Symptoms
The most common symptoms of acute periostitis are sudden pain in the shin area.These are perceived and described as oppressive and extremely unpleasant, whereby the pain radiates and can consequently be felt in adjacent anatomical areas such as the knee, ankle or foot. During movements, their localization can shift and they are often described as increased by the patient, which leads to a subjective restriction of movement. Stabbing or burning pain is rarely found in cases of periostitis.
Furthermore, the bone in the area of the tibia is painful due to pressure, which is expressed by a particularly strong sensation of pain as soon as one presses with a blunt object or with the hand on an affected area of the tibia. In addition, swelling in the shin area is relatively common, since it also leads to inflammatory changes in the soft tissues of the leg. Reddening of the skin above the shin is also observed at times.
As the tibia heats up, the five cardinal symptoms (redness, swelling, pain, overheating and impaired function) that are characteristic of the presence of inflammation are completed. If the periosteum is severely inflamed, the entire body can be increasingly affected, which the affected person notices by a general fatigue and even fever. Sometimes, pus is also formed and visible small boils appear, which are emptied under pressure. Within the maximum form of periostitis, purulent skin inflammation is the full picture of periostitis, which must be treated immediately.
Therapy
Before starting treatment for periostitis, it is important to find out what led to the inflammation, as the further procedure may differ fundamentally as a result. In the case of chronic overloading through sport, the leg should first be cooled and protected and corresponding sports activities should be avoided in the near future. Symptomatic therapy with drugs such as ibuprofen or Voltaren is recommended, as these help the inflammation to subside more quickly and reduce the existing pain.
If the inflammation of the periosteum is caused by the immigration of bacteria, antibiotic treatment must be started. Numerous antibiotics are available for this purpose, including antibiotics that are particularly effective on the tissue. A parallel application of cooling and anti-inflammatory measures is advisable in order to quickly achieve a subjective improvement of the symptoms.
In the treatment of periostitis of the shin bone, primarily anti-inflammatory painkillers are used, such as from the group of non-steroidal anti-inflammatory drugs Ibuprofen or Diclofenac. Furthermore, a periosteal inflammation of the tibia must be treated antibiotically if it is caused by bacteria. The most commonly used antibiotics are penicillins or the well-tissue-treatable Clindamycin, which should be applied within a time frame of about one week.
In exceptional cases, however, it is possible that the specific pathogen does not respond to therapy with the usual broad-spectrum antibiotics and can be eliminated sufficiently. As a result, a special analysis of potentially effective drugs, an antibiogram, must be carried out. This means that material containing the pathogen must first be obtained, e.g. by a smear test, and then analyzed in order to be able to start a targeted antibiotic therapy.
Depending on the pathogen, this can take up to several weeks and thus prolong the period until healing. Cool and anti-inflammatory ointments can help to alleviate the symptoms of periostitis of the shin bone. The active ingredient diclofenac has an analgesic and anti-inflammatory effect.
It is ideally suited for external application to the shin bone. Diclofenac is contained in Voltaren® and Diclo-Schmerzgel®, for example. The well-known active ingredient ibuprofen also has analgesic and anti-inflammatory properties.
The doc® Ibuprofen Pain Gel also has a beneficial effect on osteomyelitis of the shin. When buying other ointments, you should make sure that the products are anti-inflammatory and effective against pain. In addition to protecting the affected leg, there are home remedies that can alleviate the symptoms.
Ideal are compresses made of curd cheese, which are wrapped around the affected shinbone. The compresses cool, relieve pain, have an anti-inflammatory effect and reduce swelling. This is a tried and tested household remedy that is inexpensive and well tolerated.In addition, all other coolants, such as cooling pads or moist compresses with cold water, are suitable for cooling the tissue and reducing swelling.
Cold and warm alternating images can be effective in the further process. A further, usually complementary measure in the treatment of periostitis of the tibia is the application of a kinesiotape. Acute and severe periostitis cannot be adequately treated with kinesiotape; however, it can lead to an improvement in subjective symptoms.
Kinesiotape – an elastic adhesive tape – is applied along the course of the shin bone and ensures that the muscles running along or at the edge of the shin bone are relieved by the tensile forces applied. The duration of kinesiotape application varies according to the severity of the periosteal inflammation. If, contrary to expectations, there is a deterioration under the application, the treatment must be stopped immediately.
Sometimes it can happen that a solely conservative treatment of the periosteal inflammation is not sufficient to achieve an improvement of the symptoms. This may be the case, for example, if the periosteal inflammation has reached a chronic stage due to overstrain, so that cooling or gentle treatment no longer has any positive effect. Furthermore, a conservative therapy is usually hopeless if a bacterially caused periostitis cannot be treated effectively enough with antibiotics and is very difficult to treat.
In this case, there is reasonable concern that the inflammation could spread to other areas and cause systemic damage to the patient. In some, very rare cases, inflammation of the periosteum can spread so far that amputation of the leg would have to be considered without rapid surgical treatment of the affected area. Surgical repair of the periosteal inflammation is one of the last options to remove the inflammatory process and any causative pathogens from the body.
The surgical procedure is performed in a specialized clinic for septic diseases and is usually performed under general anesthesia. Initially, sufficient disinfection and covering is carried out, followed by a layer-by-layer removal of the soft tissue in the direction of the affected tibia. During this process, dead and highly inflamed parts are removed.
The severely inflamed periosteum must be removed proportionally and the area of the tibia rinsed with a special disinfectant solution. Finally, the severed soft tissues are reattached layer by layer and finally the skin is closed. The patient is then given an oral antibiotic to ensure that any germs that may have penetrated the normally highly sterile region of the bone are killed.
In rare cases, an antibiotic chain is also applied to the periosteum. This is a small chain coated with an antibiotic such as gentamycin. This is released directly to the surrounding area for about two weeks and can act locally.
Thus the strongly inflamed area will be treated antibiotically in high dosages, which would not be possible without side effects by the administration of a tablet. The antibiotic chain is then removed again. The removal of the chronically inflamed periosteum is often successful. Unfortunately, there are also some rare cases of chronic periosteal inflammation that do not respond successfully to any therapy. In these cases, even surgical procedures can be difficult, so that they sometimes have to be repeated several times.
