Tibialis Anterior Tendonitis

Injuries > Ankle > Tibialis Anterior Tendonitis

(Also known as Tibialis Anterior Tendinopathy, Tibialis Tendonitis, Tibialis Anterior Tendinosis)

N.B. Although recent research suggests that 'tibialis anterior tendinopathy' is the more appropriate term to describe overuse injuries to the tibialis anterior tendon, we will use the term 'tibialis anterior tendonitis' in this document as it is more widely known.

What is a tibialis anterior tendonitis?

The tibialis anterior is a muscle which lies at the front of your shin and attaches to several bones in the foot via the tibialis anterior tendon (figure 1). The tibialis anterior is primarily responsible for moving the foot and ankle towards the head (dorsiflexion - figure 2). Whenever the tibialis anterior muscle contracts or is stretched, tension is placed through the tibialis anterior tendon. If this tension is excessive due to too much repetition or high force, damage to the tendon can occur. Tibialis anterior tendonitis is a condition whereby there is damage to the tibialis anterior tendon with subsequent inflammation and degeneration.

Signs and symptoms of tibialis anterior tendonitis

Patients with tibialis anterior tendonitis usually experience pain at the front of the ankle or foot during activities placing large amounts of stress on the tibialis anterior tendon (or after these activities with rest, especially upon waking in the morning). These activities may include walking or running excessively (especially up or down hills or on hard or uneven surfaces), kicking an object with toes pointed (e.g. a football), wearing excessively tight shoes or kneeling. The pain associated with this condition tends to be of gradual onset which progressively worsens over weeks or months with continuation of aggravating activities. Patients with this condition may also experience pain on firmly touching the tibialis anterior tendon (figure 1).

Causes of tibialis anterior tendonitis

Tibialis anterior tendonitis typically occurs due to activities placing large amounts of stress through the tibialis anterior muscle. These activities may include fast walking or running (especially up or downhill or on hard or uneven surfaces) or sporting activity (such as running or kicking sports). Patients may also develop this condition following direct rubbing on the tibialis anterior tendon. This may occur due to excessive tightness of strapping or shoelaces over the tendon.

Treatment for tibialis anterior tendonitis

The vast majority of patients with tibialis anterior tendonitis heal well with an appropriate physiotherapy program. The success rate of the physiotherapy program is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.

Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Once chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence. Immediate appropriate treatment in all patients with tibialis anterior tendonitis is vital to ensure an optimal outcome.

Following the R.I.C.E. Regime with regular icing and anti-inflammatory medication may help to significantly reduce inflammation in the initial phase of this condition. A graduated flexibility, balance and strengthening program under direction from a physiotherapist is vital to ensure an optimal outcome.

In the final stages or rehabilitation, a gradual return to activity or sport should occur under guidance from the treating practitioner.

Contributing factors to the development of tibialis anterior tendonitis

There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist and may include:

• poor flexibility
• inappropriate training
• poor foot biomechanics
• inappropriate footwear
• muscle weakness

Physiotherapy for tibialis anterior tendonitis

Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence in all patients with tibialis anterior tendonitis. Treatment may comprise:

• soft tissue massage
• electrotherapy (e.g. ultrasound)
• anti-inflammatory advice
• stretches
• joint mobilization
• taping
• bracing
• the use of crutches
• ice or heat treatment
• exercises to improve strength, flexibility and balance
• education
• activity modification advice
• biomechanical correction
• footwear advice
• a gradual return to activity program

Prognosis of tibialis anterior tendonitis

Most patients with this condition heal well with an appropriate physiotherapy program. This, however, can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early physiotherapy treatment is vital to hasten recovery and ensure an optimal outcome.

Other Intervention for tibialis anterior tendonitis

Despite appropriate physiotherapy management, a small percentage of patients with this condition do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, Ultrasound, CT scan or MRI, corticosteroid injection, autologous blood injection, pharmaceutical intervention or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics and appropriate footwear advice may also be indicated.

Exercises for tibialis anterior tendonitis

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Foot and Ankle Up and Down  

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 3). Repeat 10 - 20 times provided there is no increase in symptoms.

Figure 3 – Foot and Ankle Up and Down (left leg)

Foot and Ankle In and Out 

Move your foot and ankle in and out as far as possible and comfortable without pain (figure 4). Repeat 10 -20 times provided there is no increase in symptoms.

Figure 4 – Foot and Ankle In and Out (right leg)

Lunge Stretch 

With your hands against the wall, place your leg to be stretched in front of you as demonstrated (figure 5). Keep your heel down. Gently move your knee forward over your toes as far as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided there is no increase in symptoms.

Figure 5 – Lunge Stretch (right leg)

Find a Physio for tibialis anterior tendonitis

Find a physiotherapist in your local area who can treat tibialis anterior tendonitis.

Other ankle exercises

View more ankle flexibility exercises.

View ankle strengthening exercises.

View balance exercises.

Physiotherapy products for tibialis anterior tendonitis

Some of the most commonly recommended products by physiotherapist for patients with this condition include:

1. Crutches
2. Ice and Heat Packs
3. Ankle Braces
4. Ankle Supports
5. Sports Tape (for protective taping)
6. Wobble Boards (for rehabilitation)

To purchase physiotherapy products for tibialis anterior tendonitis click on one of the above links or visit the PhysioAdvisor Shop.

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