The tibialis anterior is the dominant ankle dorsiflexor, producing approximately 80% of dorsiflexion torque. Its tendon passes medially through two bands of the inferior extensor retinaculum before inserting medially. Spontaneous tibialis anterior tendon rupture in patients over 60 produces painless foot drop — mistaken for peroneal nerve palsy — from degenerative tendon failure at the retinacular level.
The primary dorsiflexor and invertor; swing phase toe clearance; medial longitudinal arch support during eccentric loading
Tibialis anterior tendon rupture is less common than Achilles rupture but equally disabling in the dorsiflexion plane. The clinical sign is foot drop with the patient unable to clear the toes — often attributed to peroneal nerve palsy until examination reveals an absent tibialis anterior tendon prominence on forced dorsiflexion. Primary repair within 3 weeks is preferred; EHL transfer or fascia lata graft reconstruction for delayed presentations.
Spontaneous tendon failure in elderly patients producing foot drop managed with primary repair or EHL transfer for delayed cases.
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