Anterior Tibial Tendon Rupture (Tibialis Anterior Tendon Rupture)
Summary
An anterior tibial tendon rupture is a relatively uncommon injury, usually seen in people over the age of 60. The tibialis anterior muscle and tendon help lift the foot upward toward the shin. If the tendon tears, it can cause pain, swelling, weakness, and trouble walking. Some patients may even develop a dropfoot, which means they can’t lift the front part of their foot properly.
Treatment options include:
- Doing nothing
- Wearing an ankle-foot orthosis (AFO) brace
- Having surgery
The best choice depends on your activity level and personal preferences.
Symptoms of an Anterior Tibial Tendon Rupture
The tibialis anterior tendon helps lift the foot (a movement called dorsiflexion). Over time, it can become weak and eventually tear, like a rope that frays and breaks. This is called an attritional rupture.
Some people feel pain and swelling before the tendon tears due to anterior tibial tendonitis. However, many patients do not have any warning signs. The injury often affects active older adults and can be triggered by a small injury.
Common symptoms include:
- A lump or swelling on the front of the ankle (where the tendon has pulled back)
- Mild to moderate pain in that area
- Weakness in lifting the foot
- A feeling of instability or slight dropfoot
You may notice difficulty walking, especially lifting your foot. Pain usually goes away after a few days, but the weakness can remain.
Physical Examination
A doctor examining a patient with an anterior tibial tendon rupture may feel a soft lump in the front of the ankle or just above the inside ankle bone, where the tendon has retracted. While the patient may still be able to walk on their toes, they will likely have difficulty walking on their heels. Certain conditions, such as gout, diabetes, rheumatoid arthritis, and previous steroid injections in the area, can increase the risk of this injury. However, most patients with this type of rupture do not have any of these risk factors.
Imaging Studies
X-rays usually appear normal in cases of anterior tibial tendon rupture because the injury affects the tendon rather than the bone. To confirm the diagnosis and plan for surgery, doctors often use MRI scans. An MRI can show whether the tendon is completely or partially torn, pinpoint the exact location of the tear, and reveal how far the tendon has pulled back.
Treatment Options for Anterior Tibial Tendon Ruptures
The right treatment for a tibialis anterior tendon rupture depends on how active you are.
- If you’re less active or older, wearing an AFO brace may help you walk better without needing surgery.
- If you’re younger or more active, surgery is usually the better choice.
Surgical treatment options for an anterior tibial tendon rupture include:
- Stitching the torn tendon back together
- Attaching the tendon to a foot bone with a screw
- Using a tendon graft (from your own body or a donor) if the gap is too large
Surgery typically gives good results, but full recovery can take several months.
Edited by Stephen Pinney MD May 27th 2025.
