Tibialis Anterior Tendon Rupture

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Expert Patient Guide · London

Tibialis Anterior Tendon Rupture Diagnosis, Repair & Recovery

A comprehensive patient guide by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon, Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL — London, UK.

At a Glance: Tibialis Anterior Tendon Rupture

ConditionA tear in the tibialis anterior tendon — the main tendon that pulls your foot up towards your shin.
How CommonRare. But it is the third most common tendon to tear in the leg, after the Achilles tendon and the tendon below the kneecap (patellar tendon).
Who It AffectsTears that happen without a clear injury mostly affect people over 60. Tears caused by an injury or a cut are more common in younger, active people, often through sport.
Key SymptomsDifficulty lifting your foot, your foot slapping or catching as you walk, a lump at the front of the ankle, and the tendon no longer showing under the skin.
DiagnosisAn examination by a specialist, plus an ultrasound or MRI scan.
Non-Surgical CareA brace that holds the foot up (an ankle-foot orthosis, or AFO), physiotherapy and changes to your activities — best for people who are less active.
Surgical OptionsStitching the tendon back together, lengthening the tendon, moving a nearby tendon to do its job (EHL tendon transfer), or bridging the gap with a tendon graft.
OutcomesMost people do well after surgery and are happy with the result.
SpecialistMr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL, London. matthewwelck.com

01

What Is a Tibialis Anterior Tendon Rupture?

The tibialis anterior is the muscle at the front of your shin. Its tendon (a strong cord that joins muscle to bone) runs down over the front of your ankle and attaches to the inner side of your foot. It is the main muscle that lifts your foot and toes upwards — it provides about 80% of the strength needed. This helps your foot clear the ground when you walk and controls your foot as it lands.

A tibialis anterior tendon rupture is when this tendon tears, either partly or all the way through. When it tears, the front of your foot can drop or slap on the ground as you walk, and you may trip more easily. The early signs can be mild, so the injury is often missed at first. Seeing a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck in London — as soon as possible gives you the most treatment choices.

02

How Common Is It?

Tibialis anterior tendon ruptures are uncommon, and we do not know exactly how many happen in the UK each year. Even so, it is the third most common tendon to tear in the leg, after the Achilles tendon and the patellar tendon (below the kneecap).

It tends to affect two quite different groups of people. Tears that happen without a clear injury usually affect people over 60, slightly more often in men. They happen because the tendon has slowly worn away over time. Tears caused by an injury tend to affect younger, active people — for example, from sport or a cut to the front of the ankle. Because this condition is rare, it is best treated by a surgeon who specialises in the foot and ankle.

03

What Causes a Tibialis Anterior Tendon Rupture?

  • Wear and tear with age (the most common cause in older people): part of the tendon, just above where it joins the foot, has a poor blood supply. Wear builds up here over time, and the tendon can eventually give way — sometimes during an ordinary step or trip
  • An existing tendon problem: long-standing tibialis anterior tendonitis (a sore, irritated tendon) can weaken it until it tears
  • Some health conditions and medicines: diabetes, rheumatoid arthritis and other types of inflammatory arthritis, gout, psoriasis, and taking steroid tablets for a long time can all weaken tendons
  • Steroid injections near the tendon may make a tear more likely later on
  • Sports injuries and accidents: the foot being forced down and outwards while the muscle is working — for example, stumbling on a kerb, landing awkwardly or being tackled
  • Cuts: a deep cut across the front of the ankle, for example from glass or a blade
  • After other foot surgery, such as an operation to fuse (join) joints in the middle of the foot, in rare cases

04

What Are the Symptoms?

  • Difficulty lifting your foot upwards at the ankle
  • Foot slapping on the ground, or your toes catching and making you trip — this is known as “foot drop”
  • A high-stepping walk — lifting your knee higher than usual so your foot clears the ground
  • A soft lump at the front of your ankle, where the torn end of the tendon has bunched up
  • The tendon no longer standing out under the skin at the front of your ankle
  • A mild pain or ache at the front of your ankle — often much less than you might expect
  • Toes that curl up like claws if the tear has been there a long time, because the toe tendons try to do the torn tendon’s job

Many people think they have just sprained their ankle, so the tear may not be found for weeks or months. If your foot suddenly feels weak or starts to catch when you walk, see a foot and ankle specialist as soon as you can.

05

What Investigations Might You Need?

  • An examination by a specialist — this is often enough to find the problem. The specialist checks the strength of your foot, feels for the tendon and watches you walk
  • Ultrasound scan — a quick, painless scan that confirms the tear and measures the gap between the torn ends
  • MRI scan — the most detailed scan. It shows whether the tendon is partly or fully torn, how far the torn end has pulled back, how healthy the tendon is, and whether the muscle has started to shrink. This helps plan any surgery
  • X-rays — to check for a small piece of bone pulled off with the tendon, or arthritis in the middle of the foot
  • Weight-bearing CT (WBCT) — a scan taken while you stand, used if the shape of your foot or arthritis also needs checking
  • Nerve tests (nerve conduction studies) — sometimes used to check that foot drop is not being caused by a nerve problem

06

Non-Surgical Treatment Options

Treatment without surgery can be a good choice for people who are less active or for whom surgery carries a higher risk because of other health problems. The aim is to help you walk safely, rather than to get back full strength:

  • An ankle-foot orthosis (AFO) — a light brace worn inside your shoe that holds your foot up and stops it catching
  • Physiotherapy to strengthen the muscles around the ankle and improve your balance and walking
  • Supportive shoes, and changing or cutting down activities that make things worse
  • Painkillers if needed

Research shows that treatment without surgery can work well for less active people with smaller tears. However, many people are left with some weakness that does not go away, and some need to wear a brace for the long term. Over the years, a tear that is not treated can cause the toes to curl and the shape of the foot to change. This is why surgery is usually recommended for active people.

07

Surgical Options for Tibialis Anterior Tendon Rupture

The best operation for you depends on how long ago the tear happened, the size of the gap once the damaged tendon has been tidied up, and the health of the tendon and muscle. Your treatment will be planned around you.

Direct Repair

For recent tears where the two ends can be brought back together — usually when the gap is less than about 2.5 cm. The torn ends are stitched together, and may be fixed or strengthened to the bone with a small anchor or screw. This is the most common operation and is recommended for recent tears caused by an injury.

Tendon Lengthening or Turn-Down Flap

For recent tears caused by an injury, where the gap is bigger (up to about 5 cm) but the tendon is otherwise healthy. The tendon above the tear is made longer, or a strip of it is folded down, to bridge the gap.

Tendon Transfer (EHL Transfer)

For older tears, large gaps, or a badly worn tendon. The tendon that lifts your big toe (called the extensor hallucis longus, or EHL) is moved to the middle of your foot so it can do the job of the torn tendon. This is the most common tendon transfer and works for a gap of any size. Sometimes the last joint of the big toe is also fused (joined) so that the toe does not droop.

Tendon Graft Reconstruction

For large gaps where the muscle is still healthy. A piece of tendon (a graft) is used to fill the gap. This is often a hamstring tendon taken from the back of your own thigh, or a tendon from a donor. This keeps the normal structure of your foot.

A tight calf muscle can put extra strain on the repair, so a calf muscle release (gastrocnemius release) may be done during the same operation.

Typical recovery after surgery

StageWhat to expect
0–2 weeksPlaster cast or splint. Keep your leg raised and do not put weight on it. Your wound will be checked
2–6 weeksA protective boot. You will usually start putting weight on your foot at around 4–8 weeks, as advised by your team
6–12 weeksPhysiotherapy to get your movement and strength back. Back into supportive shoes at about 10–12 weeks
3–6 monthsBuilding up strength step by step. Gentle sport first, then running and more demanding activities from around 4 months
6–12 monthsYour strength and walking keep improving

Research shows that surgery gives most people good strength and a good walking pattern. Most are happy with the result, and problems are uncommon. Possible risks include problems with wound healing, infection, the tendon tearing again, nerve irritation, stiffness and some weakness that does not go away. After an EHL transfer, the tip of the big toe can sometimes droop. Your surgeon will talk these through with you fully before you decide on treatment.

08

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — one of the UK’s leading specialist orthopaedic hospitals — and Honorary Associate Clinical Professor at UCL.

He specialises only in the foot and ankle, including sports injuries, tendon repair and transfer, complex foot and ankle reconstruction, repeat (revision) surgery and total ankle replacement. He has written over 50 research papers in medical journals, has completed two advanced training fellowships, including one in Baltimore, USA, and carries out research into weight-bearing CT scans and 3D-printed surgery designed for each patient.

Tendon injuries at the front of the ankle can look like other problems, such as ankle arthritis and foot drop caused by a nerve problem. As a specialist surgeon who treats everything from tendon repair to total ankle replacement, Mr Welck can assess the whole ankle — not just the tendon.

Patients are seen across London and North London, with quick access to ultrasound, MRI and weight-bearing CT scans. All your options are discussed openly, and you and Mr Welck agree a plan that suits you. Visit matthewwelck.com to learn more.

09

Frequently Asked Questions

Can a torn tibialis anterior tendon heal on its own?

A complete tear does not usually heal back to its normal length and strength without surgery, because the torn end tends to pull back up the leg. Some less active people manage well with a brace and physiotherapy, but most active people are advised to think about having it repaired.

Do I need surgery for a tibialis anterior tendon rupture?

Not always. Surgery is usually recommended for active people of any age, because it is the most reliable way to get your strength back and walk more normally. A brace can be a good option if you are less active, or if surgery would be riskier for you because of other health problems.

How soon should a ruptured tibialis anterior tendon be repaired?

Ideally within the first few weeks. Tears treated within about four weeks can more often be stitched straight back together. After that, the torn end pulls back and the muscle can weaken, so you are more likely to need a tendon transfer or graft.

What is the recovery time after tibialis anterior tendon repair?

Most people spend around 6 weeks in a cast or boot. You will usually start putting weight on your foot at around 4 to 8 weeks, go back to normal shoes at about 10 to 12 weeks, and return to more demanding activities from around 4 months. Full recovery can take 6 to 12 months.

Will I get my full strength back?

Most people get back good, useful strength and are happy with the result. The foot may stay a little weaker than the other side, especially if the tear was an old one, but this rarely affects everyday life.

Is a tibialis anterior rupture the same as foot drop?

Not exactly. Foot drop is a symptom — it means difficulty lifting the front of your foot. It can be caused by a torn tendon or by a nerve problem, such as damage to a nerve near the knee (common peroneal nerve palsy) or a trapped nerve in the lower back. A careful examination and scans can tell the two apart, which matters because the treatments are very different.

Can I play sport again after tibialis anterior tendon surgery?

Yes. Once the tendon has healed and you have rebuilt your strength with physiotherapy, most people return to sport. Gentler activities such as cycling and swimming usually come first. Running and sports that involve twisting and turning are added slowly from around 4 to 6 months.

Where can I see Mr Matthew Welck for a tibialis anterior tendon rupture in London?

Mr Welck sees private patients across London and North London, and NHS patients at the Royal National Orthopaedic Hospital (RNOH), Stanmore. Private appointments can be booked on 07547 395 270 or by emailing secretary@matthewwelck.com.

10

Book a Consultation

If your foot has suddenly become weak, is slapping or catching when you walk, or you have noticed a lump at the front of your ankle, getting it checked by a specialist early can give you more treatment choices and a better long-term result.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Foot & Ankle Surgeon in London and North London.

References

  1. Vosoughi AR, Heyes G, Molloy AP, Mason LW, Hoveidaei AH. Management of tibialis anterior tendon rupture: recommendations based on the literature review. Foot Ankle Surg. 2020;26(5):487–493. doi:10.1016/j.fas.2019.06.003
  2. Meyer C, Herrington L, Tolin JC, et al. Evaluation of treatment options for tibialis anterior tendon ruptures. J Foot Ankle Surg. 2026;65:160.e1–160.e6. doi:10.1053/j.jfas.2026.04.016
  3. Grundy JRB, O’Sullivan RM, Beischer AD. Operative management of distal tibialis anterior tendinopathy. Foot Ankle Int. 2010;31(3):212–219. doi:10.3113/FAI.2010.0212
  4. Ellington JK, McCormick J, Marion C, et al. Surgical outcome following tibialis anterior tendon repair. Foot Ankle Int. 2010;31(5):412–417.
  5. Markarian GG, Kelikian AS, Brage M, et al. Anterior tibialis tendon ruptures: an outcome analysis of operative versus nonoperative treatment. Foot Ankle Int. 1998;19(12):792–802.
  6. Abben KW, et al. Tibialis anterior tendon rupture repair technique involving tendon transfer and tendon tenodesis: a case series. Foot Ankle Surg Tech Rep Cases. 2024;4(2):100390.

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 26 September 2026

This page is for general information and does not replace an individual consultation.

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