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Periostitis and Compartment syndromes

Periostitis (Shin splint) 
&
 Compartment Syndrome


*Periostitis*

Inflammation of the periosteum


Cause
Overuse, poor biomechanics, excessive pronation of the foot

Treatment

Acute
Cold hydrotherapy,NM tech, Rhythmic mobilization, lymphatic drainage to reduce swelling 

 Chronic
Deep moist heat hydrotherapy, compensating structures in lower back, gluteals and thigh are treated with NM tech, fascial tech to treat shortened mxl, passive stretching, cross fibre frictions on adhesions in soleus, tibias posterior, and flexor digitorum longs, Jt play for subtalar jt 

 Self care
self massage to posterior compartment, strengthening affected mxl, refer for orthotics if necessary

*Compartment syndrome*

Result of an increase in pressure within the compartment of the lower leg (structures around tibia and fibula)

SXS
Pain in the shin/tibia

Cause
Trauma, overuse, anatomical configuration, mxl imbalance, improper foot wear

FYI
"Medically" compartment syndrome is dx with compartment pressure testing. With chronic compartment syndrome, a post-exercise pressure of 15mm Hg measured 15mins after exercise stops is considered diagnostic

SXS
Acute compartment syndrome is a medical emergency!
Chronic compartment syndrome sxs are noted with exercise
Aches and tightness over the entire compartment

Assessment
ROM, mxl length testing

Differentiating causes of leg pain

Tibialis posterior tendinitis: Pain is worse on activity and its along the tibia
Tibial stress fx: Sharp localized pain to fx site, pain is constant, medial aspect of the tibia is MC
Deep vein thrombosis: Feeling of local tightness and tenderness in the calf, pain is relatively constant regardless of activity, warm redness on site is classic indicators, but it may be absent
Homan's sign, Ramirez't test used to r/o

 Treatment
Fascial release, deep moist heat hydrotherapy, cross fibre frictions to adhesion within tibias anterior followed by an ice application and stretch, jt play

Self care
Rest from activitiesSelf massage to compartment borders, stretching 
Refer to orthotics if necessary

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