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Tibialis Anterior Pain

To understand what tibialis anterior pain is it is important to first understand the anatomy of the muscle. The tibialis anterior muscle originates along the lateral side of your tibia (just outside of your shin bone) and attaches to the first metatarsal and medial cuneiform bone of the foot. It also overlaps the deep peroneal nerve and anterior tibial vessels in the top portion of your leg. The tibialis posterior muscle acts as an antagonist to the tibialis anterior and is located deep in the posterior compartment of the lower leg.

The tibialis anterior is the major dorsiflexor of your ankle. It works in harmony with extensor digitorium longus, extensor hallicus longus, and peroneous tertius.

Shin splints, which cause discomfort on the inside of the lower leg or shin, might be mistaken for tibialis anterior tendinopathy. A more likely location for tibialis anterior pain would be in a tendon on the top of your foot or the front of your lower leg, towards the outside of the tibia bone. This tendon is the major one that crosses the front of the ankle and is visible. Anterior tibialis prevents the foot arch from collapsing by pulling the foot up (ankle flexion or dorsiflexion) (1).

man holding tibialis anterior pain

What is tibialis anterior pain and tendinopathy?

Toxic buildup in the anterior tibial band is known as tibialis anterior tendinopathy. Tibialis anterior tendonitis is well-served by physiotherapy as a therapeutic option.

How does tibialis anterior pain and tendinopathy happen?

Excessive usage of the anterior tibialis tendon is a common cause of anterior tendinopathy. The anterior tibialis tendon communicates from the anterior tibialis muscle to move the foot back towards the head. Repetitive usage of the anterior tibialis muscle and, thus, the tibialis tendon may produce minute rips inside the tendon. To mend these microscopic injuries, the body initiates an inflammatory reaction. Tendinopathy is the medical term for this swelling.

Strapping or shoelaces that are too tight may injure the anterior tibialis tendon, present in front of the ankle joint. Tendinopathy develops due to the tiny rips and “wear and tear” that this compression places on the tendon (2).

Acute ankle pain can develop suddenly and includes strains, sprains, ankle impingement and stress fractures.

Tibialis anterior tendinopathy signs and symptoms

The anterior tibialis tendon, which runs across the front of the ankle joint, becomes gradually inflamed due to tibialis anterior tendinopathy. At first, this discomfort may be felt exclusively after strenuous physical activity.

The front of the ankle joint may also be stiff. The characteristic ankle pain is very prominent in most instances. Many people overlook the early symptoms of tibialis anterior tendinopathy because they subside rapidly when the ankle is walked on, or heat is applied to the front of the ankle. Continued activity may exacerbate tendinopathy, causing discomfort to the last longer and longer periods until it is present all the time. Gait issues, stiffness, deformity, and weakness are all possible signs (3).

The anterior tibialis muscle has to work overtime to maintain the medial (inside) arch in place. This may lead to pain in the muscle.

  • An overworked tibialis muscle may counterbalance an irregular stride caused by discomfort elsewhere.
  • Pain in the ball of the foot causes a heel walk, which engages the anterior tibialis muscle with greater power and for longer periods, for example.

Another cause of tibialis anterior pain is weakened or improperly activated muscles in the lower leg. The load may be too great for the tibialis anterior if it needs to take over for another muscle. Other abnormalities include when the tibialis anterior is contractured by trigger points, you are unable to clear the ground during a stride. Your big toe may claw down and your ankle might get weak.

An unusual is an anterior tibialis muscle rupture or injury due to a sudden injury. When it happens, the essential clinical symptoms tend to be handle foot drop, reduced strength of ankle flexor muscles, diminished dorsiflexor muscles power, reduced ability of eversion and inversion of the foot, and footdrop gait and claw toes. You should immediately consult a healthcare professional. For confirming an anterior tibialis rupture, MRI is used which can show the soft tissue structures.

You’d be better off seeing your primary care physician or a physiotherapist if anything like this happened. The following pedorthic therapies may be helpful in the rehabilitation process; however, they should only be used as a secondary therapy.

Treatment for tibialis anterior pain

Orthotics

The anterior tibialis muscle is less stressed when an orthotic properly supports the foot. The orthotic device helps push the foot and relieve pressure at the anterior tibialis muscle if the arch is compressed. It might also happen due to the body trying to compensate for the discomfort. To avoid this compensation, it is necessary to address the source of the suffering. The orthotic device supports the foot to avoid overcompensation if the discomfort is caused by a collapse of the arch or other mechanics in the foot.

Mechanics of the foot may not have been the source of tibialis anterior pain, but they may play a role in rehabilitation. Recovery may be slowed if the anterior muscle is already working harder than usual (4).

Footwear

Appropriate footwear might be useful to alleviate tibialis anterior pain. Orthotic devices benefit from good footwear. An orthotic may not be performing to its full capacity if the wearer is wearing the wrong footwear. A person’s unique foot anatomy may determine the right shoe. An orthotic device can be used with a neutral running or walking shoe in most situations. If your orthotic specialist advises you to wear a stability shoe with your orthotic device, do so.

Others

The shoe’s weight is another thing to keep in mind when it comes to the anterior tibialis muscle. A lighter shoe may be necessary for those with weak or delayed healing of anterior tibialis pain in the muscles. In some instances, physiotherapists may suggest the weight of a patient’s shoe as part of their rehabilitation.

Various therapies such as physiotherapy may be prescribed to alleviate discomfort in the anterior tibialis muscle. This therapy may be effective for muscular problems or aid the healing process. Muscle imbalances may be remedied with rehabilitation, which is usually suggested. Moreover, strengthening exercises and stretching techniques can be used for both prevention and treatment of injuries such as shin splints and plantar fasciitis too. You can also opt for tibialis anterior pain taping using kinesiology tape that will help reduce stress on your inflamed tendon. Using anti-inflammatory medications (NSAIDs) can help minimize pain and inflammation.

A runner holding their tibialis anterior pain

What should I do?

Tibialis anterior pain does not heal on its own. A physiotherapy evaluation should be scheduled as soon as possible if you feel you have tibialis anterior tendinopathy (5).

What should I not do?

Tibialis anterior pain should not be ignored if it is suspected. If you keep working out, you risk doing more harm and delaying your recovery (5).

Physiotherapy

Tibialis anterior tendinopathy must be treated with physiotherapy. Your physiotherapist will be able to assess your condition, identify its severity, and design a treatment plan at the outset of your therapy. Massage and range-of-motion exercises are two options for treatment.

  • Hydrotherapy
  • Orthotics

Tibialis anterior pain may be assessed and diagnosed by a physiotherapist, who can also help you avoid it in the future when you resume a full exercise regimen (6).

Tibialis anterior pain and tendinopathy: Are there any long-term effects?

The long-term implications of tibialis anterior pain and tendinopathy may be avoided if recognized and treated correctly. Untreated, the discomfort might last for a long time, preventing you from exercising for a long time (6).

References:

  1. Lemmens L, van Beek N, Verfaillie S. Postoperative results of distal tibialis anterior tendinosis. Foot and Ankle Surgery. 2020;26(8):851–4.
  2. Beischer AD, Anat D, Beamond BM, Jowett AJ, O’Sullivan R. Distal tendinosis of the tibialis anterior tendon. Foot & ankle international. 2009;30(11):1053–9.
  3. Grundy JR, O’Sullivan RM, Beischer AD. Operative management of distal tibialis anterior tendinopathy. Foot & ankle international. 2010;31(3):212–9.
  4. Donatelli R. Normal biomechanics of the foot and ankle. Journal of Orthopaedic & Sports Physical Therapy. 1985;7(3):91–5.
  5. Cignetti C, Peng J, McGee A, Lehtonen E, Abyar E, Patel HA, et al. Tibialis anterior tendinosis: Clinical characterization and surgical treatment. The Foot. 2019;39:79–84.
  6. Chleboun GS, Busic AB, Graham KK, Stuckey HA. Fascicle length change of the human tibialis anterior and vastus lateralis during walking. journal of orthopaedic & sports physical therapy. 2007;37(7):372–9. https://www.jospt.org/doi/10.2519/jospt.2007.2440
  7. Lemmens L, van Beek N, Verfaillie S. Postoperative results of distal tibialis anterior tendinosis. Foot and Ankle Surgery. 2020;26(8):851–4.
  8. Rees JD, Lichtwark GA, Wolman RL, Wilson AM. The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans. Rheumatology (Oxford). 2008;47(10):1493-1497. doi:10.1093/rheumatology/ken262
  9.  Isometric loading – https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-015-0132-3

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