The tibialis anterior is a muscle located along the front of the tibia (shin bone). It is attached to the foot by the tibialis anterior tendon. This structure is responsible for the dorsiflextion of the foot and ankle. The anterior tibialis muscle plays a large role in dorsiflextion and deceleration of the foot when walking and running. Stress from a variety of movements including walking, running, kicking, or kneeling can cause the tibialis anterior tendon to become inflamed. Pain with this condition is typically concentrated along the front of the ankle or foot.
Anterior tibialis tendinitis is most often caused by an overuse repetitive strain injury (RSI). Other high risk activities or conditions that can lead to the development of anterior tibialis tendinitis include:
- Participating in athletic activities that can strain the ankle and foot, like soccer or running.
- Repetitive strain injuries (RSI) at work occur in people who have jobs that require performing activities of a repetitive or forceful nature, like walking up and down stairs.
- Sudden trauma or an accident, like a fall where an individual lands hard on their ankle.
- Patients with rheumatoid or osteoarthritis may be susceptible to anterior tibialis tendinitis.
- Ankle pain or tenderness directly along the front of the ankle or foot
- Pain or burning sensation during activities
- Difficulty performing activities of daily living
- Weakness may occur as the inflammation gets worse
- Feeling of tightness or loss of motion due to discomfort
- Swelling of the anterior tibialis tendon
- Loss of motion at the ankle
If an individual suspects they have anterior tibialis tendinitis, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, possible splinting, ice, physical therapy and non-steroidal medications to reduce inflammation.
If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the anterior tibialis tendon irritation.
Procedures that your physician may recommend and perform in addition to physical therapy may include:
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Surgery to correct underlying pathology or the cause of the anterior tibialis tendinitis
- Splinting to rest or immobilize the ankle and effected anterior tibialis tendon
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Anterior Tibialis Tendinitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the ankle and anterior tibialis tendon.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the ankle and effected muscle.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running, jumping, kicking, or stepping) in daily use of the involved lower extremity.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the ankle and anterior tibialis tendon.
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of anterior tibialis tendinitis.
It is easier to prevent anterior tibialis tendinitis than to treat it. Below are some tips to reduce the risk of anterior tibialis tendinitis.
- Warm up lightly before activity to improve circulation and lubricate the muscle and anterior tibialis tendon. Warm up should be performed to the area that will be used.
- Stretch the tendons and muscles you will be using after your warm up, prior to the activity and after it. Do not bounce when stretching. Instead, hold the stretch for 15-20 seconds.
- Strengthen the muscles and tendons that you need to use for your activity. A regular strengthening program three times a week will keep muscles prepared for the job you are asking them to perform.
- Do not work through pain. Listen to your body. Avoid the “no pain, no gain” philosophy