Tibialis Anterior Tendinopathy

Tibialis anterior tendinopathy (or tendinitis) causes pain, stiffness or weakness at the front of your ankle, particularly when you’re bending your foot up to bring your toes towards the sky. Other symptoms include your foot ‘slapping’ on the ground instead of being lowered down carefully, swelling at the front of the foot and ankle, and a creaking feeling when the foot is moved.

What is tibialis anterior tendinopathy?

Your tibialis anterior is a large muscle at the front of your shin bone. Like all muscles, while the ‘belly’ of the muscle is located at the front of the shins, it has a tendon (a thick connective tissue) that connects the muscle to the bone. In this case, the tibialis anterior tendon runs along the front of the ankle and attaches to the inner side of the foot. 

The tibialis anterior plays an important role in helping your foot to move upwards (and inwards) on the ankle, which is essential for walking when we need to lift our foot and toes up to clear the ground. When the tendon at the front of the ankle is damaged or inflamed, this is what our podiatrists call tibialis anterior tendinopathy. 

Tibialis anterior tendinopathy is typically caused by overuse – meaning that the tendon is strained and stressed past the point that it can safely manage, and damage occurs. We see this happening from:

• Running and kicking sports where the foot is repeatedly moved up and down on the ankle when making kicks, as well as clearing the ground during running
• Training uphill – running or moving uphill requires us to move our foot further up to avoid bumping the toes on the ground. When we suddenly increase our training intensity or duration on uphill terrain, this may overload the tendon.
• Biomechanical foot problems: having variations in our foot biomechanics like flat feet means that the tendon will have to work harder with each step to lift the foot off the ground, which can add up over time (especially when paired with other contributing factors) and lead to the development of this condition.
• Running downhill – interestingly, when we run downhill, the tibialis anterior muscle is working eccentrically, which means it is lengthening at the same time as contracting, placing even greater loads through the muscle. This can also contribute to overuse.
• Footwear that is too tight or stiff at the front of the ankle and compresses the tendon can cause friction and damage, also resulting in tibialis anterior tendinopathy.

Can you fix it?

Yes. Our podiatrists have extensive experience managing tibialis anterior tendinopathy. We carry out a comprehensive assessment to understand the extent of the injury and the likely causes, see if any other structures have been injured together with the tendon. We form a treatment plan that reduces the strain on the tendon to allow it to heal and repair, while putting the right measures in place to help prevent the pain from recurring in the future.

How can you fix it?

Treatment should ideally start as early as possible to help prevent the severity of the injury from worsening – but we work with all levels of the injury, from mild to severe. 

Initially, treatment focuses on alleviating your painful symptoms. This means ceasing any avoidable physical activity that is exacerbating your symptoms, and following RICE (rest, ice, compression, elevation) to help reduce your pain and swelling. Non-steroidal anti-inflammatories (NSAIDs) may also be used. While your pain is reducing, we transition to focusing on helping heal and repair the tendon. To do this, we may use:

• Shockwave treatment: shockwave emits acoustic pressure waves onto the damaged area to help reduce pain and inflammation, stimulate tendon regeneration, reboot the healing process in longstanding injuries, encourage the formation of new blood vessels, and more. You can learn about the benefits of shockwave treatment and why we love it here.
• Custom foot orthotics: our orthotics are uniquely designed to best support each person’s feet and optimise their recovery. They’re created from a 3D foot scan paired with the results of a comprehensive analysis. Your podiatrist then prescribes the best orthotic features that support your foot biomechanics while also helping heal your injury.
• Footwear assessment: we’ll check the shoes you’re wearing on a regular basis to ensure that they are supporting you throughout your recovery and not hindering you.
• Foot mobilisation: we may use foot mobilisation to address any stiffness, tension or dysfunction present in or around your ankle.
• Strengthening and stretching program: based on the results of your assessment, we may provide a program that strategically uses stretching and strengthening to address tight or weak muscles that may be contributing to abnormal or restricted function around your ankle. This will include strengthening your tibialis anterior after it has sufficiently healed.
• Activity modification: we may need you to modify certain movements or activities for a specific time to best support your recovery.

FAQs

How long does it take to recover from tibialis anterior tendinopathy?

This varies from person to person depending on the severity of your tendinopathy, as well as a range of other personal factors. In general, mild to moderate cases of tibialis anterior tendinopathy can take several weeks to a few months to fully recover. However, more severe cases can take several months or longer to recover.

Can tibialis anterior tendinopathy be prevented?

In some cases, yes. Generally, ways to help prevent tendinopathies include:

• Wearing appropriate footwear for the activity can help provide adequate support and cushioning to the foot and ankle, reducing the risk of injury.
• Gradually increasing the intensity or duration of an activity, rather than jumping into it too quickly, can help reduce the risk of overuse injuries such as tendinopathy.
• Regular stretching and strengthening exercises for the lower leg muscles, including the tibialis anterior, can help improve flexibility and reduce the risk of injury.
• Using proper technique during physical activity, such as running or jumping, can help reduce stress on the foot and ankle and lower the risk of injury.
• Allowing adequate rest and recovery time between activities or workouts can help prevent overuse injuries, including tendinopathy.
• Activities that put excessive stress on the foot and ankle, such as jumping or running on uneven surfaces, should be avoided or performed with caution.

Are there any exercises or physical therapy that can help with tibialis anterior tendinopathy?

Yes – your podiatrist will prescribe a rehab exercise program that will involve both stretching and strengthening exercises to best support and optimise your recovery. This will likely include a combination of isometric and eccentric strengthening exercises, and stretching exercises, and may involve mobilisation therapy.

Can tibialis anterior tendinopathy cause long-term complications?

When left untreated and unresolved, you may experience ongoing pain, muscle weakness, greater stiffness, and recurrent injuries (and overall increased injury risk).