The periostitis is an acute inflammation of the periosteum, ie the connective tissue sheath of the bone, and occurs preferably on the shinbone.
The affected area is located where the muscles attach: the posterior tibial muscle and the floe muscle (soleus); the other bone areas do not hurt.
The stitches are very painful, because the periosteum is strongly innervated, it feels like “a kick in the shin”.
The case of infectious periosteitis, which is caused by a mostly bacterial infection and must be treated with antibiotics or drugs specially tailored to the patient’s illness, is different.
What are the causes of periostitis?
The vast majority of those affected are runners (long-distance runners or sprinters), but football players, basketball players and other athletes with a high workload can also develop periosteitis.
In athletes, there is a functional overload of the structure at the rear interior of the shin.
The periosteum can also become inflamed as a result of direct force on the bone.
The posterior tibial muscle is a supinator, i.e. an important muscle for balance and correction of posture.
Athletes with hollow foot or overpronation are more affected because the posterior tibial muscle remains stretched in the dynamic running phase.
Periosteal inflammation occurs mainly when the running workload or running speed is increased too much or when a return to training takes place after prolonged inactivity.
Other factors that favor the occurrence of periostitis are:
- inappropriate running shoes;
- running training on sloping ground;
- too hard running surface;
- uneven leg length.
What are the symptoms of periosteitis?
The pain becomes noticeable after trauma or overload, the symptoms can vary depending on the cause.
The athletes initially feel slight pain, which becomes stronger and stronger over time, until they are finally unbearable and also occur at night.
Typical are pain in the middle and inner area of the shin, only one leg or both legs can be affected.
When running and jumping, the pain during the flexion of the foot to the sole of the foot (plantar extension) is particularly intense, in the resting position there is a significant improvement.
The pain increases when pressing on the inflamed area.
Which diagnostic procedures are suitable for periosteal inflammation?
X-rays show abnormalities in the periosteum and shin, while bone scintigraphy is helpful to rule out other conditions, such as oncological diseases and stress fractures.
With a magnetic resonance, a possibly existing bone edema can be visualized.
What therapy is used for periosteal inflammation?
In the acute phase, ice packs (cryotherapy) and a break in running are best used; it is important to interrupt sports activities so that periosteal inflammation does not become chronic.
After 2-3 days, the origin of the problem should be known, so that the cause and not only the symptoms can be eliminated; otherwise, there is a risk of relapse when training is resumed.
So you have to clarify the following questions:
- Is there a hollow foot or overpronation of the foot?
- Does the patient have muscle weakness in the floe muscle or posterior shin muscle?
- Have you completed exaggerated training sessions on hard or sloping surfaces?
Kinesio taping for tibial periostitis contracture of anterior tibial muscle, anterior tibial artery, tendonitis: Action: drainage contracting. Form: A stripe on “I”. Length: dall’alluce to the head of the fibula. Place your foot in plantar flexion and anchor the base of the big toe band through a circular hole. The adhesive strip without tension after expiration of the tibialis anterior on the head of the fibula.
There are physical therapies that have an anti-inflammatory effect; good results are achieved above all by Tecar® and laser therapy, which penetrate the connective tissue periosteum.
Shock waves can be used effectively in this disease, but since the site hurts strongly, this form of therapy can cause severe discomfort.
In addition, in the case of a foot deformity of the patient, special insoles in the running shoes can help to correct the rolling of the foot.
If the cause lies in the training behavior, this must be changed to such an extent that the periosteum of the shin is loaded as little as possible; a tape bandage can also be helpful.
Manual therapy (osteopathy) releases joint blockages in feet and ankles and eliminates muscle contractures. In this way, the foot and ankle are given a more natural movement and the load on the bone is reduced.
How long are the recovery times? The prognosis for recovery
Healing takes about a month with protection and appropriate treatment.
It is important to prevent relapses; for this it is necessary to change footwear, train on other surfaces, lose weight and possibly use insoles.