The Connection between Anterior Tibialis Tendinitis and Pronation



Healthy and Hyperpronated Foot

The tibialis anterior originates at the lateral condyle of tibia where the interosseous membrane is located.

The insertion point for this muscle is at the medial and plantar surfaces of the first cuneiform and on the base of the first metatarsal.

The anterior tibialis muscle acts as a dorsiflexor of the ankle joint and flexes the foot upward or back toward the shin.

Biomechanical stressors on the ankle develop when the tight Achilles tendon (normally associated with Anterior Tibialis Tendinitis) limits the ankle range of motion. This causes the foot to strike the ground with a massive amount of force.

The muscles in the lower leg, particularly the anterior tibialis, attempt to lessen the force and slow the foot strike, which leads to overuse muscle fatigue.

As a result of this, inflammation starts developing in and around the tendon, which is also known as peritendinitis. This is usually felt as pain in the front portion of the leg, where the anterior tibialis muscle is located.

This pain gets aggravated by repetitive physical activities such as walking, running or going down the stairs, which apply an excess amount of force to the muscle.

In order for the anterior tibialis muscle to function efficiently, it is important for the foot to be properly aligned with the leg.

In the case of hyperpronation, the anterior tibialis muscle twists within its sheath which can either cause tiny tears in the muscle or cause the muscle to rub abnormally against its sheath to produce inflammation and pain.

In addition to this, excessive pronation places additional stress on the knee by increasing internal tibial rotation, which increases the likelihood of developing pathologies of the lower extremity.

Treatment modalities for Anterior Tibialis Tendinitis need to include correcting mechanical as well as biomechanical abnormalities or else, recurrence is likely.

Injury-management techniques are determined by the severity of the condition.

Conservative measures such as rest, ice, electrotherapy and nonsteroidal anti-inflammatory medications are recommended to reduce inflammation in the region.

Stretching exercises, especially of the Achilles tendon, are often needed to increase the range of ankle dorsiflexion.

Isotonic or dynamic exercises are required to strengthen the anterior tibialis muscle, which are helpful in preventing any future recurrences.

Custom made orthotics such as MASS4D® orthotics need to be included as part of an active rehabilitation program, to facilitate the recovery process.

These augment the function of the anterior tibialis muscle by repositioning the foot in neutral alignment and by decreasing the stress of heel strike on the foot and leg.

This improves the biomechanics of the gait, enabling the patient to perform daily activities with the most amount of energy and without causing postural abnormalities that could potentially contribute to more lower limb injuries.

Related Links

References:

  1. Kim Christensen (2006) Rehab Recommendations for Anterior Tibialis Tendinosis. Dynamic Chiropractic: July 30, 2006, Vol. 24, No. 16.
  2. Michael R. Simpson, Thomas M. Howard (2009) Tendinopathies of the Foot and Ankle. Am Fam Physician: November 15, 2009, 80(10):1107-1114.

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