Anterior Tibialis Tendinitis

By Liz Brabston, PTA

What is Anterior Tibialis Tendinitis?

The quick answer, Anterior Tibialis Tendinitis is inflammation of the anterior tibialis tendon. It can also be the degeneration of the tendon sheath. The anterior tibialis muscle can be found easily by lifting the foot up toward the head and seeing the muscle belly contract on the front of your shin.

Symptoms of Anterior Tibialis Tendinitis

Common symptoms felt are a gradual onset of pain or stiffness along the front of the ankle. Pain when lifting foot or toes, swelling, feeling of ankle weakness, or tenderness when palpating the tendon. The pain can increase with activity, most commonly with walking or running uphill or downhill. Overuse is often the most common cause of anterior tibialis tendinitis.

Diagram of the Human Leg Anatomy showing the Anterior Tibialis

What does the Anterior Tibialis Tendon do?

This muscle runs down the front of your shin and crosses over your ankle joint. It then runs down the inside of your foot where it connects. It enables you to lift the foot upwards towards the head.

How can the Anterior Tibialis Tendon become damaged?

When stretching, there is tension on the anterior tibialis tendon. The following factors are also indications for injury:

Poor foot biomechanics.
Inappropriate Footwear.
Tight Muscles of the lower leg.
Excessive training or overtraining.

Any repetitive or high force activity can cause damage to the tendon. Running uphill or on uneven surfaces or kicking with toes pointed are perfect examples. If you overpronate (your foot rolls inward when walking or running), this can also overstretch the tendon resulting in damage. Finally, improper footwear that is too small or too tight can also cause ATT.

Anterior Tibialis Tendonitis

How is ATT diagnosed?

Your MD or Physical Therapist will perform an assessment. It will cover your ankle strength, range of motion and applying resistance to your foot while you attempt to lift your foot toward your head (this motion is referred to as dorsiflexion). Sometimes, an MRI will be performed to rule out a tear or torn tendon.

How do you fix Anterior Tibialis Tendinitis?

Physical Therapists treat Anterior Tibialis Tendinitis using various methods. Decreasing inflammation with rest and ice is a good place to start at home. Once you meet with a Physical Therapist, they will instruct you on various exercises for a home program. Their exercises will consist of ankle mobility, ankle strengthening, and balance exercises to improve your symptoms.

Ankle Mobility

Manual therapy performed by a PT to maintain mobility and inhibit pain. This is just another way in physical therapy to get back to a full recovery. Stretching of all of the structures of the ankle is also very important.

Proper way to stretch the calf

Strengthening

Theraband exercises for all motions of the ankle.
Eccentric exercises to promote the loading of the tendon.
Intrinsic muscle strengthening using marbles or towels.

Balance or Proprioception Training

Stability and improve proprioception of ankle joint on stable and unstable surfaces.
Improve Coordination and decrease the risk for re-injury
Neuromuscular response.

Correct Biomechanical Problems

Excessive Knee Valgus or Varus and overpronation are factors related to this injury.

Your physical therapist may also use Graston tools to increase flexibility and decrease pain. As well as education on the proper footwear. They may also recommend orthotics or taping for improved stability.

What are the benefits of strengthening the Tibialis Anterior Muscle?

Strengthening the tibialis muscle will allow for improved stability, coordination, balance, and agility. It will also help decrease the risk for re-injury. In other words, physical therapy can really help the healing process with this injury.

Ankle Exercises Picture

Recovery from anterior tibialis tendinitis can last from a few weeks to several months. Depending on the inflammation’s severity and damage to the tendon. If you have been dealing with ATT for some time, chances are your recovery will be longer than someone who seeks treatment early on. In addition, you may also return to activities sooner.

Related Video:

Basic Ankle Ankle Exercises Video

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Author: Liz Brabston, PTA