The foot has several tendons that originate in the lower leg and extend into the foot. They each have different functions to stabilize the foot and help us to propel our bodies forward when we walk or run. The anterior tibial tendon is one of these tendons. Although tibialis anterior tendonitis may be the least common complaint of those experiencing tendon pain around the ankle joint, it’s important to understand how to recognize and what can be done to eliminate your pain.
Anatomy and function- The anterior tibial tendon is the third largest tendon in the foot and ankle. The largest is the Achilles tendon and the second largest is the posterior tibial tendon. The anterior tibial tendon originates as a muscle in the lower leg adjacent to the shin, tibia, and extends down to the foot. It is on the front of the ankle. It inserts onto the top and inner side of the arch.
Its function is to pull the foot up and support the arch. It also assists in supinating the foot. Supination is a motion often referred to and means that the arch of the foot increases and the foot angles towards the opposite foot. Finally, it decelerates the downward motion of your foot towards the ground. From the time your heel contacts the ground to the point of the ball of the foot bearing weight it prevents your foot from slapping against the ground. So, it’s very important for normal gait to occur. It helps to identify the tendon by pulling your foot up towards you and it will be the tendon that protrudes on the front of the ankle and is running towards the inside of the foot towards the big toe.
Where will the pain be if I have tibialis tendonitis?
It is most common towards the front of the ankle area. The symptoms of tibialis anterior tendonitis may also create pain above the ankle in the lower leg adjacent to the tibia. This may be referred to as anterior shin splints. Referring to shin splints on the front of the leg. Symptoms may also be closer to or at the point where the tendon attaches to the foot on the inner side of the arch.
What causes tibialis anterior tendonitis?
- Overuse – this may occur from doing too much too soon which can happen in any activity. However, any activity that requires you to extend your foot in front of the knee joint may increase the probability of overuse. Examples of this may be racquet sports, hiking, or running downhill.
- Biomechanics – If your born with a flat foot the tendon may have to work harder to help support your arch.
- Improper running technique – Over striding while running can also cause overuse of the tendon. By taking shorter strides you won’t be extending the foot in front of you as much as this will help to reduce the need for the anterior tibial tendon to stop foot slap.
- Neurological problems – Neurological problems may not cause pain along the tendon, however, may cause damage to the nerves that stimulate the anterior muscle to contract. This is referred to as drop foot. Drop foot can be associated with back issues of a nerve issue around the see. Nerve surgery called decompression surgery can help with this.
- Trauma – a severe ankle sprain could cause a tear to the tendon. Also, a laceration to the ankle area may also cause a partial or full tear.
- Shoe gear – High heels may also be a cause and they will put more demand on the tendon to reduce the potential for foot slap because of the elevation of the heel off the ground.
Evaluation
- Imaging – MRI scans or diagnostic ultrasound are useful to confirm the diagnosis and see the extent of the tendon damage. The diagnosis will frequently be tibialis anterior tendinopathy. The tendon may be damaged but not torn.
- Physical examination – The physical examination alone will give the doctor a good idea if the tendon is damaged. There will be pain and swelling along the tendon or its muscle higher up the leg. Also, weakness of the tendon may be noted
- X-rays – these will not show tendon damage but are useful to rule out other problems.
Treatments
- Rest and elevation – when the tendonitis is acute and not that severe, take an anti-inflammatory medication. Along with icing and resting may help
- Immobilization – in some situations the use of a cam boot may be recommended
- Surgery – if a partial or full tear is noted surgery to repair the damage may be recommended. With a full tear weeks of non- weight bearing may be needed.
- Orthotics – custom made arch supports called orthotic’s may be recommended if a flatfoot deformity is thought to be the cause of the tendonitis
- Laser – the use of Multiwave laser (MLS laser) has also shown success.
- Human cellular tissue products – you may have heard of this term, or another one referred to as regenerative medicine. This treatment has significantly reduced the chance of surgery when partial tears are noted. It is important to note that in many cases the tendon may not be inflamed as much as it is breaking down. This is sometimes referred to as tendinosis rather than tendonitis. For this reason, regenerative medicine is very appropriate as it helps to repair the tendon.
How to avoid tibialis anterior tendonitis?
It’s important when taking up a new activity to not do too much too soon. Also, if you suffer from flat feet, make sure you have supportive shoes or consider over-the-counter arch supports or custom-made orthotics.
Hopefully this blog will help you to better understand if you have tibialis anterior tendonitis and how some of the newer treatments available including regenerative medicine and laser treatments can help manage the condition. Our foot and ankle clinics cater to patients from Colorado, Wyoming and Nebraska. We also see patients from all over the United States and even our neighbors from Canada who have searched for a ‘expert podiatrist near me‘. Watch our patient testimonials on YouTube as we now have over +6500 followers.
