The tibialis anterior tendon is the largest tendon in the anterior compartment, crossing the ankle and midfoot to insert on the medial cuneiform and first metatarsal base. It is the primary ankle dorsiflexor and the tendon responsible for foot clearance during swing phase of gait. Its rupture, while uncommon, produces a significant foot drop deformity that is often initially mistaken for a common peroneal nerve palsy.
Dorsiflexion and inversion of the foot during swing phase of gait
Tibialis anterior tendon rupture is an underdiagnosed condition occurring predominantly in older patients, producing a painless or minimally painful foot drop that is initially assumed to be neurological. The diagnosis is confirmed by palpation of the absent tendon on the dorsal foot during attempted dorsiflexion. Unlike common peroneal nerve palsy, tibialis anterior rupture preserves toe extension strength because EHL and EDL are intact. Surgical repair or reconstruction produces better outcomes than conservative management in active patients.
Spontaneous or traumatic tendon rupture producing foot drop without neurological deficit, confirmed by absent tendon on dorsal foot palpation and MRI, managed with surgical repair in active patients.
Overuse degeneration producing dorsal ankle and medial midfoot pain reproduced by resisted dorsiflexion and worsening with prolonged walking, common in middle-aged hikers with heavy boots.
