EpistemisEnthesitis of the goose's foot
Specialty: Musculoskeletal.
Why it occurs
- Inflammation of the common insertion of the tendons of the sartorius, gracilis and semitendinosus muscles on the anteromedial aspect of the proximal tibia
- Bursitis of the pes pes (bursa deep to the tendon insertion)
- Mechanical alterations of the knee (severe genu valgus, medial femorotibial osteoarthritis)
- Overweight or obesity (produces shearing in the medial compartment)
- Diabetes mellitus (predisposition to tendinopathies and bursitis)
- Runners with excessive pronation or sudden increase in distance
Initial workup
Physical examination (pain on direct pressure on the medial aspect of the proximal tibia, about 5 cm below the joint line) | High-resolution ultrasound of the inner aspect of the knee (demonstrates tendon thickening and fluid distension of the anserine bursa) | Simple weight-bearing knee x-ray (to assess underlying osteoarthritis or bone exostoses).
red flags
Exquisite pain on the medial aspect of the proximal tibia associated with fluctuating indurated swelling, local erythema, heat to the touch and inability to actively flex the knee, with feverish peaks (anserine septic bursitis, requiring surgical drainage and antibiotics).
Standard management
- Ibuprofen — 400 mg every 8 hours orally during periods of acute pain
- Ultrasound-guided perilesional infiltration of methylprednisolone — 20 mg with 1% lidocaine, highly effective for quick relief
- Paracetamol (1 g every 12 hours orally for analgesic support).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3