Knee

Goose’s foot | symptoms, causes, treatment

Gęsia stopkaA goose’s foot- the name is a little bit misleading because the injury refers to a knee, not a foot. The goose’s foot syndrome refers to a set of pains located about 5 cm below the medial knee joint. It is a place in which final attachments of three muscles connect: sartorius muscle, gracilis muscle and semitendinosus muscle. The attachments connect to the tibial fascia and form the “tendinous tenia”, which resembles a goose membrane. This is where the name comes from.

The basic function of the muscles which form the goose’s foot is to bend a knee, rotate the hip inwards and stabilize the knee dynamically to prevent knee distortion. This disease is very frequently afflicted by long-distance runners because an extensive friction leads to local inflammable of periarticular structures (bursa, ischiocrural muscle tendons).

Goose’s foot – symptoms

Distinctive symptoms of the goose’s foot is pain located in the medial area of the knee joint which usually occurs at night, local stiffness in the morning for more than an hour, pain when touching and local edema. The pain intensifies when walking on stairs as well as sitting down and standing up, or getting out of the car. These symptoms do not necessarily need to occur simultaneously to be able to diagnose the inflammation of the goose’s foot area. Some experience symptoms when running only when muscle attachments are irritated by unsuitable position of the lower limb or wrong running technique.

Depending on functions of muscles which control biomechanical position of the limb, the pain may occur at the beginning, during or at the end of the distance covered. Another aspect is training intensity – increased loads may cause pain. It is essential that you diagnose the problem because the pain may also come from damaged medial meniscus, degenerative changes to the medial knee joint compartment, damage to medial collateral ligament, or inflammation of fatty tissue in the area of the medial knee joint.

Major symptoms of the goose’s foot are the following:

  • Medium-intensity pain
  • Pain which intensifies when taking physical activities – increased discomfort in the morning
  • Increased goose’s foot muscle tension
  • Local edema

Goose’s foot – causes

The cause frequently applies to thighbone position biomechanics – increased pelvis anteversion, internal rotation of thighbone, extensive internal rotation of the back of the foot – these are factors which predispose to injuries. The symptoms are „knock-knees”, extensive bend of the body in hip joint (bending forward) when running, or sinking longitudinal arch of foot. This syndrome most frequently leads to combination of “knock-knees” and instability of ligaments confirmed by special orthopedic tests. As a rule the cause of the inappropriate position of bone structures during dynamic work is deteriorated force and muscle endurance of the pelvic girdle, ischiocrural muscles, quadriceps and hip joint adductors. Another important factor is a possibility of performing eccentric works (controlled muscle lengthening) by ischiocrural muscles. Such work is a key to having a suitable control over the shin when inhibiting straightening in the limb when running.

A frequent causes of the goose’s foot inflammation, particularly among runners, may be training mistakes (including no warm-up), extensive training, or training despite clear knee joint dysfunction and limited range of movement, as well as wrong technique of exercises and badly-chosen running shoes.

Goose’s foot – treatment

At the early stage, when pain is considerable, training load is reduced so that the pain does not intensify. A solution may be cooling the painful area and placing a cushion between knees before falling asleep. Physiotherapeutic work is concerned with relaxing muscles which comprise the goose’s foot. Also stretching and exercises which strengthen adductor muscles and quadriceps as the basic knee joint stabilization instrument are adopted. In particular, it is essential that you strengthen a teardrop muscle. When selecting exercises, it is important that you analyze body biomechanics in order to determine causes of pain. A frequent instrument used by physiotherapists in this respect is FMS (Functional Movement Screen).

Goose’s foot – exercises

Examples of stretching exercises presented by MA Zuzanna Kulczyńska

gęsia stopka ćwiczenie

 

Goose’s foot exercise 1 Stretching front part of the hip 

A single-knee bend. Make sure the pelvis is positioned properly through pulling up a tailbone. Move the torso forward so that the front of the hip is stretched.

 

 

 

Gęsia stopka ćwiczenia

Goose’s foot exercise 2. Stretching gluteus muscles

Sit upright, one leg straightened, another leg must be bent in the knee, positioned on the side of the other leg. Make sure the spine is straightened. Rotate your torso towards the bent knee so that you can feel the buttock stretching.

 

 

 

Gęsia stopka rehabilitacja

Goose’s foot exercise 3. Stretching internal side of the hip

Straddle in the sitting position, keep your knee straight. Make sure your lumbar region is straightened. Rotate your torso.

 

 

 

 

gęsia stopka rozciąganie

Goose’s foot exercise 4. Stretching ischiocrural muscles

Lie on your back, lower leg straight and on the ground. Upper leg leaning against the wall. It must be straight so that the thigh is in vertical position. Keep that position for about 30-40 seconds.

 

 

 

 

Goose’s foot treatment ­ – discussed by PhD Dominik Sojak (Rehasport Clinic orthopedist in Gdańsk)

  1. We always start with rehabilitation and physiotherapy aimed at preventing inflammation and pain as well as manual therapy and stretching. If we cannot see clear progress for 4-6 weeks and when the ultrasound scan is positive, we proceed with injections of bursa with corticosteroid.
  2. Injection of bursa with corticosteroid. A steroid injection may be controlled by ultrasound scan, is more precise, yet not necessary for a goose’s foot. The orthopedist may administer medicine directly. As a rule one injection is made, and it is enough to make sure pain is bearable or reduced to the extent that can be treated with rehabilitation. In the case of more acute conditions, it is permissible to make three injections at a few-week intervals. It is important that the patient avoids physical activities for about a week after getting corticosteroid injections. As far as performance sportspersons are concerned, they cannot allow long breaks at their trainings, the break may be 2-3 days long. If the ultrasound scan shows the bursa is filled with liquid, we perform the so-called drainage to remove the liquid with a syringe.

Goose’s foot – how to prevent

Above all you need to take care of correction of biomechanical body positions. To do so, introduce relevant exercises adapted by the physiotherapist and improve running biomechanics. It is also advisable to consult a trainer in order to prepare a suitable training which involves run, loads and motor skills exercises.

Goose’s foot – where to find help?

If you suspect that you may suffer from goose’s foot, while rest and break in your trainings do no help you, it is high time you contacted a specialist. You can count on our physiotherapist and orthopedists in Warsaw, Poznań, Gdańsk and Konin.