What Is an Anterior Tibialis Tendon Rupture?
Managing a Tear in the Front of Your Ankle
Medically reviewed by Oluseun Olufade, MDFact checked by Maddy Simpson
A tibialis anterior tendon rupture is a rare injury that causes sudden pain in the front of your ankle and trouble moving your foot.
The tibialis anterior tendon attaches a muscle in the front of your shin to the front of your foot. If the tendon tears, it can cause pain and trouble doing normal activities like walking and running.
This article will go over what causes a tibialis anterior tendon rupture, how it’s diagnosed, and how it can be treated.
Learn More: The Most Common Causes of Foot Pain
Anatomy of the Tibialis Anterior
The tibialis anterior muscle starts at the front of your shin bone (tibia). It travels down your shin and turns into a tendon that attaches to the top inner portion of your foot.
Takeaway
The name of the tendon comes from the Latin words for its location in the body: tibialis, meaning tibia, and anterior, meaning "in the front."
The function of the anterior tibialis is to pull your foot and toes up toward the front of your shin (dorsiflexion).
When you’re walking, the tibialis anterior contracts to lift your foot and toes, helping them clear the floor or ground. The muscle also pulls your toes and foot inward (inversion).
Learn More: Anatomy and Function of the Anterior Tibialis Muscle
Tibialis Anterior Rupture Causes and Grading
A tibialis anterior rupture is a rare injury. It is the third most common lower extremity tendon tear after the Achilles tendon and the patellar tendon.
The injury is usually caused by a traumatic event where your foot and ankle are forcefully pulled down and out. This places the tendon on maximal stretch, causing it to tear.
There are three grades of tibialis anterior tendon tears:
Grade I is a small tear of the tendon.
Grade II is a larger tear of the tendon.
Grade III is a full-thickness rupture, or a complete tear, of the tendon.
Learn More: Foot and Ankle Tendonitis
Tibialis Anterior Rupture Symptoms
Signs and symptoms of a ruptured tibialis anterior can include:
Footdrop gait
Loss of ankle flexion strength
Ankle foot pain
Claw toes
If you have injured your foot or ankle, you will need to seek medical care. A healthcare provider can do tests to diagnose the injury and recommend the best treatment.
Learn More: What Causes Foot Arch Pain?
How Tibialis Anterior Rupture Is Diagnosed
If your provider thinks you have torn your anterior tibialis tendon, special tests can be done to confirm the injury.
Your provider will start by checking for swelling, the range of motion (ROM) of your foot, and the strength of the muscles around your foot.
A provider can use imaging tests like X-rays to rule out other injuries, like a broken bone, that could explain your symptoms.
The "gold standard" test for diagnosing an anterior tibialis rupture is magnetic resonance imaging (MRI). An MRI will show the soft tissue structures around your foot and ankle, which helps to confirm that the tendon has torn.
Learn More: What Is Range of Motion?
How Tibialis Anterior Rupture Is Treated
The first treatment for an anterior tibialis rupture is usually rest, ice, and immobilization. These strategies protect the injured tissues and promote healing. Your provider may have you wear a brace to keep your foot and ankle still for a few weeks.
Your treatment will be based on the severity of the tear:
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 need a few more weeks of rest, after which time you can start physical therapy (PT) 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 can 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 allowed to put weight on your foot for a while. You may need to use a wheeled walker or crutches to get around. Your foot and ankle will likely be immobilized in a cast or removable boot until it is healed.
Learn More: What Is the P.O.L.I.C.E. Principle for Sprains?
Tibialis Anterior Rupture Rehabilitation and Recovery
Rehabilitation of a ruptured tibialis anterior tendon typically starts about three or four weeks after injury. If you need surgery, your rehab will start about four weeks after the procedure.
You may benefit from working with a physical therapist (PT) during rehab. A PT can assess your injury and guide you through your recovery. There are several parts to rehab after an anterior tibial tendon rupture.
Learn More: How PT Can Help With Posterior Tibial Tendon Dysfunction
Weight Bearing and Gait Training
After surgery to repair your tibialis anterior, you will be non-weight bearing. That means that you will not be able to place any weight on your foot. During this first phase, 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 starts with placing about 25% of your weight through your foot for one week, then going up to 50% weight bearing for one week. After spending a week placing 75% of your weight through your foot, you can move on to full weight bearing.
Your PT can help you make progress walking with crutches. Typically, two crutches are used to start when you are non-weight-bearing.
As you progress with bearing weight on your foot, you might only need 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. For example, 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.
Learn More: What Is Gait Training?
Range of Motion
The progressive range of motion of your foot and ankle is another important component of your rehab after an anterior tibialis tendon rupture.
Range of motion (ROM) exercises can be done passively or actively:
Passive ROM: Your PT moves your foot while you rest.
Active ROM: 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 can be done as well.
Learn More: What Is a Normal Range of Motion?
Strengthening
Your PT can prescribe exercises to improve the strength of the muscles around your ankle after a tibialis anterior rupture.
A resistance band can be used to improve the muscular function of the tibialis anterior, tibialis posterior, ankle evertors, and calf muscles. The bands come in different thicknesses to help you safely progress with strengthening.
As you improve, more advanced strengthening can be done. For example:
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 can also be useful.
Learn More: How to Do Exercises for Better Balance
Manual Techniques
During your PT sessions, your therapist can use manual techniques to help decrease swelling, improve scar tissue mobility, and increase range of motion.
Massage can relax muscles and decrease swelling around your foot and ankle. Manual resistance exercises help to improve muscle activation and strength.
Learn More: How Does Scar Tissue Massage Work?
Prognosis for Tibialis Anterior Rupture
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. Your specific recovery could take longer or be shorter than someone else’s. If you have questions or concerns about your recovery, talk to your provider about them.
Learn More: PT Exercises to Recover From Ankle Injuries
Summary
A rupture of the tibialis anterior tendon is a rare, but painful, injury. You may need a combination of rest, physical therapy, and surgery to recover from a tibialis anterior tendon rupture. Depending on how bad the injury is, it may take weeks or months before you'll be back to your regular activities.
It's important to follow your provider's recommendations during your recovery, such as not putting weight on your foot too soon and keeping up with physical therapy exercises.
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