The tibialis anterior tendon has a plantar-medial insertion on the first metatarsal base and medial cuneiform, providing both dorsiflexion and inversion forces and importantly supporting the medial column of the midfoot. Its broad plantar insertion is analogous to a medial column tie-rod that prevents the arch from flattening. Spontaneous rupture produces dramatic foot drop in older patients.
First ray stabilisation; medial column support during midstance; active dorsiflexion across the ankle
Spontaneous tibialis anterior tendon rupture occurs in patients over 60, often with a history of steroid use or inflammatory arthritis. The patient notices progressive difficulty lifting the foot but often presents late. EHL tendon transfer to the first metatarsal restores dorsiflexion in patients with significant delay from rupture.
Painless foot drop from age-related tendon failure in older patients managed with EHL tendon transfer for active patients.
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