Anterior Tibial Tendon

The anterior tibial tendon is in the front of the ankle and dorsiflexes or brings the foot/ankle up. Tears usually occur in older patients and those with other conditions such as inflammatory arthritis or diabetes. The patient may experience a sudden pain or pop. The inflammation and pain may resolve in a few days. The patient then starts noticing a “foot drop” as they walk. A foot drop is when the patient cannot or has difficulty dorsiflexing the ankle. This can result in tripping. X-rays are negative, but a MRI or ultrasound will confirm the diagnosis. Nonoperative treatment can strengthen the foot and ankle in general and allow the patient to recruit other muscle groups. With longer walks the ankle will fatigue and if the drop will be more noticeable. A low demand older patient with significant medical conditions may opt for nonoperative treatment. This however may result in requiring a permanent ankle brace to keep the “foot up”. Most patients, elect for surgical repair of the tendon. It is an outpatient procedure under general or regional anesthesia. The patient will be placed in a nonremovable splint and will be nonweightbearing with crutches. At two weeks, the stitches are removed and the patient is placed in a removable boot. The patient is still on crutches for week three and four. Partial weight-bearing in the boot will begin at four weeks and physical therapy at six weeks. The patient transitions from the boot to a lighter brace as they become stronger over the next one month.