If you have felt a sudden pain in the front of your ankle and are having difficulty moving your foot normally, you may have suffered a painful injury called a tibialis anterior tendon rupture.
The tibialis anterior tendon attaches a muscle in the front of your shin to the front of your foot. A tear of this tendon may cause pain and difficulty performing normal activities like walking and running.
Anatomy of the Tibialis Anterior
The tibialis anterior muscle arises from the front of your shin bone, also known as the tibia. It travels down your shin and turns into a tendon that attaches to the top inner-portion of your foot. Its name is derived from its location—tibialis, meaning tibia, and anterior, meaning "in the front."
The function of the anterior tibialis is to dorsiflex your foot and ankle, the action of pulling your foot and toes up towards the front of your shin. When walking, the tibialis anterior contracts to lift your foot and toes, helping them clear the floor. The muscle also serves to pull your toes and foot inwards, a movement called inversion.
An tibialis anterior rupture is a relatively rare injury, although it is the third most common lower extremity tendon tear after the Achilles tendon and the patellar tendon.1
The injury is usually caused by a traumatic event where your foot and ankle are forcefully pulled down and outwards. This places the tendon on maximal stretch, causing it to tear.
There are three grades of tendon tear. Grade I is simply overstretching the tendon. A grade II tear is a partial rupture of the tendon, and a grade III tear involves a full thickness rupture of the tendon.
Tibialis Anterior Rupture Symptoms
You may experience signs and symptoms that can indicate you have torn your anterior tibialis tendon. These may include:
Pain in the top of your foot and ankle
Swelling around your foot, ankle, and toes
Difficulty pulling your foot and toes upwards
Pain while attempting to walk
Discoloration and bruising of your foot and ankle
If you have injured your foot or ankle, you must see your physician right away. They can perform specific tests to diagnose your condition and get you started on the right treatment course.
If your physician suspects you have torn your anterior tibialis tendon, special tests may be done to confirm or reject the suspicion. First, your physician may perform a clinical examination and assess swelling, range of motion of your foot, and the strength of the muscles around your foot.
An X-ray may be done to rule out any bony abnormality like an ankle fracture. The gold standard diagnostic test for confirming an anterior tibialis rupture is magnetic resonance imaging (MRI).1 An MRI will show the soft tissue structures around your foot and ankle, and the diagnosis of tibialis anterior rupture can be confirmed (or rejected).
Initial treatment of an anterior tibialis rupture includes rest, ice, and immobilization. This is done to protect the injured tissues and promote an environment where healing can occur. Your physician may have you wear a brace to keep your foot and ankle still for a few weeks as things are healing.
Grade I tears of the tibialis anterior tendon typically do not require surgery. After a few weeks of immobilization, you can begin rehabbing the injury. A grade II rupture may require a few more weeks of rest, but then you may start physical therapy to safely regain mobility of your foot and ankle.
A full thickness grade III rupture of your tibialis anterior tendon usually requires surgery to repair. The surgery involves making one or two small incisions in the top of your foot to access the tendon.
The tendon may then be reattached to the bone with sutures. Sometimes, a neighboring tendon, the extensor hallucis longus, is used to strengthen the repair.
After surgery, you will likely not be able to bear weight on your lower extremity, so you may need a wheeled walker or crutches to walk. Your foot and ankle will likely be immobilized in a cast or removable boot.
Rehabilitation of a ruptured tibialis anterior tendon typically begins about three or four weeks after injury. If you require surgery, your rehab will start about four weeks after your surgical procedure.
You may benefit from working with a physical therapist (PT) during rehab. Your PT can assess your condition and guide you during your recovery. There are several different components to rehab after an anterior tibial tendon rupture.
Weight Bearing and Gait Training
When you first have surgery to repair your tibialis anterior, you will be non-weight bearing. That means that you cannot place any weight on your foot. Your PT can teach you how to properly walk with crutches.
As you progress with your rehab, you can start to put more weight through your lower extremity. Usually, progressive weight bearing involves placing about 25% of your weight through your foot for one week, then upping that to 50% weight bearing for one week. After spending a week placing 75% of your weight through your foot, you can begin full weight bearing.
Your PT can help you progress with walking with crutches. Typically, two crutches are initially used when you are non-weight bearing. As your progress with bearing weight on your foot, you may use one crutch and then possibly a straight cane for walking.
Your PT may work with you to fine-tune your walking by using gait training techniques. They may have you step sideways or walk over and around obstacles. This type of training can help improve the way your foot and ankle are able to tolerate the loads placed upon it while walking.
Range of Motion
The progressive range of motion of your foot and ankle may also be an important component of your rehab following anterior tibialis tendon rupture.
Range of motion exercises may be done passively, where your PT moves your foot while you rest, or the exercises may be active where you use your muscles to gradually move your foot in specific directions to improve ankle and foot range of motion.
Directions of motion for the ankle usually include dorsiflexion, plantar flexion (pointing your foot down), inversion (moving your foot inwards), and eversion (moving your foot out). Toe range of motion exercises and stretches may be done as well.
Your PT can prescribe exercises to improve the strength of the muscles around your ankle after a tibialis anterior rupture.
A resistance band may be used initially to improve muscular function of the tibialis anterior, tibialis posterior, ankle evertors, and calf muscles. The bands may be of varying thicknesses to safely progress with strengthening.
As you improve, more advanced strengthening may be done. Heel raises can improve calf strength, and standing toe raises can improve the function of your tibialis anterior muscles.
Weight-bearing exercises like mini squats or lunges can be performed once full weight bearing is achieved. Balance exercises may also be done.
During your PT sessions, your therapist may utilize manual techniques to help decrease swelling, improve scar tissue mobility, and increase range of motion. Massage may be done to relax muscles and decrease swelling around your foot and ankle. Manual resistance exercises may be done to improve muscle activation and strength.
If you have ruptured your anterior tibialis tendon, you can expect to return to your previous level of function and activity within eight to 12 weeks. Your course of recovery depends on the severity of your injury and your level of function and physical health at the time of injury.
Every person is different, so your specific recovery may be a bit longer or speedier. Be sure to work closely with your physician and healthcare team to understand your specific expected prognosis.
A Word From Verywell
A rupture of the tibialis anterior tendon in the front of your shin and ankle can be a painful injury leading to difficulty with walking, running, and participating fully in work and recreational activities.
Understanding the symptoms and management of the injury is an important step in getting the proper treatment. Working hard during rehab and recovery can help to improve your lower extremity motion and quickly get you back to your previous level of function.