Anterior Tibial Tendon Rupture S86.219A 727.68

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

Anterior Tibial Tendon Rupture ICD-10

• S86.211A Strain muscle(s) and tendon(s) anterior muscle group at lower leg level, right leg, initial
• S86.212A Strain muscle(s) and tendon(s) anterior muscle group at lower leg level, left leg, initial
• S86.219A Strain muscle(s) and tendon(s) anterior muscle group at lower leg level, unspecified leg, initial
• See All Anterior Muscle Group lower leg ICD-10 codes
• M66.871 - Spontaneous rupture of other tendons, right ankle and foot
• M66.872 - Spontaneous rupture of other tendons, left ankle and foot
• M66.879 - Spontaneous rupture of other tendons, unspecified ankle and foot

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

• Infection
• Compartment Syndrome
• CRPS
• DVT / PE

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