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Tibialis Anterior Pain

Before we can understand tibialis anterior pain, we need to understand the anatomy of the muscle. The tibialis anterior muscle starts 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. You’ll find the tibialis posterior muscle located deep in the posterior compartment of the lower leg, and it acts as an antagonist to the tibialis anterior.

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

The discomfort we know as ‘shin splints’ – sometimes experienced when running – is often mistaken for tibialis anterior tendinopathy. But 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?

Tibialis anterior tendinopathy is the toxic build up in the anterior tibia, but it does respond well to physiotherapy as a therapeutic option.

How does tibialis anterior pain and tendinopathy happen?

Anterior tendinopathy is a commonly caused by overuse of the anterior tibialis tendon. Since the anterior tibialis tendon communicates from the anterior tibialis muscle to move the foot back towards the head, repetitive use of the muscle and tendon can produce small rips inside the tendon. In this instance, the body starts an inflammatory reaction to fix these tears, and this swelling is know as ‘tendinopathy’.

Meanwhile, the anterior tibialis tendon can also be injured by strapping or shoelaces that are too tight. Tendinopathy develops due to the tiny rips and “wear and tear” which can be caused by such compression on the tendon (2).

Most importantly, 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 becomes inflamed due to tibialis anterior tendinopathy. At first, this discomfort is felt exclusively after strenuous physical activity.

Commonly, the front of the ankle joint may also be stiff, but the characteristic ankle pain is very obvious 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 physical activity can worsen tendinopathy, and cause discomfort to the last longer until it is present all the time. Gait issues, stiffness, deformity, and weakness are all possible signs (3).

As a result, the anterior tibialis muscle has to work overtime to maintain the medial (inside) arch in place, which can 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.

Other causes

Tibialis anterior pain can also be caused due to weakened or improperly activated muscles in the lower leg. When it needs to take over for another muscle, the load may be too much. In addition, when the tibialis anterior is contractured by trigger points, you are unable to clear the ground during a stride. In this instance,  your big toe may claw down and your ankle might get weak.

The anterior tibialis muscle could rupture due to a sudden injury. When this happens, the 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 see a healthcare professional immediately. An MRI is used  to show the soft tissue structure which can identify an anterior tibialis rupture.

The following pedorthic therapies may be helpful in the rehabilitation process; but, they should only be used as a secondary therapy.

Treatment for tibialis anterior pain

Prolozone Therapy

Some of the structures associated with the tibialis anterior muscle have a poor blood supply, it is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolozone Therapy involves an injection of oxygen and nutrients into these structures to help them heal them and provide pain relief.

As the treatment helps to treat the root cause of the problem, it is deemed to be a permanent fix.

You can read more about Prolozone Therapy here.

Orthotics

An orthotic can reduce stress on the anterior tibialis muscle by properly supporting the foot. The device helps by pushing the foot and relieving pressure at the anterior tibialis muscle if the arch is compressed. 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.

While the mechanics of the foot might not be the source of tibialis anterior pain, they do play a role in rehabilitation. And if the anterior muscle is already working harder than usual, it could slow your recovery (4).

Footwear

Wearing appropriate footwear can alleviate tibialis anterior pain. Orthotic devices work best when paired with good footwear which enables them to perform to their full capacity. They can be used with a neutral running or walking shoe in most situations, but your orthotic specialist may advise you to wear a stability shoe with your orthotic device.

Other treatments

Bear in mind the shoe’s weight when it comes to the anterior tibialis muscle. A lighter shoe may help with weak or delayed healing of anterior tibialis pain in the muscles, which is why some physiotherapists may suggest the weight of a patient’s shoe as part of their rehabilitation.

Physiotherapy is one route to alleviate discomfort in the anterior tibialis muscle, and can be extremely effective for muscular problems and the overall healing process.

Muscle imbalances can be remedied with rehabilitation, while strengthening exercises such as 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, and 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 you keep working out, you risk doing more harm and delaying your recovery (5).

Physiotherapy

Tibialis anterior tendinopathy must be treated with physiotherapy. A 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).

 

Frequently Asked Questions:

Why would my anterior tibialis hurt?

There might be many reasons why your tibialis anterior is hurting. Some of the causes may be:

  • Overuse of your anterior tibialis muscle
  • Repeated stress to the shin bone
  • Tear of the anterior tibialis muscle
  • Frequent pressure from jumping or running
  • Traumatic ankle injury
  • Your walking style

How do you treat tibialis anterior pain?

To treat tibialis anterior pain, you need to find out the cause first. Early diagnosis can help you treat your tibialis anterior pain reliably. So, you can treat your tibialis anterior pain by:

  • tibialis anterior exercise
  • physical therapy
  • relieving the anterior tibialis stress
  • bracing
  • anti-inflammatory drugs
  • stretching the calf muscle
  • corticosteroid injections aren’t recommended to treat milk pain.

What does tibialis anterior pain feel like?

Tibialis anterior pain feels like a mild to moderate strain or stiffness at the front of the lower leg. This pain may worsen while simply walking or applying pressure to the affected muscle. You may also feel ankle weakness or pain while lifting your toes or foot.

How long does anterior tibialis tendonitis take to heal?

The healing time of anterior tibialis tendonitis entirely depends upon your condition. Healing may take one week or two to improve if you’ve milk anterior tibialis tendonitis. Or, if you’ve severe anterior tibialis tendonitis, it may take some months to heal completely; however, some medication can speed up the healing process.

How do you massage anterior tibialis?

To massage your anterior tibialis, you might need a foam roller. You can massage your anterior tibialis by:

  • First, place the foam roller on the floor and place your lower leg on the roller carefully.
  • Rotate your leg internally to prevent direct rolling on your tibia bone.
  • Now, gently roll up and down to massage your muscles sideways.

How do you relieve the tibialis anterior?

The relief of the tibialis anterior depends on the severity of the condition. You can relieve tibialis anterior by:

  • Physical therapy
  • Reducing stress on your tibialis anterior carefully
  • Planning a good exercise by consulting with your doctor

 

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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