Anterior tibial tendonitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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The anterior tibial tendon helps control the front of your foot when it meets the ground.

If this tendon is strained, you may feel pain when you go down stairs or walk or run on hills. Anterior tibialis tendonitis is an overuse condition common in runners especially running downhill. On exam, there is tenderness over the muscle belly andtendon. There is also pain upon active dorsiflexion. Treatment involves rest, stretching, NSAIDs.

A common accompanying problem is anterior shin splints. This common form of shin splints involves the anterior tibialis tendon. This tendon runs on the front of the leg and inserts onto the top mid portion of the arch.

The muscle for this tendon is located on the upper outside of the shin. It is more common with anterior tibial shin splints for the muscle to be involved rather than the tendon. The symptoms are usually confined to the soft tissue of the muscle. A tight calf muscle usually causes these shin splints.

The injury comes when the tight calf muscle limits ankle motion. This causes the foot to hit the ground with a great deal of force. The muscle tries to slow the foot strike. This leads to overuse muscle fatigue and eventually muscle inflammation and pain.

The muscle in the front of the leg which usually becomes painful is the tibialis anterior muscle, which is encased in a thin sheath. This muscle attaches to the foot, and flexes your foot upward, or back towards the shin; and as long as the foot is in proper alignment with the leg, the muscle functions efficiently and pain-free. However, when the foot is pronated (the foot rolls outward at the ankle and you walk more on its inner aspect), the tibialis anterior muscle twists within its sheath. This twisting of the muscle within its sheath can cause tiny tears in the muscle, or the muscle rubs abnormally against its sheath, and produces inflammation and pain.

The main cause of these injuries is pronation. This is a biomechanical defect of the foot that is sometimes responsible for pain in the foot, ankle, leg, knee, hip, and lower back.

When pronation is present, the tibialis anterior, soleus, and tibialis posterior muscles overwork in an attempt to maintain the foot in a normal alignment with the leg.

When this normal alignment is not maintained, then the foot becomes unstable. This instability of the foot cause more stress on the leg muscles. This continued "overusage" by the leg muscles will cause pain, swelling, tears within the muscle, and eventually the muscle will tear away from the tibia (the shin), or stress fractures will occur.

Treatment:

1. Rest with elevation of the leg is necessary to reduce the pain and inflammation. Ice will help, as will mild compression to the painful area. Compression can be applied with a 3-inch Ace Elastic Bandage applied from the ankle to just below the knee. This should be done whenever you must be weight-bearing; but use only mild compression.

2. If the problem persists, or if you want to prevent re-occurrence and remain active, you should follow this medical truism: "The best treatment is prevention or early intervention." This is best accomplished by custom-made orthotics. Custom-made orthotics will realign your feet, correcting pronation. When your foot is stabilized, the leg muscles do not need to perform this function, and they do not become "overused." This removes the main cause of shin splints; the orthotics will stabilize the feet, not the leg muscles. This allows the leg muscles to move you forward without pain, inflammation, and muscle tears.

For more information on tendonitis, visit our other site:

Tendonitis Tendonitis-Treatment-Tips.com provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

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