Bodyworks: Tibial Periositis

How to recognise it, how to overcome it

by Patrick Milroy

There is pain and tenderness along the inside of the lower tibia (shin). You are probably an overpronator with uncorrected feet and may have begun more hill sessions or speedwork.

A light touch to the bone by your doctor may cause you to overreact! Your injured leg probably looks no different to the other, although running through long-term injury may cause muscle-wasting and alter its appearance.

Medical investigations
As above, although x-rays are generally negative and bone scans positive. Biomechanical assessment is readily available, and you should certainly seek it if you have a recurrent or chronic injury.

What else could it be?
All the other lower-leg conditions. There is much overlap between periositis and stress fractures.

Rest is probably the most important element of RICE, as ice itself sometimes causes more pain. Make sure you have appropriate shoes, which will almost certainly include some sort of orthoses to limit your pronation.

Medical treatment
If reducing and modifying your training and correcting your biomechanics do not cure the condition, you might need a few non-weight-bearing weeks on crutches, or even an operation called a fasciotomy to relieve the muscle strain.

Can you run through it?/Recovery time
If you have a mild case and make appropriate footwear changes, you may only lose a few days. But if you continue to run uncorrected, and then need surgery, there could well be a three-month gap in your training diary.

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Tibial Periositis

Discuss this article

6 weeks and still no pain relief but I have lost £90:00 to ineffectual physio therapy. The pain is about 2cm below my left knee on the outside of the main bone and in a very specific location. About 1cm square and right on the edge of the outside edge of the bone. The slightest pressure causes great pain, but pressure around the area causes no pain. I can run fine with no pain but this is because my gait is compensating as I realised due to new pain in my hip and ankle on and after long runs (90 min+).The only other way I get pain is if I bend/pull my toes up towards my shin. Hence no normal foot roll from heel to toe when running. Please help. I have tryed running through it and have tryed 3 weeks with no running. The pain has neither got better or worse with any of these actions and still persists today. please help Im getting desperate!
Posted: 19/11/2002 at 09:08

Is this ITBS?
I got pain on the outside of the knee, just below the bone, and quite specific. Physio used ultrasound and gave me exercises, and podiatrist analysed gait and gae me insert oft left shoe, it all helped.
Best of luck.
Posted: 19/11/2002 at 09:25

I am experiencing severe pain that increases with distance on the outside of my lower leg with specific site of pain about two inches below the knee. It has become gradually worse over the past two weeks to the point that it is now painful even to walk. It is painful to go up, but not down stairs. Does anyone have any suggestions as to what it is and how to treat it. i recently suffered shin splints but these were cured by new trainers. thanks!
Posted: 05/04/2005 at 11:03

Where is the best place to go for gait assessment. I have tried the local practices and have not been able to get on with the orthotics they offered. It seems thay are not able to match the orthotic to my trainers and then my comfortable trainers are just plain uncomfortable. Any recommendations.
Posted: 03/01/2006 at 22:38

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