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Tibialis Anterior Tendinopathy

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Other Names

  • Tibialis anterior tendinosis
  • Tibialis anterior tendinitis
  • Tibialis anterior tendon rupture
  • TA Tendinopathy
  • Distal TA tendinosis
  • Distal tibialis anterior tendinopathy (DTAT)

Background

  • This page refers to tendinopathies of the Tibialis Anterior (TA)
    • This includes ruptures and other forms of tendinopathies

History

Epidemiology

  • Rare disease, not well described in the literature
  • Spontaneous rupture
    • Average age 65.8 years[1]
    • Male > female[2]
  • Distal tibialis anterior tendinopathy (DTAT)
    • Seen in overweight women, age 50 to 70 years[3]

Pathophysiology

  • General
    • Tendinosis often precedes tendon rupture
  • Rare clinical entity

Etiology

  • Mechanism of rupture[1]
    • Direct trauma
    • Closed indirect trauma
    • Applied dorsiflexion force
    • Spontaneous subcutaneous rupture
  • Dorsiflexion
    • Forced plantarflexion with active dorsiflexion
    • Eccentric contraction of the TA can lead to rupture

Associated Conditions

  • Foot Arthritis[4]
    • 1st Tarsometatarsal Joint
    • Medial Naviculocuneiform Joint
    • Talonavicular Joint

Pathoanatomy


Risk Factors


Differential Diagnosis


Clinical Features

  • History
    • There may or may not be a history of trauma
    • Pain is often localized to the medial midfoot, worse at night
  • Physical Exam
    • Palpable tender mass on medial midfoot or dorsal ankle
    • Rupture is usually found at or between 0.5 and 3cm from the insertion site
    • Absent or painful dorsiflexion
    • Decreased range of motion
    • In complete tears, Foot drop on high step gait, recruitment of EHL and EDL
    • Heel walking is difficult
  • Special Tests

Evaluation

Radiographs

Ultrasound

  • Findings with tendon rupture/ tear[5]
    • Tendon discontinuity with retracted stump ends
    • The proximal end of the severed tendon appears irregular, hypoechoic and enlarged
    • Regular fibrillar pattern appears disorganized and interrupted
  • Distal tendinopathy[5]
    • Irregular, hypoechoic swelling of the distal third of the tendon
    • Hypervascular local changes at the insertion with longitudinal splits which may appear fluid filled
    • There can be an effusion in the proximal synovial sheath
  • Tenosynovitis
    • Edematous tendon thickening with hypoechogenicity
    • Thickening of the synovial sheath,
    • Increased fluid within the tendon sheath seen in the upper synovial portion of the TAT.
    • Peritendinous subcutaneous edema and/or hyperemia on Doppler imaging

MRI

  • Findings with rupture
    • Tendon discontinuity with retracted stump ends

Classification

  • Not applicable

Management

Nonoperative

Operative

  • Indications
    • Controversial
    • Failure of conservative management
  • Technique
    • Surgical repair

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Nonoperative management of distal tibialis anterior tendinopathy (DTAT)
    • 25/40 patients did well with nonoperative management while the other 15/40 eventually went on to need surgical intervention[3]

Complications

  • Long term following untreated rupture[6]
    • Clawing of the toes due to EHL and EDL overcompensation
    • Gastrocnemius and Achilles tendon contracture
    • Limited ambulation

See Also


References

  1. 1.0 1.1 Christman-Skieller C, Merz MK, Tansey JP. A systematic review of tibialis anterior tendon rupture treatments and outcomes. Am J Orthop (Belle Mead NJ) 2015;44:E94–9.
  2. Benzakein, R., et al. "Neglected rupture of the tibialis anterior tendon." Journal of the American Podiatric Medical Association 78.10 (1988): 529-532.
  3. 3.0 3.1 Grundy, Julian RB, Richard M. O'Sullivan, and Andrew D. Beischer. "Operative management of distal tibialis anterior tendinopathy." Foot & ankle international 31.3 (2010): 212-219.
  4. 4.0 4.1 Mengiardi, Bernard, et al. "Anterior tibial tendon abnormalities: MR imaging findings." Radiology 235.3 (2005): 977-984.
  5. 5.0 5.1 Varghese, Ajay, and Stefano Bianchi. "Ultrasound of tibialis anterior muscle and tendon: anatomy, technique of examination, normal and pathologic appearance." Journal of ultrasound 17.2 (2014): 113-123.
  6. Patten A, Pun WK. Spontaneous rupture of the tibialis anterior tendon: a case report and literature review. Foot Ankle Int 2000;21:697–700.
Created by:
John Kiel on 26 June 2019 22:08:47
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Last edited:
4 October 2022 12:39:16
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