Medical Analysis Report

1. Imaging Findings

Based on the provided lower limb bone scans, CT, and MRI images, continuous, smooth, and wave-like periosteal reactions are observed in both tibias (especially around the tibial shaft and adjacent cortical bone). The radiotracer uptake on bone scan is concentrated on the periosteal surface, with no significant deep bone marrow signal or structural destruction. MRI shows no obvious abnormal signal within the bone marrow; most changes are limited to the periosteum and soft tissue edema. Notable soft tissue edema is present in both lower limbs, and some subcutaneous areas in the calf region demonstrate enlarged veins, varicose vein thrombosis, or calcification (possibly calcium deposits in thrombi). There are no typical signs of bone erosion, destruction, or intramedullary changes on imaging, and no clear fracture lines are identified.

2. Differential Diagnoses

1. Chronic Venous Insufficiency-Related Periosteal Reaction (Venous Periostitis)
   Prolonged venous hypertension leads to lower limb edema and chronic inflammatory stimulation, potentially causing periosteal proliferation and new bone formation. Imaging typically shows a smooth, wave-like periosteal reaction without deeper bone destruction, consistent with this case.
2. Osteomyelitis (Especially Chronic Osteomyelitis)
   If skin ulcers or bacterial infections spread to the bone, osteomyelitis can occur. However, typical osteomyelitis findings on MRI often include diffuse inflammatory changes in both the bone marrow and soft tissues, or bone destruction with irregular cortical irregularities. In this case, no obvious bone marrow signal changes or bone destruction are seen, so this remains only a differential rather than the primary consideration.
3. Non-Infectious Periostitis or Other Causes of Periosteal Proliferation (e.g., Neoplastic or Metabolic)
   Certain neoplastic processes (such as osteosarcoma) or metabolic causes can also present with periosteal reactions, but these typically involve irregular or layered periosteal proliferation and the potential for intramedullary involvement. The imaging in this case does not support such a diagnosis.

3. Final Diagnosis

Considering the patient’s advanced age (73 years), history of chronic venous insufficiency of both lower limbs, clinical presentation, and the imaging characteristics described above, the most likely diagnosis is “periosteal new bone formation resulting from chronic venous insufficiency in the lower limbs (venous periostitis)”, rather than osteomyelitis or other malignant processes.

4. Treatment and Rehabilitation Plan

Treatment and rehabilitation in this case should focus on reducing lower limb edema, promoting venous return, and preventing infection. Main approaches include:

1. Conservative Management
   
   • Use medical compression stockings or elastic bandages to provide effective compression therapy to the lower limbs.
   • Elevate the affected limbs to promote venous return and reduce edema and inflammatory reactions.
   • If there are skin ulcers or early signs of infection, timely wound care and maintaining local cleanliness are essential. Antibiotics may be used as necessary.
2. Pharmacotherapy
   
   • If there is prominent chronic venous edema, diuretics and venotonic medications (e.g., drugs that improve venous tone) may be used to relieve symptoms.
   • For patients with potential infection risks, short-term prophylactic or empirical antibiotic therapy may be considered under medical supervision.
3. Surgical Intervention
   In general, if there is no severe varicose veins or other functionally significant issues, immediate surgery is not required. If there are extensive varicose veins, valve incompetence, or chronic non-healing skin ulcers, referral to vascular surgery for possible surgical intervention may be considered.
4. Rehabilitation and Exercise Prescription
   
   • Follow the FITT-VP (Frequency, Intensity, Time, Type, Progression, Personalization) principle:
     • Frequency: Recommend moderate lower limb activities 3–5 days per week, such as walking or cycling.
     • Intensity: Begin with low intensity (like slow, level-ground walking) to avoid excessive stress on joints and soft tissues. Use the Borg Rating of Perceived Exertion scale to maintain a target intensity around “somewhat hard.”
     • Time: Start with 15–20 minutes per session and gradually increase to 30 minutes or more, depending on patient endurance and tolerance.
     • Type: Emphasize low-impact aerobic exercise that promotes lower limb blood circulation, such as walking on flat ground, using a stationary bike, swimming, or aquatic exercises. Choose activities carefully to avoid injury or strain.
     • Progression: As edema decreases and lower limb function improves, gradually increase the exercise intensity and duration. Avoid abrupt overexertion.
     • Personalization: Tailor the plan to the patient’s age, cardiovascular function, bone health, and the specifics of this condition. Extra caution is needed if there is risk of skin ulceration or amputation, ensuring proper protection before exercise.
   • Monitor the local skin condition and edema during exercise. If pain worsens or there are abnormal skin color changes, seek medical evaluation promptly.
   • Supplement with lower limb strengthening exercises (such as seated ankle pump movements or light resistance training) to enhance calf muscle strength, along with stretching to prevent muscle contractures.

Disclaimer

This report is a reference-based analysis derived from the provided images and brief history. It does not substitute for an in-person consultation or professional medical advice. Specific diagnosis, treatment, and rehabilitation plans should be made based on the patient’s complete clinical data and other examination results. If you have any questions or if the condition changes, please consult a qualified physician promptly.