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Anterior Tibial Tendon Rupture S86.219A 727.68

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

synonyms:tibialis anterior tendon rupture, anterior tibial tendon rupture, tibialis anterior tear, anterior tibial tendon tear

Anterior Tibial Tendon Rupture ICD-10

Anterior Tibial Tendon Rupture ICD-9

  • 727.68 Rupture of tendon, nontraumatic, other tendons of foot and ankle

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