Pes anserinus syndrome

Do you have pain on the inside of your lower leg? Then it could be pes anserinus syndrome. The causes differ. Learn more about the clinical symptoms and therapy options. 

Pes anserinus syndrome

What is pes anserinus syndrome?

Pes anserinus syndrome is irritation of the tendon attachment, which is expressed as pain on the inside of the lower leg. Pes anserinus concerns the tendon attachment of three muscles (the semitendinosus muscle, gracilis muscle and sartorius muscle). These are located just under the knee joint on the shin bone. As the three-legged tendon attachment resembles a goose foot, it was given the name “Pes anserinus” (Latin for goose foot).  

More about the anatomy of the knee joint 

Pes anserinus syndrome: Causes and risk factors for pain on the inside of the lower leg

Pes anserinus syndrome is more prevalent in women. This is owing to the female anatomy, often due to leg misalignments (knock knees). It is particularly common among elderly women who are slightly overweight and those with accompanying diseases (such as osteoarthritis). Besides these cases, Pes anserinus syndrome occurs, above all, in: 

  • Patients with a knee endoprosthesis (postoperative) 
  • Active individuals and sportsmen/women (in particular long-distance runners) 

Knee pain at the side and inside below the knee when running/walking and bending: Typical symptoms of pes anserinus syndrome

Pes anserinus syndrome is the name given to pain occurring on the inside of the lower leg just below the knee joint. There is irritation in the tendon, and the synovial bursa may also be inflamed. Pain worsens under stress, such as when climbing stairs, when crouching, or after walking/running and jumping. Pain subsides at rest, but returns with renewed strain. The symptoms may last for anywhere between a few days up to several years.  

Can pes anserinus syndrome be prevented?

Pes anserinus syndrome is a condition caused by an overloadTargeted, balanced training is a sensible option to prepare the affected region for future strain.  

Treatment: What helps with pes anserinus syndrome?

In the acute phase of pes anserinus syndrome, it may be necessary to completely relieve pressure on the knee. This means temporarily avoiding exercise. 

However, physiotherapy to strengthen and stretch the muscles and tendons involved is an important part of treatment for pes anserinus syndrome: The leg muscles are strengthened with targeted exercisesStretching exercises, such as for a shortened hamstring (ischiocrural muscles, back of the thigh), are also very important for pes anserinus syndrome.  

Therapy-supporting exercises that aid recovery with pes anserinus syndrome

If you are suffering from pes anserinus syndrome, there is a lot you can do yourself to improve your knee pain on the inside of the lower leg. Familiarise yourself with our exercises to complement therapy, which you can carry out at home in consultation with your treating doctor, such as to warm up and strengthen the thigh muscles, as well as stretching exercises:  

Cycling with one leg

Aim: Warm-up

Starting position

  • Lying with your lower back on the floor, propped up on your forearms


  • Bend the right leg and bring it upwards
  • Circular movements with the right leg (pedalling in the air)
  • Repeat the exercise with the left leg

Note: Keep the lower back on the floor.


  • 3 sets, 20 seconds each
  • 60 seconds rest

Activation of the pes anserinus group

Aim: Strengthening of the pes anserinus tendon muscles group

Starting position

  • Tie the band around the leg of a table
  • Slip your heel into the band
  • Stand up straight, offset from your standing leg, in front of the table with your legs hip-width apart, supporting yourself on the table, if necessary
  • Slightly bend the knee of the leg in the loop


  • Extend the leg out behind you with the heel pointing upwards and inwards (towards the opposing shoulder)

Note: Perform the exercise in a slow and controlled manner. Keep your torso straight, produce the movement using only your hips and knees.


  • 10-15 reps

Bridging with Physioband

Aim: Strengthening the posterior thigh muscles (ischial muscle)

Starting position

  • Tie the Physioband into a loop and wrap it around the thigh, just above the knee
  • Lie on your back
  • Bend your legs – keeping your legs hip-width apart. Important: keep the band under slight tension


  • Lift the pelvis into a bridge position, keeping your knees hip-width apart
  • Slowly lower your pelvis to the floor again while keeping the band under tension

Note: Perform the exercise in a slow and controlled manner.


  • 10-15 reps

Knee flexing with Physioband

Aim: Strengthening the anterior thigh muscles (quadriceps)

Starting position

  • Tie the Physioband into a loop and wrap it around the thighs, just above the knee
  • Stand with legs hip-width apart


  • Push your buttocks out behind you and go into a low squat position
  • While doing so, push your knees outwards against the resistance of the Physioband
  • Keep your weight on your heels and centred through your torso
  • Return to the starting position

Note: Perform the exercise in a slow and controlled manner. Make sure to maintain the tension in your torso throughout.


  • 3 sets, 15 reps each

Stretching in a standing position

Aim: Stretching the inner thighs (adductors)

Starting position

  • Standing with legs wide apart


  • Shift your weight onto one side while bending the knee of the same side, keeping the other leg extended

Important: Keep your torso straight. Perform the exercise one leg at a time.


  • 3 sets, 45 second hold each
  • 60 seconds rest

Stretching in a sitting position

Aim: Stretching the posterior thigh muscles (ischial muscle)

Starting position

  • Sit on the floor
  • Extend one leg out in front of you, keeping the other leg bent at the knee so that its sole touches the inner thigh of the extended leg


  • Now move your upper body in the direction of the extended leg
  • Perform the exercise with one leg and then the other


  • 3 sets, 45 seconds hold each
  • 60 seconds rest

Information material for download: 

Which doctors treat pes anserinus syndrome?

Your family doctor is your first point of contact. If necessary, they will refer you to a specialist, such as an orthopaedist or sports medicine specialist.  

Genumedi® PA knee orthosis and other medi products for pes anserinus syndrome

The Genumedi PA orthosis was specially developed to support the therapy of pes anserinus syndrome. It stimulates and relieves the affected tendon attachment. Thanks to a special tendon dilator, it can alleviate the pain and allow for a stable range of motion in the kneecap

A: Re-establishment of muscular equilibrium
A dilator (see image left) reduces the tension in the outer section of the thigh musculature. The second dilator (see right) activates the weakened inner section.

B: Simulation of the Pes anserinus through a special tendon dilator
A belt can be used to adjust the pressure applied to the tendon to your liking.

C: Stable range of motion in the kneecap

In addition, the M.4s OA orthosis can also be used when treating knock knees. In the event of a foot misalignments, the doctor treating you can recommend an insole fitting, such as the igli Active Light for skew foot and fallen arches.  


Health personnel will make the diagnosis and can prescribe medical aids, e.g. from medi if necessary.

Your medical retailer will fit them individually for you.