Tibialis Anterior Rupture 845.00

synonyms:

Tibialis Anterior Rupture ICD-9

• 845.00 ( sprains and strains of ankle and foot: unspecified site)

Tibialis Anterior Rupture Etiology / Epidemiology / Natural History

• Uncommon
• Occurs from blunt trauma or tendon laceration. Atraumatic ruptures can occur following eccentric loading of a plantar flexed foot, generally in men >45yrs old.
• Risk factors: inflammatory arthritis, gout, diabetes mellitus, corticosteriod use.

Tibialis Anterior Rupture Anatomy

• Tibialis Anterior:Innervation = deep peroneal nerve (L4); origin = lateral tibia; insertion = medial cuneiform and 1st metatarsal; functions to dorsiflex foot.
• See also Ankle Anatomy.

Tibialis Anterior Rupture Clinical Evaluation

• Anterior ankle pain
• Drop foot; ankle dorsiflexion weakness
• Loss of the countour of the tibialis anterior tendon on the anterior ankle.
• EHL and EDC are used to dorsiflex ankle
• May have stappage or flat-slpping gait or tendency to toe-drag.
• Classic Triad: (1)pseudotumor at the anterior part of the ankle that corresponds with the ruptured tendon end, (2)loss of the normal contour of the tendon, (3)weak dorsiflexion. (Sammarco VJ, JBJS 2009;91A:325)

Tibialis Anterior Rupture Xray / Diagnositc Tests

• A/P, mortise and lateral ankle xray indicated to r/o fracture or avulsion.  Avulsion fx best seen on lateral xray

Tibialis Anterior Rupture Classification / Treatment

• Ankle-foot orthosis: generally for elderly patients with low functional demand and delayed presentation (>3 months old)
• Acute rupture generally treated with direct repair or suture anchor reattachment of avulsions. (Sammarco VJ, JBJS 2009;91A:325).
• Chronic rupture: plantaris tendon graft/extensor digitorum longus graft (Sammarco VJ, JBJS 2009;91A:325)

Tibialis Anterior Rupture Associated Injuries / Differential Diagnosis

Tibialis Anterior Rupture Complications

Tibialis Anterior Rupture Follow-up Care

Tibialis Anterior Rupture Review References

• Sammarco VJ, JBJS 2009;91A:325

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