Pain can also be reproduced with active resistance of the foot in plantar flexion and inversion. Radionuclide angiograms and blood-pool images are normal. The diagnosis of periostitis is important to the professional or serious amateur athlete because training can be continued when shin splints is present. Periostitis must be differentiated from stress fractures. Stress fractures usually involve more focal pain, radiographic changes, and a characteristic focal area of radionuclide uptake in the affected area.
Stress fractures require patients to refrain from activity and often require a short-leg cast.
Infection and acute muscle inflammation should also be considered in the differential diagnosis. Henkin R, et al. All rights reserved.