Orthopedics Book

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Anterior Tibial Tendinopathy

Aka: Anterior Tibial Tendinopathy, Anterior Tibial Tendonitis, Tibialis Anterior Tendinopathy, Tibialis Anterior Tenosynovitis, Tibialis Anterior Tendinitis
  1. Physiology
    1. Images
      1. ankleMedialAndLateral.jpg
    2. Anterior tibial tendon contracts during heel strike while walking, controlling the how the forefoot contacts the ground
    3. Anterior tibial tendon specific functions
      1. Foot dorsiflexion (major function)
      2. Foot adduction
      3. Foot inversion
  2. Causes
    1. Chronic overuse in age over 45 years
    2. Forced dorsflexion against resistance of a plantar flexed foot (eccentric stress on tibialis anterior tendon)
      1. Distance Running
      2. Soccer or football
  3. Risk Factors
    1. Women
    2. Overweight
    3. Runners (overuse injury, esp. with hills and increased mileage)
  4. Symptoms
    1. Anterior ankle pain and medial midfoot pain
    2. Pain worse at night and also with activity
  5. Signs
    1. Pain (and possibly swelling) localized to the anteromedial ankle and foot overlying the anterior tibial tendon
      1. Palpable mass in low anterior leg if anterior tibial tendon rupture
    2. Weak and painful foot dorsiflexion on resistance
    3. Gait may demonstrate a Foot Drop or Slapping gait
    4. Passive Stretching of anterior tibial tendon may result in pain
      1. Plantar flexion
      2. Hindfoot eversion
      3. Midfoot abduction
      4. Ankle pronation
  6. Differential Diagnosis
    1. Anterior Tibial Tendon Rupture
    2. Lumbar Radiculopathy
    3. Peroneal nerve palsy
  7. Complications
    1. Complete peroneal tendon rupture (more common in age >50-60 years)
  8. Management
    1. Ankle Foot Orthotic (for dorsiflexion assistance) OR
    2. Immobilization (e.g. CAM walker boot)
      1. Start with 3 weeks of immobilization
      2. Next 3 weeks
        1. Range of motion Exercises AND
        2. Immobilization (e.g. CAM Walker boot) with ambulation only
    3. Foot dorsiflexion strengthening
    4. Orthopedic referral indications
      1. Complete peroneal tendon rupture
      2. Refractory Anterior Tibial Tendinopathy
        1. Consider surgical Debridement for refractory symptoms >5 months
        2. Grundy (2010) Foot Ankle Int 31(3): 212-9 [PubMed]
  9. References
    1. Deu (2022) Am Fam Physician 105(5): 479-86 [PubMed]
    2. Simpson (2009) Am Fam Physician 80(10): 1107-13 [PubMed]

Tibialis anterior tenosynovitis (C0343224)

Concepts Disease or Syndrome (T047)
SnomedCT 240012002, 202918005
English Tibialis ant tenosynovitis, Tibialis anterior tenosynovitis, Tibialis anterior tenosynovitis (disorder)
Spanish tenosinovitis tibial anterior (trastorno), tenosinovitis tibial anterior
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Tibialis anterior tendinitis (C0554596)

Concepts Disease or Syndrome (T047)
SnomedCT 202880006
English anterior tibial tendinitis, anterior tibial tendinitis (diagnosis), anterior tibial tendonitis, anterior tibialis tendinitis, tibialis anterior tendinitis, Tibialis anterior tendinitis, Tibialis anterior tendinitis (disorder), Anterior tibialis tendinitis
Spanish tendinitis del músculo tibial anterior (trastorno), tendinitis del músculo tibial anterior
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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