Anterior Tibial Tendon Rupture 727.6

 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Anterior Tibial Tendon Rupture ICD-9

  • 727.6 Rupture of tendon, nontraumatic 

Anterior Tibial Tendon Rupture Etiology / Epidemiology / Natural History

  • Rare
  • May result from forced plantar flexion of the foot against resistance. 
  • Associated with direct trauma, gout, inflammatory arthritis, local steroid injections, and diabetes.
  • Associated with cross country skiing. 

Anterior Tibial Tendon Rupture Anatomy

  •  Tibialis anterior:  Innervation=deep peroneal nerve.  Origin=lateral tibia.  Insertion=medial cuneiform/1st metatarsal.  Action=dorsiflex and invert the foot.

Anterior Tibial Tendon Rupture Clinical Evaluation

  • Weakness in dorsiflexion of the foot.
  • Foot drop.  May not develop initially.  Ambulate with a steppage gait (slapping foot)
  • Elderly patients may complain of vague dorsal foot pain.
  • May have tender small mass on the mediodorsal foot or along tibialis anterior.  Definite gap in tendon may be palpated.
  • Compare contour of tibialis anterior to contralateral side while patient actively dorsiflexes foot. 

Anterior Tibial Tendon Rupture Xray / Diagnositc Tests

  • Ankle xrays, foot xrays: indicated to rule out osseous lesions.   Generally normal. 
  • Ultrasound: demonstrates tendon rupture
  • MRI: demonstrates tendon rupture

Anterior Tibial Tendon Rupture Classification / Treatment

  • Younger, healthy, active patient ;  Surgical repair results in improved patient satisfaction 
  • Elderly, nontraumatic:  molded AFO for 6 months and then for long periods of activity; repair extremely difficult in older pts with poor tissues

Anterior Tibial Tendon Rupture Associated Injuries / Differential Diagnosis

  •  

Anterior Tibial Tendon Rupture Complications

Anterior Tibial Tendon Rupture Follow-up Care

  • Isokinetic testing has shown decreased dorsiflexion and inversion strength compared with the uninvolved side even after successful surgical repair.

Anterior Tibial Tendon Rupture Review References

  • Sammarco V,  JBJS 2009:91;325
  • Kopp FJ, Backus S, Deland JT, O'Malley MJ. Anterior tibial tendon rupture: results of operative treatment. Foot Ankle Int. 2007 Oct;28(10):1045-7.
  • Couglin MJ, Schon LC. Disorders of tendons. In: Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. Vol 1. 8th ed. Philadelphia, PA: Mosby; 2007:707-735
  • Kashyap S, Prince R. Spontaneous rupture of the tibialis anterior tendon : A case report. Clin Orthop 1987 ; 216 : 159-161.
  • Kausch T, Rütt J. Subcutaneous rupture of the tibialis anterior tendon : review of the literature and a case report. Arch Orthop Trauma Surg 1998 ; 117 : 290-293.
  • Miller RR, Mahan KT. Closed rupture of the anterior tib- ial tendon : a case report. J Am Podiatr Med Assoc 1998 ; 88 : 394-399.
  • Stuart MJ. Traumatic disruption of the anterior tibial ten- don while cross-country skiing. Clin Orthop 1992 ; 281 : 193-194.
  • Van Acker, G, Acta Orthopædica Belgica, 2006;72:105

 

 

 

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate. While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer.