Anterior Tibial Tendonitis: Causes, Symptoms and Treatment Options

Anterior tibial tendonitis can occur with repetitive and excessive force on the anterior tibial tendon. A study found that among 93 people who came to the hospital for anterior tendon issues, 80 of them had tendinopathy ⁽²⁾. This study also suggested that females are more likely to suffer from tendinopathy than males and older people.

The various risk factors of anterior tibial tendonitis include: 

• High Impact Activities: Running, jogging, and jumping sports can increase stress on the anterior tibial tendon and cause strain ⁽³⁾.
• Occupational Factors: Jobs that require prolonged periods of standing or walking without adequate breaks can contribute to overuse ⁽⁴⁾. Also, repetitive lifting or carrying heavy loads may strain the tendon.
• Abnormal Foot Structure: Lack of arch such as in flat feet can increase the stress on the anterior tibial tendon ⁽⁵⁾. Also, high arches can alter foot mechanics affecting the function of the tendon.
• Gait Abnormalities: Overpronation or supination during walking or running can contribute to tendon stress ⁽⁶⁾. Poor shock absorption during movement can increase the impact on the anterior tibial tendon.
• Natural Wear and Tear: Aging can make tendons less elastic making them more prone to injury ⁽⁷⁾. Also, aging may increase the susceptibility to degenerative changes in the tendon.
• Improper Footwear: Shoes lacking proper arch support may contribute to increased stress on the anterior tibial tendon ⁽⁸⁾. Tight or ill-fitting shoes can compress the tendon and lead to irritation and inflammation.
• Muscle Imbalances: Weakness in the muscles responsible for dorsiflexion can contribute to tendon stress ⁽⁹⁾. Tightness of calf muscles may alter biomechanics and affect the anterior tibial tendon.
• Previous Injuries or Conditions: Injuries that compromise the ankle or a history of tendonitis or stress may increase the risk of recurrent issues.

Understanding these risk factors is important for implementing preventive measures and developing targeted therapeutic approaches for individuals at risk or already affected by anterior tibial tendonitis.

The symptoms that may indicate anterior tibial tendonitis may include: 

• Dull aching pain along the front of the leg or ankle. There is a throbbing sensation or sharp discomfort. The pain may get aggravated with weight-bearing activities such as walking, running, or standing for extended periods.
• The upward movement of the foot towards the shin may be limited or painful. There may be difficulty in lifting the foot during the swing phase or walking, leading to altered gait.
• There may be visible swelling along the anterior aspect of the shin or around the ankle. The affected area may be tender to touch due to inflammation of the anterior tibial tendon.
• The symptoms develop gradually and the severity may escalate if the condition is left untreated or if the contributing factors persist.
• The pain may intensify during activities that stress the anterior tibial tendon such as running, jumping, or walking on uneven surfaces. The symptoms may improve with rest but return upon resuming activities.
• In some individuals the pain may radiate to the top of the foot or extend to the toes. In severe cases, nerve compression may lead to the sensation of numbness or tingling in the foot.
• Changes in walking patterns may be observed to minimize pain. The individual may limp to reduce pressure on the affected tendon.
• There may be tenderness and swelling along the anterior tibial tendon during physical examination. The range of motion may be limited.

The physician examines the individual. The gait of the person is observed. They check for physical swelling and tenderness around the front of the ankle. 

• X-ray is performed to rule out other potential causes of pain such as stress fracture and bony abnormalities. It can help provide valuable information about the structure of the foot and ankle.
• MRI scan can be effective in visualizing soft tissues including tendons and surrounding structures. It helps in identifying inflammation, tears, or other abnormalities in the anterior tibial tendons.
• Real-time imaging of the tendon can help assess for inflammation, tears, or structural changes. This may help capture tendon movement during ankle dorsiflexion.

The aim of the treatment for anterior tibial tendonitis may be to improve function and relieve pain. 

• Conservative Management: Rest, ice, compression, and elevation (RICE), can help reduce inflammation, alleviate pain, and control and minimize swelling. Nonsteroidal anti-inflammatory drugs reduce pain and inflammation. Topical non-steroidal creams can provide localized pain relief. Physical therapy can help improve flexibility and reduce tension, strengthening the muscles surrounding the anterior tibial tendon, correcting biomechanical issues contributing to tendon stress, and promoting healing and reducing inflammation.
• Orthotic Devices and Footwear: Customized over-the-counter orthotics and inserts help in providing arch support and correct biomechanical abnormalities. These help in distributing pressure evenly and reduce stress on the anterior tibial tendon. Ill-fitting footwear should be avoided as they compress the anterior tibial tendon.
• Corticosteroid Injections: Localized injection of corticosteroids can help reduce inflammation and alleviate pain. These are considered in cases where persistently the symptoms are not responding to conservative measures.
• Surgical Interventions: Tenosynovectomy is the surgical removal of inflamed tissue surrounding the tendon. It aims to improve the tendon gliding and reduce irritation. Surgical repair of damaged anterior tibial tendon and reconstruction involving using grafts to augment or replace the damaged portion are other surgical intervention options for the anterior tibial tendon.
• Activity Modification: Slow and controlled return to physical activities to prevent overuse is advised. Cross-training is incorporated to minimize repetitive stress on the anterior tibial tendon. Education should be provided on proper warm-up and cool-down routines.
• Patient Education: The patient should be provided teaching on the importance of rest, proper footwear, and activity modification. The individuals should be empowered for self-monitoring and early intervention.
• Long-term Prevention Strategies: Regular monitoring should be done to assess the patient’s progress and identify recurrent symptoms. Adjustments in treatment plants are done according to long-term needs. 

The choice of therapeutic approach depends on the severity of symptoms, underlying cause, and individual patient factors.

• It is important to engage in dynamic stretching and light aerobics activities before an intense physical workout. The focus should be on mobilizing the ankle joint and warming up muscles surrounding the anterior tibial tendon. A gradual decrease in intensity should be done to allow the body to transition from exercise to arresting state.
• The physical activities should be gradually progressed.
• Strength and flexibility exercises targeting surrounding muscles should be implemented. Proprioception training should be included to improve overall limb balance.
• Footwear with adequate arch support, cushioning, and shock absorption should be chosen. Worn-out shoes should be regularly assessed.
• Biomechanical assessment should be done, if there is a history of gait abnormality or foot structure issues.

Proper guidance should be provided for proper running and walking techniques.

• Regular rest days should be incorporated into the exercise routine to allow the body to recover.
• Lifestyle modifications including maintaining adequate weight, consuming a balanced diet, and staying well-hydrated should be followed.

Having an understanding and addressing anterior tibial tendonitis is crucial for maintaining lower limb health and overall well-being. This condition is characterized by inflammation and irritation of the anterior tibial tendon and can significantly impact daily activities and if left untreated may lead to chronic issues.

Early recognition of indications such as pain, difficulty in dorsiflexion, and swelling, facilitates timely intervention, reducing the risk of complications and chronicity.

Therapeutic approaches include a spectrum of interventions, ranging from conservative measures like RICE, physical therapy, and orthotic use to more advanced options such as corticosteroid injections and surgical procedures when necessary. By implementing these strategies, an individual can strive to minimize the impact of anterior tibial tendonitis, fostering a lifestyle that supports optimal foot and ankle health for the long term.