with a one-day hospital stay, is safe and the patient returns to full activities within 2 - 3 weeks.