A small bursa occasionally develops between the distal tibialis anterior tendon and the medial cuneiform or first metatarsal base at or near its insertion, reducing friction as the tendon glides over the bony surface during dorsiflexion. It is an adventitial bursa that develops in response to repetitive loading in athletes and in individuals with tightly laced footwear.
Tibialis anterior bursitis produces localised pain at the dorsomedial first TMT joint level, reproduced by direct palpation and by active ankle dorsiflexion against resistance. The location may mimic first TMT joint arthrosis or insertional tibialis anterior tendinopathy. Ultrasound distinguishes a fluid-filled bursal sac from tendinopathy. Treatment includes shoe modification, anti-inflammatories, and ultrasound-guided corticosteroid injection.
Irritation of the tibialis anterior bursa at the medial cuneiform insertion from tight footwear or repetitive ankle dorsiflexion produces dorsomedial foot pain at the first TMT level, managed with footwear modification, padding, and targeted injection.
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