Bursitis is inflammation of a bursa -- a fluid-filled sac that cushions bone, tendons, and muscles at points of friction. In the lower limb, trochanteric bursitis (lateral hip), pes anserine bursitis (medial knee), and prepatellar bursitis (kneecap) are the most common forms that affect walking. The pain is typically localised, provoked by specific movements or pressure, and can be acutely limiting even though the underlying joint itself is unaffected.
Trochanteric Bursitis: Lateral Hip Pain and Gait
Greater trochanteric pain syndrome (the preferred current term, which includes trochanteric bursitis and gluteal tendinopathy) causes pain over the lateral hip that is provoked by walking, side-lying, and crossing the legs. The IT band slides over the greater trochanter with each stride, and with inflammation this provokes sharp pain at the lateral hip at specific points in the gait cycle.
A cane in trochanteric bursitis is held on the same side as the pain (ipsilateral -- this differs from hip OA contralateral use). The rationale: a contralateral cane reduces hip abductor demand on the painful side, which theoretically reduces the compression load on the trochanteric bursa from the gluteal muscles. However, some clinicians prefer ipsilateral use to reduce lateral hip sway. The choice should be guided by which hand position reduces pain in practice.
Pes Anserine Bursitis: Medial Knee Pain
Pes anserine bursitis causes pain at the medial tibial plateau, approximately 5-7 cm below the medial joint line. It is particularly common in obese patients with knee osteoarthritis and in people with valgus (knock-knee) deformity. Walking provokes medial knee pain, and climbing stairs is particularly aggravating.
A cane in pes anserine bursitis is held contralateral to the affected knee, reducing medial knee compartment load in the same way as for knee osteoarthritis. This is the more consistent recommendation than for trochanteric bursitis.
Prepatellar Bursitis (Housemaid Knee)
Prepatellar bursitis causes swelling and pain directly over the kneecap, provoked by kneeling and direct pressure. Walking on level ground is typically tolerated; stairs and inclines provoke pain. A cane may help on stairs but is not usually required for level walking.
Bursitis Type and Cane Recommendation
| Bursitis Site | Pain Pattern | Cane Side | Most Useful When |
|---|---|---|---|
| Trochanteric (lateral hip) | Lateral hip pain on walking; worse on stairs | Ipsilateral or contralateral -- test which reduces pain | Walking distances that provoke lateral hip pain |
| Pes anserine (medial knee) | Medial knee pain 5-7cm below joint line | Contralateral to affected knee | Prolonged walking, stairs, obese patients with knee OA |
| Prepatellar (kneecap) | Anterior knee swelling; kneeling painful | Not usually required for level walking | Stairs and inclines only |
Explore DaiWalk walking canes. Related: Walking Cane for Hip Osteoarthritis | Walking Cane for Knee Osteoarthritis
