Anterior Tibial Tendonitis

Synopsis

Anterior Tibial Tendonitis is considered an overuse syndrome of the tibialis anterior muscle and tendon.  Anterior Tibial Tendonitis is the most common factor in the development of shin splints. The symptoms of Anterior Tibial Tendonitis occur at the origin of the tibialis anterior  muscle and tendon on the front of the tibia or shin bone.  

Location of the Anterior Tibial Tendon

Diagnosis and Treatment

Diagnosis of anterior tibial tendonitis is usually based upon the location and character of the symptoms.  Diagnostic testing may include x-rays, bone scans or MRI studies to rule out tibial stress fractures or compartment syndromes.  

If the determination of the anterior tibial tendonitis is a mechanical problem, we are safe to assume that a mechanical solution is in order.  The key to treating anterior tibial tendonitis is to change the functional length of the tibialis anterior muscle and tendon (biomechanical changes).  The symptoms of inflammation may be treated concurrently, but without treating the mechanical component of anterior tibial tendonitis, recurrence is likely.

Biomechanical changes can be fairly simple and consist of two changes.  

1. Decrease the length of stride.  Taking shorter steps decreases the functional length of the tibialis anterior and subsequently reduces the pull of the TA muscle on the tibia.  

2. Modified arch support to decrease the functional length of the tibialis anterior.  This can be accomplished by extending the arch of an arch support or orthotic distally to reach under the first metatarsal and big toe joint.  Changes should be made slowly and incrementally.  As you build up and extend the arch, you are decreasing the functional length of the tibialis anterior. 

In addition to treating the mechanics of anterior tibial tendonitis, steps can be initiated to soothe the inflammation associated with this condition.  This becomes increasingly important as the severity of the condition increases.  Ice before and after activity helps.  Anti-inflammatories or ultrasound treatments also help.  As a last resort, rest is helpful but never a final solution.  Rest can be as simple as a decrease in activity, a walking cast or even a cast with crutches.  It is important to recognize that rest without treatment of the biomechanical origin of this condition will never be a final solution