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 runs down along the front of the ankle and attaches to the inner side of the foot. 

The main action of the tibialis anterior is to help us bend our foot at the ankle to point our toes towards the sky, which is essential for walking as we need to lift our foot and toes up to clear the ground so that we don’t trip over. It also helps our foot and arch to lower down carefully when we walk instead of slapping hard against the ground.

When the tendon at the front of the ankle is damaged, this is what our podiatrists call tibialis anterior tendinopathy. You may also see the term tibialis anterior “tendonitis”, which simply denotes that some inflammation is present with your injury, though “tendinopathy” is more commonly used to describe all stages of the injury process, as pain tends to linger even after the inflammation has settled.

Common symptoms of tibialis anterior tendinopathy may include one:

• Pain, tenderness or swelling at the front of the ankle or the inside of the midfoot where the tendon inserts
• Ankle weakness, or reduced range of movement at the ankle
• Night pain may be present because as we hop in bed, the foot relaxes putting the tendon under tension
• Pain exacerbated by walking or running, or kicking an object while the toes are pointed
• Pain tends to start gradually and worsen over time

Tibialis anterior tendinopathy is typically caused by overuse - meaning that the tendon is strained and stressed past the point that it can safely handle, 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.

If you’re experiencing pain and weakness on the front of your shins, ankle or on the inside of your midfoot, start by limiting the sporting or physical activities that bring on your symptoms, if you’re regularly engaging in any. We want to try to reduce the risk of any further damage to the tendon, as this may worsen your injury, exacerbate your pain and symptoms, and lead to a long recovery time. You can try managing the pain at home by:

• Using non-steroidal anti-inflammatories to help you temporarily manage your pain and swelling
• Switch to supportive footwear that is not tight-fitting or narrow, and instead feels comfortable and the right size for your feet.
• Periodically ice your foot (through a towel or cloth to protect the skin), particularly on the inside of the midfoot, for no more than 15 minutes at a time, up to four times a day. This can help reduce your pain and inflammation.
• Periodically elevate your foot to help reduce swelling and pain
• Using non-steroidal anti-inflammatories to help you temporarily manage your pain and swelling

If your pain is only very mild, you may try some stretching and strengthening exercises to help strengthen the tendon and muscle, particularly resisted eccentric inversion exercises. These can help if muscle and tendon weakness is one of the contributing factors to your injury, so the strength can gradually increase so you can return to normal training without pain or injury recurrence.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with tibialis anterior tendinopathy, and utilise a range of evidence-based treatment methods to help you get the best outcome. Our goal is not only to make you comfortable now, but to understand the root of the problem so you can exercise and stay active without being held back by foot pain.

Every appointment starts with a comprehensive assessment to uncover the causes of your foot pain, which includes analysing your gait, testing for muscle imbalances, assessing joint stiffness or tightness, analysing your foot posture and alignment, and more. We’ll then create a tailored treatment plan based on the results. This may include:

• Orthotics (insoles): our podiatrists can prescribe custom foot orthotics that will work to add the right support to the foot and ankle, including the inside of the midfoot where the tibialis anterior tendon inserts, to help reduce strain and best support your recovery. 
• Strengthening and stretching program: as muscle weakness and tightness in the lower limbs (not just the foot and ankle) can both play a role in the development of tibialis anterior tendinopathy, as well as in delays in healing and its recurrence, a stretching and strengthening program is an important part of both your current recovery and in preventing the problem from recurring in the future. It is important to have this prescribed professionally, especially if you’re experiencing significant pain and discomfort as this will ensure that you introduce the right exercises at the right time, when you can safely handle them, and not too early while the tendon is still in a very vulnerable state.
• Footwear recommendations: in some cases, your existing footwear may be leaving your feet in an unsupported position that will be making it harder for your tibialis anterior tendon throughout your recovery. If that’s the case, we can recommend other footwear, both casual and sports-specific, that will support your recovery as well as your general comfort and foot health.
• Activity modifications: in order to optimise your recovery, we need to ensure the activities you’re doing are supporting your healing, and not placing excess pressure on your tibialis anterior tendon and hence making your injury worse. We may suggest some modifications to your existing training routines and techniques to achieve this.
• Gait retraining: we may work with you to help retrain your gait and work on your technique to address biomechanical issues that may be contributing to your pain and injury.
• Moon boot: in severe cases, or when there is a tear in the tendon, you may be required to wear a moon boot temporarily to best support your healing and tendon repair.

In very few cases, where the nature of your injury means that you have not been able to achieve the results we expect and your symptoms are continuing to interfere with your daily function and quality of life, we may refer you to an orthopaedic surgeon for a consultation.