Hi Orris, I've been having knee problem for about 2 months, it gets worse after running or long walks, cycling is on unless I peddle really hard. the pain is usually in the inner side in specific point but sometimes it moves around to other part. I also noticed my feet can get numb when i run (same leg) and muscles above and below the knee are also sanative after exercise, workout in the gym on the knee is not causing pain, actually usually helping. what can it be?
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Now I have enough to give you a thorough, well-sourced answer. Here it is:
What Could Be Causing Your Knee Problem
Your symptom pattern is quite specific and points toward a few distinct possibilities. Let me walk through the most likely ones.
1. Saphenous Nerve Entrapment - Most Likely Top Candidate
This fits your picture very well. The saphenous nerve is a purely sensory branch of the femoral nerve (roots L3-L4) that travels down the inner thigh through the adductor canal, then exits near the inner knee and branches into the leg and foot.
Why it matches your symptoms:
- Focal medial (inner) knee pain that can "move around" - the infrapatellar branch and the main trunk can both be irritated
- Foot numbness on the same leg - the saphenous nerve supplies sensation down to the medial foot and ankle; numbness during running is a classic feature
- Muscle sensitivity above and below the knee - the nerve runs alongside the muscles of the inner thigh and calf, and adjacent soft tissue can become irritated
- Worse with running and walking (repetitive knee flexion/extension aggravates the nerve at the adductor canal)
- Cycling is fine at low resistance - steady low-effort pedaling doesn't compress the adductor canal the way hard pedaling or running does
- Gym work helps - controlled strengthening reduces valgus stress on the knee and compressive forces on the nerve
The entrapment usually occurs where the nerve pierces the roof of the adductor canal above the knee, or at the level of the infrapatellar branch. There is no muscle weakness (it's purely sensory), so gym-based quad and hip work won't cause pain and may actually help.
- Localization in Clinical Neurology, 8e, p. 134; Saphenous nerve compression review, PMC12051653
2. Pes Anserine Bursitis - Strong Secondary Candidate
The anserine bursa sits just below the inner knee joint line (about 2-3 cm below it), underneath the three tendons that form the "pes anserinus" - the sartorius, gracilis, and semitendinosus. It lies just on top of the MCL.
Why it fits:
- Focal medial knee pain, often very point-specific - exactly as you describe
- Worse after running and walking; less so with low-resistance cycling
- Muscle tenderness above and below: the three pes tendons run a long way up and down the leg, so irritation can spread
- Gym work (especially isolated quad work or hip strengthening) typically helps by reducing the load on these tendons during functional activity
- Rosen's Emergency Medicine, p. 2355
3. MCL (Medial Collateral Ligament) Strain - Worth Considering
The MCL spans the inner knee. Low-grade strains (Grade 1-2) can present as chronic medial knee pain after repetitive impact activity without any single traumatic event. However, the foot numbness is not explained by an MCL injury, which makes this less likely as the primary diagnosis.
4. Medial Meniscus Irritation
If the pain is right at the joint line (the crease of the knee), the medial meniscus is a possibility. Running and walking load it more than low-resistance cycling. However, again, the foot numbness is not a meniscal symptom.
The Foot Numbness Is the Key Clue
The fact that your foot goes numb during running on the same leg is the detail that sets this apart from a simple mechanical joint problem. Numbness means a nerve is being compressed or irritated during activity. The saphenous nerve is by far the most likely candidate given that:
- It supplies the medial knee and the medial lower leg/foot
- Running specifically compresses it at the adductor canal with each stride
- Gym work (stable, controlled movement) doesn't provoke it
What You Should Do
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See a sports medicine physician or physiotherapist - this presentation really needs a hands-on exam. They will look for a specific tender point along the inner thigh (Tinel's sign at the adductor canal) to confirm saphenous nerve entrapment, and assess the anserine bursa and joint line separately.
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What to expect diagnostically: A diagnostic nerve block (small injection of local anesthetic near the saphenous nerve) that relieves your pain for a few hours is considered confirmatory for saphenous neuritis. MRI can also show fluid in the anserine bursa or meniscal changes.
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In the meantime: Continue the gym work - it's genuinely helping. Avoid hard cycling and high-mileage runs. When running, focus on reducing valgus knee collapse (knees caving inward) as this is a common mechanical driver of saphenous compression.
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Treatment if confirmed: Physiotherapy addressing hip abductor and glute strength, nerve mobilization techniques, and possibly a guided steroid/anesthetic injection into the nerve or bursa. Surgery is rarely needed.
Important caveat: This is a pattern-based analysis, not a diagnosis. The foot numbness in particular needs proper neurological assessment to rule out lumbar disc involvement at L3-L4 (which can also cause medial knee pain and foot numbness from higher up). Please get it evaluated in person.
what about Meniscus tear? I have limitation in rotating the leg for example for lotus sitting pose which I could in the past and now hard to get the leg bended enough
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Good - now I have solid material. Here's a thorough answer:
Meniscus Tear - Yes, It Deserves Serious Consideration
The new information you've added - loss of rotation and reduced deep flexion (can no longer get into lotus pose) - actually strengthens the case for a meniscal tear. This is a classic and important sign.
Why Your Symptoms Fit a Medial Meniscus Tear
Here's how your full symptom picture maps onto a medial meniscus tear:
| Your Symptom | Meniscus Tear Explanation |
|---|---|
| Inner knee pain, point-specific | Medial joint line - exactly where the medial meniscus sits |
| Pain worse with running/walking | Repetitive compression and rotation loads the meniscus |
| 2 months duration, gradual | Degenerative or incomplete tears often come on gradually in active people |
| Cycling fine at low resistance | Low-load steady rotation doesn't compress the meniscus as hard as impact |
| Lost rotation & deep flexion | Torn fragment mechanically blocks or impinges during extreme flexion/rotation |
| Gym work helps | Controlled quad and hip strengthening reduces load on the meniscus without compressing it into the problem range |
| Pain sometimes moves around | Meniscal tears can produce referred pain and variable loading patterns |
The lotus pose specifically requires external rotation of the hip combined with deep knee flexion - this motion places the medial meniscus under significant stress. Losing this range painlessly, compared to before, is a red flag for a structural mechanical block inside the joint. The textbook specifically notes: "with posterior medial meniscal tears patients suffer pain on high flexion or squatting." - Bailey and Love's Short Practice of Surgery, 28th Ed.
What the Evidence Says About Diagnosis
Joint line tenderness (pressing on the inner crease of the knee) is the most sensitive clinical test for a meniscal tear. If a doctor presses there and it's sore, that's a strong signal.
The classic McMurray's test involves bending the knee, applying a valgus stress, externally rotating the leg, and slowly extending it - a click or pain on the medial side suggests a medial meniscus tear.
MRI is the gold standard - it has ~93% sensitivity and ~88% specificity for medial meniscus tears compared to arthroscopy. An MRI will show the tear's shape, location (anterior horn, posterior horn, body), and whether it's a degenerative vs. traumatic tear. This distinction matters enormously for treatment.
The One Symptom That Doesn't Fit Perfectly
The foot numbness during running is harder to explain with a meniscal tear alone. The meniscus is a mechanical structure inside the joint - it doesn't directly cause foot numbness. However, a meniscal cyst (a fluid-filled cyst that can form at the site of a tear) can compress the nearby saphenous nerve at the knee level - this is actually documented in the neurology textbook: "A meniscal cyst can compress the nerve at the knee." - Localization in Clinical Neurology, 8e, p. 134.
So one scenario that ties everything together is: a medial meniscus tear that has formed a small cyst, which is compressing the infrapatellar branch of the saphenous nerve during high-impact activity like running.
What This Means for Next Steps
Given the combination of:
- Medial knee pain for 2 months
- Restricted deep flexion and rotation (new loss of range)
- Foot numbness during running
- Mechanical nature (worse with impact, better with controlled gym work)
An MRI of the knee is the right next investigation. It will show:
- Whether the medial meniscus is torn, and what type of tear
- Whether there is a meniscal cyst
- The state of the MCL, cartilage, and other structures
At this point, trying to distinguish meniscal tear from pes anserine bursitis or saphenous nerve entrapment without imaging is not reliable. All three are plausible, and they can co-exist. The loss of range of motion is the key new detail that makes a meniscal tear harder to rule out and warrants imaging sooner rather than later.
Do not ignore the range of motion loss - if a loose fragment of meniscus migrates, it can cause a "locked knee" (sudden inability to straighten the leg) which is a more urgent situation.
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