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Anterior tibialis tendon rupture in Adult
Other Resources UpToDate PubMed

Anterior tibialis tendon rupture in Adult

Contributors: Brian Grover, Benedict F. DiGiovanni MD, FAOA, FAAOS
Other Resources UpToDate PubMed

Synopsis

Causes / typical injury mechanism: Anterior tibialis tendon rupture is a rare condition that may occur spontaneously or be caused by acute trauma. Spontaneous rupture is typically seen in older patients with underlying chronic medical conditions and is caused by underlying degeneration of the anterior tibialis tendon. Acute rupture is not commonly seen in younger patients; when it occurs, it may be due to sports injuries. Tibial fracture, laceration, and traumatic force against a dorsiflexed foot are other causes of acute rupture of the anterior tibialis tendon.

Classic history and presentation: Older patients with spontaneous anterior tibialis tendon rupture will typically not report a major traumatic event but instead a mild stumble or fall. They may or may not remember the event. They have pain and swelling at the ankle but may believe it was an ankle sprain. This pain and swelling are likely to subside over time, but the patient will continue to experience a foot drop that impedes normal ambulation. It is not uncommon for patients to present weeks after the injury due to a "mass" or "lump" at the anterior ankle at the stump of the anterior tibial tendon that is evident once the swelling improves.

Younger patients with acute anterior tibialis tendon rupture will often present after the sudden onset of pain and swelling due to a sports-related or traumatic injury.

Prevalence:
  • Age – Older patients (aged 50-70 years) or younger athletes
  • Sex / gender – 75% of cases occur in men
Risk factors:
  • Diabetes
  • Inflammatory arthritis
  • Rheumatoid arthritis
  • Gout
  • Impingement due to underlying exostosis
  • Steroid injection history
  • Current fluoroquinolone use
Pathophysiology: Anterior tibialis tendon rupture is caused by underlying tendon degeneration or acute injury.

Codes

ICD10CM:
M66.879 – Spontaneous rupture of other tendons, unspecified ankle and foot

SNOMEDCT:
700352001 – Disorder of tibialis anterior tendon

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Ganglion cyst located in the region of the anterior ankle
  • Anterior tibial tendinosis without rupture
  • Peroneal nerve palsy
  • L4-5 radiculopathy
  • Ankle arthritis
Pitfalls: Neurologic causes must be ruled out.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:11/17/2021
Last Updated:11/11/2021
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Anterior tibialis tendon rupture in Adult
Copyright © 2022 VisualDx®. All rights reserved.