The tibialis anterior tendon inserts onto the medial cuneiform and the base of the first metatarsal, passing beneath the inferior extensor retinaculum to reach its insertion. At the insertion level it may have a sesamoid bone (os tibiale) within the tendon substance.
Tibialis anterior tendon rupture at its distal insertion produces foot drop and an inability to lift the foot — it is the most commonly ruptured anterior compartment tendon, occurring in middle-aged to elderly men after a trip or stumble. Clinical diagnosis is confirmed by the visible gap at the dorsomedial foot and inability to dorsiflexion-invert the foot. Direct repair is preferred within 6 weeks; tendon transfer from EHL or extensor tenodesis is used for delayed presentation.
Avulsion or rupture of the tibialis anterior at its cuneiform-metatarsal insertion producing foot drop and dorsomedial foot gap, repaired primarily within 6 weeks or reconstructed with EHL transfer for delayed presentation.
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