Tibial periostitis, or medial tibial stress syndrome, is a common condition in sports such as road cycling and mountain biking. It is caused by bone overload due to repetitive impacts, which leads to irritation of the tibial muscles and pain in the front part of the leg, which can become disabling if not treated. The tibia, a key bone in stability and athletic performance, articulates with the femur, patella, and fibula, and is covered by the periosteum, a fibrous sheath with blood vessels and nerves. Two main muscles are involved in tibial periostitis: 

• Anterior tibial: Extends along the outer edge of the tibia and allows for dorsiflexion of the foot.
  
  
• Posterior tibial: Located behind the tibia, it stabilizes the plantar arch and is key in pedaling.

If you practice road cycling or seek maximum performance in mountain biking, knowing the causes and prevention of tibial periostitis will help you avoid discomfort and improve your experience on the bike.

What causes tibial periostitis?

The anterior and posterior tibial muscles become insufficient to control foot landing and take-off, causing the carrera to be biomechanically deficient. This, along with the following causes, leads to tibial periostitis:

• Overuse due to excessive training.
• Poor biomechanics of the carrera.
• Inappropriate footwear.
• Worn-out shoes with no cushioning.
• Foot hyperpronation.
• Carrera on very hard surfaces.
• Starting running in a non-progressive way.
• Excessive external or internal hip rotation.

How to detect and treat it

The runner begins to notice a burning sensation or dull pain in the front of the leg, which is relieved by rest, but returns when performing the activity, even making execution difficult. Diagnosis is mainly made through examination and clinical history, and it is advisable to carry out a biomechanical gait study to complete it. Treatment of tibial periostitis consists of reducing training load. If sports activity is performed on a hard surface, such as asphalt, it is necessary to switch to a softer surface. When you finish exercising, apply ice to the affected area for 15 minutes and stretch the surrounding muscles (soleus and calves) along with the anterior tibial and peroneal muscles. If the pain persists, it is advisable to carry out a biomechanical gait study for the application of a plantar orthosis to reduce stress on the affected tissue.

Another treatment option is shock waves and platelet-rich plasma, but the main treatment is resting from sports activities that involve putting weight on the foot. It can be replaced by non-impact sports, such as cycling or swimming. The return to sports activity should be gradual and under the supervision of a physical therapist or sports re-adaptation specialist. In the event that the treatment fails, surgery will be the treatment of choice.

Can it be prevented?

There are a series of recommendations to prevent the onset of tibial periostitis. Among these, the following guidelines stand out:

• Good planning of training sessions.
• Proper footwear for your type of stride and in good condition.
• Proper warm-up before starting sports activity.
• Stretching after sports activity (anterior tibialis, fibular muscles, calves, soleus).
• Ankle proprioception.
• Avoid, as much as possible, running on hard surfaces.