Tibialis anterior tendon !

The tibialis anterior tendon crosses the front of the ankle to the inner midfoot; it lifts the foot and is the most inner tendon there.

Official name: Tendon of tibialis anterior

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What it is

The tendon of the shin muscle. It crosses the front of the ankle to the inner midfoot (the medial cuneiform and the first metatarsal).

What it does

Lifts the foot and helps hold up the inner arch.

Key facts

Attaches: Most medial tendon at the front of the ankle, under the extensor retinacula in its own compartment, to the medial and plantar surfaces of the medial cuneiform and the base of the first metatarsal
Function: Dorsiflexion and inversion; lowers the forefoot under control after heel strike; with the fibularis longus forms a stirrup under the midfoot
Tight in: Plantarflexion with eversion

Relations

Course: Down the lateral surface of the tibia, across the lower tibia to lie in front of the medial malleolus, then in its own sheath under the extensor retinacula to the inner midfoot
Lateral: Extensor hallucis longus tendon, then the anterior tibial artery and the deep fibular nerve
Deep: Lower tibia and the front of the ankle capsule
Medial: Great saphenous vein and saphenous nerve, passing in front of the medial malleolus

How to find it

With the foot lifted and turned in, it stands out as the thickest cord at the front of the ankle, on the inner side, running toward the inner midfoot.

Examination

Resisted dorsiflexion and inversion: weakness with a missing tendon outline suggests rupture; walking on the heels is difficult

On imaging

Ultrasound and MRI show thickening near the insertion in tendinopathy, and a gap with a retracted stump, often near the extensor retinacula, in rupture.

Common problems

Rarely, it tears in older adults, causing the foot to slap when walking.

Clinical notes

In rupture the other dorsiflexors work and sensation is normal; in a deep fibular nerve palsy the toe extensors are weak too and the first web space may be numb
After a clubfoot is corrected by casting, a foot that keeps turning in when walking (dynamic supination) is treated by moving the whole tendon to the lateral cuneiform
The anterior approach to the ankle, used for ankle replacement and some plafond fractures, enters just lateral to this tendon, with the anterior tibial artery and deep fibular nerve kept lateral

Anatomical variants

The tendon may split into two bands to the medial cuneiform and the first metatarsal, or end on only one of them; rare attachments to the talus or the big toe are described

Memory aid

Front of the ankle, medial to lateral: 'Tim Has A Nasty Dog' (Tibialis anterior, Hallucis longus, Artery, Nerve, Digitorum longus).

Test yourself

Think of the answer, then tap the question to see it.

What is the order of structures at the front of the ankle from medial to lateral?

Tibialis anterior, extensor hallucis longus, anterior tibial artery, deep fibular nerve, extensor digitorum longus ('Tim Has A Nasty Dog').

Where does the tibialis anterior tendon insert?

On the medial cuneiform and the base of the first metatarsal.

Why is tibialis anterior rupture in older adults often missed?

The toe extensors still lift the foot partly; clues are a lump above the ankle, lost tendon outline and a slapping gait.

How is tibialis anterior rupture told apart from deep fibular nerve palsy?

In rupture the toe extensors work and sensation is normal; in the nerve palsy the toe extensors are weak and the first web space may be numb.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): musculus tibialis anterior TA2 2644
Official Spanish (DeCS): Tendón del tibial anterior DeCS D013710
English (TA2): Tendon of tibialis anterior

Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Bony Pelvis and Lower Limb: Tibialis Anterior Muscles.

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Representative model, for educational purposes only.

Tibialis anterior tendon highlighted on the Durgical 3D model