Periostitis: Causes and how to treat it

periostitisIf you are passionate about running, you may already be familiar with periostitis. It is a condition that occurs when the tissue surrounding the bones around the periosteum become inflamed. Many runners have heard the term “shin splints,” which are a type of periostitis.

Repetitive stress such as running, jumping, or lifting heavy weights can lead to periostitis. Frequently, stress on the tibia or shinbones results in this condition. For most people, it is a short-term annoyance, but others experience chronic discomfort. In some situations, it can involve an unpleasant, infectious condition that requires a lot of care.

Periostitis symptoms


The best periostitis definition is simply inflammation of the membrane enveloping a bone. If you are a runner, it may be easy to blame your pain on this condition, but as mentioned above, you can get it from other types of movement. Knowing the symptoms will help you identify the problem.

Here is a look at some of the typical symptoms associated with periostitis:

  • Difficulty bearing weight on affected limb
  • Pus forming
  • Intense pain in affected area
  • Fever
  • Chills
  • Swelling of tissue around bone
  • Pain in front part of tibia
  • Bone tenderness
  • Stiffness, especially when getting out of bed in morning

Types of periostitis

When people get periostitis, a periosteal reaction can occur. This is when new bone forms as a response to the injury. There are several types of periosteal reaction. Some are single-layered, some are multi-layered, while others are solid, sloping, or triangle in nature.

There are, in fact, different types.

  • Simple—develops with bruises and broken bones and includes inflammation near the periosteum.
  • Suppurative—the periostitis grows when there is an infection. Fever and extreme pain and swelling occur.
  • Albuminozy—congestion takes place at the periosteum, creating a mucous-like fluid.
  • Ossificans—this is an excessive outgrowth of the bone.

What causes periostitis?

The cause of your periostitis depends on whether it’s acute or chronic. In acute cases, it can develop from infections in other parts of the body. It may sound odd, but a UTI or STI can lead to periostitis. You can also get it from a cut that doesn’t heal.

People who suffer from chronic ulcers, people who develop pressure sores, and those who suffer from autoimmune diseases are more susceptible to acute periostitis. Leukemia and some other cancers and blood disorders can lead to bone infections, so they have the potential to cause periostitis.

Often, staphylococcus or similar bacteria can cause periostitis. This type of bacteria can cause infections in people who have underlying illnesses. Osteomyelitis is an infection of the bone itself.

In terms of chronic periostitis, repeated stress on the bone usually causes the condition. Athletes who place repeated stress on their bones could get periostitis. It can be caused by the overuse of the lower leg region, trauma to the shin, and improper running techniques.

Periostitis risk factors

Risk factors for acute periostitis include having any systemic infection, joint replacement surgery, poor circulation, and having an open fracture where the bone pierces through the skin. Chronic periostitis risk factors include being an athlete or being a person who drastically increases their exercise regime or having Osgood-Schlatter disease which is common among growing children. Osgood-Schlatter disease is inflammation of the knee and results in swelling and chronic pain.

Diagnosing periostitis

There are different ways to diagnose periostitis. As your doctor conducts a physical exam, they will rule out other conditions such as fracture, Lyme disease, arthritis, Hypertrophic Pulmonary Osteoarthropathy, Caffey’s disease, and other potential ailments.

Here’s a rundown of the different procedures that might be conducted to determine if you have periostitis.

  • X-Ray—this can eliminate the possibility of a stress fracture
  • MRI—can expose stress fractures as well as localized edema where muscles are attached to the bone.
  • Bone scan—shows high blood flow and activity level in the shinbone. Is very effective in confirming periostitis.

A physician will look for tenderness, swelling, and redness along with the different diagnostic tests. A detailed review of patient medical history can also help in coming to a final diagnosis.

Treating periostitis

Periostitis treatment involves a healing period and rehabilitation. During healing, the treatment focuses on controlling the symptoms. When the time comes for you to participate in rehabilitation, the aim is to rebuild the affected area and minimize the risk of the condition reoccurring.

The following list covers the healing stage:

  • Rest—if you have periostitis, you need to limit physical activities. However, swimming and activities that are not weight bearing can be okay.
  • Stretching—gentle stretching of the muscles can be helpful in your recovery.
  • Icing—cold works well when applied for 10–15-minute intervals.
  • Deep tissue massage—this technique can help reduce pain and prevent recurrence.
  • Anti-inflammatories—NSAIDS are used to treat some people with it.
  • Leg elevation—elevating legs above the heart can help reduce inflammation and pain.
Here are some suggestions to take into consideration during the rehabilitation phase:

  • Taping—some people have noticed benefits from taping their shins
  • Shock absorbing shoes—these shoes or inserts in your shoes can reduce the load on the shins.
  • Medical arch supports—these can be helpful for people with flat feet. Using them can lead to reduced pain.
  • Calf support stockings—this type of stocking can provide gentle compression to the muscles of the lower leg and lessen the force muscles exert on the bone.
  • Immobilization—walking casts or boots can be useful for short periods of time
  • Gradual return to activity—gradually increasing activity avoids recurrence of periostitis.

Periostitis diet

Research suggests that following a diet containing antioxidant-rich fruits and vegetables can help people with shin splints. Vitamin E, omega-3 fatty acids, and selenium are known to help the body fight inflammation. Foods like whole-grain bread, nuts, and salmon are beneficial. You can also consider multivitamins to ensure you get the essential nutrients your body requires.

Periostitis can be painful. However, in the majority of cases, the outcome is positive with proper treatment. Not returning to a normal level of activity immediately following treatment can help you avoid future episodes. The best approach is to get the go-ahead from your doctor before resuming your usual physical routine. Remember, once you do get the okay, increase activity gradually so you don’t reinjure yourself.

Prevention and prognosis of periostitis

Prognosis for periostitis is good as long as treatment is completed. For those with acute periostitis, surgery may be performed and antibiotics administered through IV. After a few weeks of IV, oral antibiotics may be prescribed.

If surgery was performed on the leg bone, then physical therapy may be required to regain walking ability. For arm surgery, several weeks of limited movement is necessary.

For minor shin splits, a few days of rest and icing is enough to heal. By treating minor injuries right away, you can prevent chronic periostitis from occurring.

Prevention of chronic periostitis involves preventing overuse injuries. For example, if you’re a runner, working alongside a coach or trainer can help you improve your form so that you don’t experience an overuse injury. This can be applied to all athletes – it’s best you perfect your form and change up your routine to lower your risk of overuse injuries.

If you perform activities that can potentially increase your risk of periostitis, then you should pay close attention to your body. Don’t push yourself if something doesn’t feel right or you’re experiencing pain.


Other prevention tips include controlling your blood sugar levels, not smoking, losing weight, and making the appropriate dietary changes that help you manage blood sugar and cholesterol levels. If your doctor has advised you that you are at a higher risk for infection, then take the necessary steps to reduce your risk of infection. This may involve avoiding cuts, scrapes, and being exposed to others who have an infection.

You shouldn’t have to live with pain, and by ignoring it, you are putting yourself at a greater risk for complications. If you experience back, leg, or arm pain, then speak to your doctor as you could be preventing periostitis.

Related: 9 tips to prevent bone loss


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