Anterior tibial tendonitis is a type of ankle injury. The anterior tibial tendon lies at the front of the ankle and helps flex the foot upward. Injury to this tendon usually occurs due to overuse.
Tendons connect muscles to bones and joints. They support bones and joints with the strength and power of muscles. Tendons also support muscle contraction and movement. However, they also have to endure repetitive, high force movements. For example, running puts strain on the tendons of the feet and ankle tendons.
The anterior tibial tendon is at the front of the ankle where it meets the foot. It helps lift the foot and turn it inward. Overuse injuries from walking and running may result in swelling, known as tendonitis. Doctors sometimes use the term “tendinopathy” interchangeably.
Anterior tibial tendonitis is inflammation that occurs when a person overuses the anterior tendon. This tendon sits where the front of the ankle meets the foot.
It supports the anterior tibialis, the
People with anterior tibial tendonitis often feel a twinge of pain that may come and go at the front of the ankle or the medial midfoot. The medial midfoot is the middle of the foot, right under where shoelaces would be on a shoe.
Anterior tibial tendonitis pain tends to get worse with an activity that puts stress on the tendon, such as when pulling the foot up or when turning the foot in. It might also cause cracking and difficulty moving the joint. The pain of tendonitis tends to develop slowly and get worse over time. Often, the pain gets better with rest.
This type of tendonitis can develop in anyone who regularly places repetitive, excessive force on the anterior tibial tendon. This might include people who regularly run, especially up hills. Wearing shoes that are too tight around the ankle might also increase the risk.
A 2019 study of 93 people, who came to the hospital with anterior tendon issues, found that 80 of them had tendinopathy. The results of the study suggest that females are more likely to come to the hospital with anterior tibial tendinopathy than males and that older people are at a higher risk of this injury.
A physician will look at how a person walks, as well as check for physical swelling and tenderness around the front of the ankle. The foot may make a slapping sound while hitting the ground due to not having enough dorsiflexion, and they may also look for foot drop. This means difficulty lifting the foot and toes.
The physician will usually diagnose anterior tibial tendonitis based on the clinical examination alone. However, they may also carry out imaging studies.
Treatment for anterior tibial tendonitis aims to improve function and relieve pain.
It is possible to manage mild tendonitis at home within 2–3 weeks. However, more severe anterior tibial tendonitis might need physical therapy or treatment from an orthopedic specialist — a physician whose specialty is muscles and bones. Surgery may be necessary to repair the damage and restore full movement.
The standard course of treatment for anterior tibial tendonitis will typically involve rest and the use of orthopedic aids, such as a cast or walking boot, to help reduce pain and swelling.
People with mild tendonitis may find temporary relief from an over-the-counter (OTC) ibuprofen gel, which reduces pain from inflammation. A physician might refer those with longer-lasting, severe, or movement-restricting pain for physical therapy.
A physical therapist can help people with tendonitis improve their range of motion and relieve pressure on the joint through a range of guided exercises and stretches.
Full ruptures of the anterior tibialis tendon are rare, according to the Journal of the American Academy of Orthopaedic Surgeons (AAOS). However, doctors identify many ruptures late, meaning they may significantly affect walking and foot function. At this stage, surgery may be necessary.
Options might include surgical repair or reconstruction. A surgeon reattaches the tendon to the bone through various methods. This might include:
- a tendon transfer, in which a surgeon attaches a different tendon to the anterior tibialis muscle or attaches different tendons to each other
- debridement, which involves removing damaged tissue
- reconstruction and grafting, which aims to extend the tendon using artificial materials or tissue from the person’s own body
It is not possible to completely prevent anterior tibial tendonitis. However, those who engage in exercise featuring regular, repetitive motions, such as running or jumping, can take certain measures to reduce the risk. These may include:
- warming up fully before exercise and stretching gently, but fully, afterward
- choosing supportive, comfortable shoes or orthotic insoles for running
- taking breaks from repetitive exercise often
- giving tired muscles a rest between exercise sessions
- training properly before starting a new sport or exercise format
- switching up an exercise routine to prevent repetitive exercises
Anterior tibial tendonitis affects the tendons connected to the muscles at the front of the ankle. Overuse of this tendon during repetitive exercise can lead to soreness, swelling, and pain, especially when moving the foot. Foot drop and foot slapping while walking are common symptoms.
For many people with this type of tendonitis, symptoms resolve with immobilization, rest, pain management, and physiotherapy.
Surgery to repair or reconstruct the tendon may be necessary if tendonitis leads to a rupture. Resting between sessions of repetitive exercise, wearing appropriate footwear, and avoiding too much repetition in exercise can reduce the risk of tendonitis.