What is periostitis
Periostitis is also known as periosteitis or periosteal reaction, is a medical condition caused by inflammation of the periosteum, a layer of connective tissue that surrounds bone. Periostitis is generally chronic, and is marked by tenderness and swelling of the bone and pain.
The term “periostitis shin splints” refers to pain along the shin bone (tibia) — the large bone in the front of your lower leg. Shin splints are common in runners, dancers and military recruits. Medically known as medial tibial stress syndrome, shin splints periostitis often occur in athletes who have recently intensified or changed their training routines. The increased activity overworks the muscles, tendons and bone tissue.
If you have shin splints, you might notice tenderness, soreness or pain along the inner side of your shinbone and mild swelling in your lower leg. At first, the pain might stop when you stop exercising. Eventually, however, the pain can be continuous and might progress to a stress reaction or stress fracture.
Most cases of shin splints periostitis can be treated with rest, ice and other self-care measures. Wearing proper footwear and modifying your exercise routine can help prevent shin splints from recurring.
Acute versus chronic periostitis
Periostitis may be broadly characterized as acute or chronic, or more specifically broken down by pattern.
Periostitis may be classified as acute or chronic based on the time course of the initiating process.
Acute periostitis
Acute periostitis is due to infection, is characterized by diffuse formation of pus, severe pain, constitutional symptoms, and usually results in necrosis. It can be caused by excessive physical activity as well, as in the case of medial tibial stress syndrome (also referred to as tibial periostalgia, soleus periostalgia, or shin splints). Congenital infection with syphilis can also cause periostitis in newborn infants.
Chronic periostitis
Chronic periostitis can result from trauma and stress to the bones. Shin splints from running are an example.
Shin splints are caused by repetitive stress on the shinbone and the connective tissues that attach your muscles to the bone.
You’re more at risk of shin splints if:
- You’re a runner, especially one beginning a running program
- You suddenly increase the duration, frequency or intensity of exercise
- You run on uneven terrain, such as hills, or hard surfaces, such as concrete
- You’re in military training
- You have flat feet or high arches
Shin splints prevention
To help prevent shin splints:
- Analyze your movement. A formal video analysis of your running technique can help to identify movement patterns that can contribute to shin splints. In many cases, a slight change in your running can help decrease your risk.
- Avoid overdoing. Too much running or other high-impact activity performed for too long at too high an intensity can overload the shins.
- Choose the right shoes. If you’re a runner, replace your shoes about every 350 to 500 miles (560 to 800 kilometers).
- Consider arch supports. Arch supports can help prevent the pain of shin splints, especially if you have flat arches.
- Consider shock-absorbing insoles. They might reduce shin splint symptoms and prevent recurrence.
- Lessen the impact. Cross-train with a sport that places less impact on your shins, such as swimming, walking or biking. Remember to start new activities slowly. Increase time and intensity gradually.
- Add strength training to your workout. Exercises to strengthen and stabilize your legs, ankles, hips and core can help prepare your legs to deal with high-impact sports.
Periostitis causes
The causes of periostitis vary depending on whether the condition is acute or chronic.
Acute periostitis causes
Acute periostitis can develop from a variety of infections in other parts of the body, eosinophilic granuloma (Langerhans cell histiocytosis), aneurysmal bone cyst, osteoid osteoma, hemophilia 1 and trauma.
People who have chronic ulcers, such as those with diabetes or who are immobile and develop pressure sores, are more likely to develop periostitis. This is especially the case if the ulceration doesn’t heal or is allowed to continue to develop.
Certain autoimmune diseases can lead to acute periostitis. Leukemia and various cancers and blood disorders are all potential conditions that can lead to serious bone infections.
Proliferative periostitis, or osteomyelitis, is one type of bone infection. Staphylococcus and other similar bacteria are usually the cause.
Staphylococcus bacteria are present in healthy people. They’re considered a part of the normal bacteria that reside on the skin and the nose. This type of bacteria may also cause infections of the skin, especially in people who have weakened immune systems or chronic underlying illnesses. If you don’t get treatment for an infection due to Staphylococcus or related bacteria, you may get osteomyelitis.
Risk factors for acute periostitis
Having any of the following increases your risk of acute periostitis:
- any systemic infection, especially bloodstream infections
- joint replacement surgery or another type of orthopedic surgery
- poor circulation, which can be due to atherosclerosis, diabetes, or pressure sores or ulcers
- an open fracture, which is a fracture of the bone that pierces the skin and exposes the bone to the germs of the skin and surrounding environment
Chronic periostitis causes
Repeated stress on your bones can lead to chronic periostitis. Athletes and people who frequently jump, turn, or lift weights are at an increased risk of developing shin splints. The repetitive stress that these activities places on your bones can lead to the inflammatory changes that are responsible for periostitis.
Risk factors for chronic periostitis
Exercise
Runners, dancers, soldiers, and anyone else who is extremely active physically are at increased risk of chronic periostitis. Anyone who dramatically increases their exercise regimen is at risk for developing periostitis.
Osgood-Schlatter disease
Certain other noninfectious forms of periostitis, such as Osgood-Schlatter disease, are more common in growing children. Osgood-Schlatter is an inflammation of the knee, where the tendon from the knee attaches to the tibia. This condition results in a chronic pain and swelling of the proximal shin, or the area just below the kneecap, or patella.
Osgood-Schlatter disease is most common in adolescent boys, especially those who are physically active and perform higher-risk activities such as jumping and running.
Periostitis symptoms
Acute periostitis symptoms
The symptoms of acute periostitis can include:
- intense pain
- difficulty bearing weight on the affected limb
- pus formation
- a fever
- chills
- swelling of the tissue surrounding the bone
Chronic periostitis symptoms
Chronic periostitis or even temporary bouts of shin splints and similar injuries, also causes swelling and inflammation. The bones affected by noninfectious periostitis also ache and may be tender to the touch. People who have chronic periostitis don’t appear as ill as those who have acute periostitis.
While periostitis often affects the bones in your legs, it can also affect the long bones in the arms and the spine.
Periostitis diagnosis
See your doctor if running or other activities lead to shin splint symptoms and rest doesn’t help. You should see your doctor if you have pain in your joints or your bones that lingers. Tiny fractures may be present. In the case of acute periostitis, a serious infection could be damaging your bones.
During your appointment, your doctor will examine the affected area. They may apply some pressure to the area to help diagnose the problem, so be prepared for a little discomfort. Tests they may order include:
- an X-ray, which may reveal fractures or signs of damage due to infection
- an MRI scan, which can provide a detailed look at the bone and the surrounding soft tissue
- bone scans to determine if an infection is present
- a complete blood count to determine your white blood cell count and look for evidence of infection
Periostitis treatment
Your treatment options depend on the type of periostitis you have.
Treatment for acute periostitis
Doctors use antibiotics to treat the underlying infection of acute periostitis. If the infection produces pus and fluid, your doctor may need to drain it surgically.
Your doctor may also have to remove any bone tissue that becomes necrotic from infection. Doing this can prevent the spread of infection. This is called surgical debridement.
Treatment for chronic periostitis
In most cases, you can treat shin splints with simple self-care steps:
- Rest. Avoid activities that cause pain, swelling or discomfort — but don’t give up all physical activity. While you’re healing, try low-impact exercises, such as swimming, bicycling or water running.
- Ice. Apply ice packs to the affected shin for 15 to 20 minutes at a time, four to eight times a day for several days. To protect your skin, wrap the ice packs in a thin towel.
- Take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others) to reduce pain.
Resume your usual activities gradually after your pain is gone.
If self care doesn’t work, you may have a more serious underlying injury that requires physical therapy. You may need a steroid injection to reduce the inflammation. In general, though, resting the affected area should ease symptoms.
Periostitis prognosis
If you have surgery to treat acute periostitis, you’ll probably get antibiotics intravenously, or through your veins, for four to six weeks. A few weeks of oral antibiotic treatment may follow. After that, your recovery will depend on the nature of the bone surgery.
If you had surgery on a bone in your leg, you might need several weeks of physical therapy to regain normal walking ability. If you had surgery on a bone in your arm, you might need to limit the use of that arm for several weeks.
For a minor case of shin splints, a few days of rest and ice may be enough to ease the inflammation. Periostitis can develop when minor injuries aren’t allowed to heal properly. The more time you give the little injuries to heal, the more likely you are to avoid a major problem later.
Acute periostitis is rare if you haven’t had bone surgery or if you don’t have major infections or circulation problems.
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