Who Knew Standing Was A Contact Sport? A Case Report of a Tibialis Anterior Tear

Friday, October 24, 2025

12:00 PM - 1:30 PM MT

Location: Kiosk 3

Primary Author(s)

Brandon Badillo, MD,MS (he/him/his)

Resident Physician
Icahn School of Medicine At Mount Sinai PM&R Program
New York, New York

Co-Author(s)

Adam T. Schulman, MD (he/him/his)

Resident Physician
Icahn School of Medicine At Mount Sinai PM&R Program
Piscataway, New Jersey
LG

Lori Garjian, MD

Assistant Professor
Mt Sinai Med Center
New York, New York

Disclosure(s):

Brandon Badillo, MD,MS: No financial relationships to disclose

Adam T. Schulman, MD: No financial relationships to disclose

Lori Garjian, MD: No financial relationships to disclose

Case Diagnosis: Tibialis anterior tendon rupture

Case Description or Program Description: A 77-year-old female with a history of scoliosis and low back pain presented with left foot pain for 10 days. It started when she attempted to stand out of bed overnight and felt a snap in her foot associated with severe foot cramping. The next morning, she noticed lateral anterior left leg pain and bruising over the medial ankle. An X-ray ruled out fracture. She reports continued weakness in left ankle dorsiflexion, foot slap, and difficulty ambulating on uneven surfaces, limiting her ability to partake in her active lifestyle. Six months before presentation, she received a steroid injection into the medial aspects of the foot for a similar pain, which was repeated six weeks before presentation. Exam of the left lower extremity revealed ecchymosis of the anterior, medial foot and swelling at the medial ankle. She was slightly weaker in left ankle dorsiflexion and internal rotation and ambulated with a foot slap and difficulty on her heels.

Setting: Rehab outpatient clinic

Assessment/Results: MRI showed complete avulsion of the tibialis anterior (TA) tendon with 4.6 cm retraction. The patient underwent surgical reconstruction of the tibialis anterior tendon.

Discussion (relevance): TA tendon tears are rare and often overlooked because of the large muscle size, strength of the tendon, and multiple compensatory muscles. However, this patient’s multiple risk factors, including older age and a recent corticosteroid shot in the area, as well as anterior ankle swelling, weakened dorsiflexion, and steppage gait, are consistent with TA tear. There are multiple methods of management, but given the high-grade tear, the patient ultimately opted for surgical reconstruction.

Conclusions: This case illustrates the importance of a detailed history and physical exam, and the utility of MRI, in working up the uncommon, often overlooked diagnosis of tibialis anterior tendon tear.