Tibial periostitis

Specialty: Musculoskeletal.

• medial tibial stress syndrome
• tibial periostalgia
• shin pain

Why it occurs

• Tractional overload of the posterior tibial muscle or soleus tendon on the anterior or medial tibial periosteum
• Racing on hard surfaces with shoes with inefficient cushioning
• Excessive rearfoot pronation during walking or running
• Sudden increase in the intensity or volume of physical training
• Limb dysmetria or alterations in pelvic alignment
• Decreased tibial bone density (pre-stress fracture phase)

Initial workup

Plain x-ray of the tibia (usually normal in initial stages) | Bone scan with Technetium-99 or MRI of the tibia (shows linear periosteal edema along the inner tibial tibial cortex, method of choice to differentiate from stress fracture).

Standard management

• Ibuprofen — 400-600 mg every 8 hours orally for a limited period of 5-7 days to mitigate the acute inflammatory phase
• Paracetamol — 1 g every 8 hours orally, as a rescue analgesic
• Topical local cold application through direct cryomassage for 10-15 minutes three times a day.