Tibialis Anterior Tendonitis

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Expert Patient Guide · Foot & Ankle Surgeon · London & North London

Tibialis Anterior Tendonitis (Tibialis Anterior Tendinopathy)

A comprehensive patient guide to tibialis anterior tendonitis — written by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and Honorary Associate Clinical Professor at UCL. Mr Welck treats NHS and private patients across London and North London, with particular expertise in tendon problems of the foot and ankle and sports-related injuries.

At a Glance: Tibialis Anterior Tendonitis

Condition	Wear, thickening and tiny tears in the tibialis anterior tendon, usually close to where it attaches to the middle of the foot.
Who Is Affected	Most often women aged 50–70, and more common if you are carrying extra weight. It is also seen in runners, hikers and other active people who use the tendon heavily.
Most Common Cause	Long-term overuse and natural wear as we get older, often made worse by the tendon rubbing on a small bony lump in the middle of the foot.
Typical Symptoms	Burning pain and swelling over the top or inner side of the middle of the foot, often worse at night.
Diagnosis	An examination in clinic (including a gentle stretch test of the tendon), an MRI scan, an ultrasound scan and a standing X-ray.
Non-Surgical Care	Adjusting your activities, a custom-made insole, anti-inflammatory painkillers, night splints, physiotherapy, and a walking boot if symptoms are severe.
Surgical Options	Cleaning out and repairing the tendon; using a nearby tendon from the big toe (an EHL transfer) to reinforce it if the damage is more extensive; and lengthening a tight calf muscle if needed.
Reported Outcomes	Published studies report good pain relief and improved use of the foot, with most patients satisfied when reviewed after surgery.
Specialist	Mr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL, London. matthewwelck.com

What Is Tibialis Anterior Tendonitis?

The tibialis anterior tendon runs down the front of the shin and attaches to two small bones on the inner side of the middle of the foot. It is the main tendon that lifts your foot upward as you walk, and it controls your foot as it lowers to the ground with each step.

Tibialis anterior tendonitis — more precisely termed tibialis anterior tendinopathy — means the tendon has become worn, thickened and developed tiny tears, usually close to where it attaches to the middle of the foot. This is not the same as a tibialis anterior tendon rupture, where the tendon tears right through. However, if tendonitis is left untreated, in a small number of people it can go on to rupture. Specialist assessment by a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck, who sees patients across London and North London — helps distinguish between the two and guides the right course of treatment.

How Common Is It?

This condition is often missed. It is much less well known than problems with the Achilles tendon or the tendon on the inner side of the ankle, even though it wears down in a similar, gradual way. Published studies show it mainly affects women in their fifties to seventies, and it is more common in people carrying extra weight.

It can also affect younger and more active patients, including runners, hikers and people who play field sports, when the tendon that lifts the foot is used over and over again. This is one of the reasons the condition is treated as a sports injury by foot and ankle surgeons.

What Causes It?

Long-term overuse and natural wear with age, especially in a section of tendon a few centimetres above its attachment that has a poorer blood supply and so heals less easily
The tendon rubbing against a small bony lump (a spur) on one of the bones or joints in the middle of the foot
Tight calf muscles, which put extra strain through the tendon
Repeated high-impact activity, or a lot of uphill or downhill work, in runners, hikers and field-sport players
Arthritis or a previous injury in the middle of the foot, which changes the way the foot works

What Are the Symptoms?

Burning pain over the top or inner side of the middle of the foot, often worse at night
Tenderness in one specific spot, where the tendon attaches to the bone
Swelling along the front of the ankle and the middle of the foot
Pain when the tendon is gently stretched during examination in clinic
A feeling of weakness when lifting the foot, or a sense that the foot is dropping or catching, in more advanced cases
Symptoms that flare up with walking or activity and settle with rest

Investigations

An examination in clinic, including a gentle stretch test of the tendon and a check for tightness in your calf muscles
An MRI scan — the most useful test. It shows whether the tendon is thickened or worn, whether there are splits within it, whether there is fluid around it, and whether a bony spur has formed where it attaches
An ultrasound scan — useful for watching the tendon move, and for guiding an injection accurately if one is needed
An X-ray taken standing up — to look for arthritis in the middle of the foot, or a bony spur

Non-Surgical Treatment

Most people get better without surgery. Treatment is built up in stages over several months, and your foot and ankle surgeon will review you at each stage:

Weeks 0–6: Initial Management

Resting the foot and cutting back on activities that aggravate it, along with ice and anti-inflammatory painkillers or paracetamol for short-term pain relief
A full-length, cushioned insole that supports the arch of your foot, plus a splint worn overnight if you find it comfortable

Weeks 6–12: Intermediate Management

Physiotherapy — specific strengthening exercises, stretches and work on the way you walk
If symptoms are more stubborn, a spell in a removable walking boot or a cast, or a custom-made insole

Months 3–6: Advanced Non-Surgical Management

Treating any tightness in the calf muscles, alongside continued physiotherapy
Injections such as PRP (platelet-rich plasma, made from a sample of your own blood) are sometimes discussed if symptoms are not settling. The evidence for these is still limited, so they are not used as a first step

Surgical Options

Surgery is considered if your symptoms have not settled after a proper trial of non-surgical treatment — usually 6 to 12 months — or if your scans show the tendon is badly worn. The right operation depends on how much healthy tendon you have left, so the plan is tailored to you.

Debridement and Repair

The worn part of the tendon and any bony spur are removed, and the healthy tendon that remains is repaired and reinforced — usually by stitching it securely to the bone with a small anchor. This operation is generally suitable when around half or more of the tendon is still healthy once the damaged part has been cleared away.

Extensor Hallucis Longus (EHL) Tendon Transfer

If more than half of the tendon is worn away, the repair is strengthened by moving a nearby tendon — the one that normally straightens your big toe — across and attaching it to the bone in the middle of your foot. This gives you a second working tendon to help lift the foot. Published studies report much better pain relief and use of the foot with this technique, and the large majority of patients say they are satisfied or very satisfied afterwards. A small number of people notice their big toe does not move quite as far as before, but this is usually mild and causes no real difficulty.

Gastrocnemius Recession

If your calf muscles are tight, they can be gently lengthened at the same time as the tendon surgery. This takes strain off the repair and helps it heal.

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 tertiary orthopaedic centres — and Honorary Associate Clinical Professor at UCL.

He treats problems of the foot and ankle only. His particular areas of expertise include ankle replacement, complex foot and ankle reconstruction, redo surgery when a previous operation has not worked, standing (weight-bearing) CT scanning, and sports injuries — including tendon problems such as tibialis anterior tendonitis. He has written more than 50 published research papers, has completed two international specialist fellowships, and continues to carry out research into standing CT scanning and 3D-printed instruments made specifically for each patient.

Patients are seen across London and North London, with quick access to MRI and standing CT scans and to a wider team of specialists where needed. All the options are talked through with you, and a plan is agreed together that suits you.

Frequently Asked Questions

Is tibialis anterior tendonitis the same as a tibialis anterior tendon tear?

No. Tendonitis means the tendon is worn and thickened, sometimes with small splits in it. A rupture means the tendon has torn right through. Tendonitis is more common in women aged 50–70, while a full rupture is more common in men over 60. If tendonitis is left untreated it can occasionally go on to rupture, which is one reason it is worth being seen early.

Do I need surgery for tibialis anterior tendonitis?

Most people get better without an operation — by adjusting their activities, wearing insoles, doing physiotherapy and, if needed, spending a period in a boot. Surgery is usually only considered if your symptoms carry on despite giving these a proper try, normally over 6 to 12 months.

How long does non-surgical treatment take to work?

Treatment usually runs in stages over 3 to 6 months. The first 6 weeks focus on adjusting your activities and wearing insoles, followed by physiotherapy and, if needed, a period in a boot, with a further review at 3 to 6 months.

What happens if tibialis anterior tendonitis is left untreated?

Symptoms often carry on or get worse, and in a small number of people the tendon can eventually tear right through, which is harder to treat than tendonitis caught early. Getting the right diagnosis from a foot and ankle surgeon is the first step to avoiding this.

How long is the recovery after tibialis anterior tendon surgery?

You will usually be asked to keep weight off the foot, or to wear a protective splint, for the first two weeks. After that you move into a lightweight boot you can walk in for around 4 to 6 weeks, followed by physiotherapy and a gradual return to normal shoes and activity over 3 to 6 months.

Can I keep playing sport with tibialis anterior tendonitis?

If symptoms are mild, you can often keep going with adjusted training. If they persist, you will usually need a period of rest and rehabilitation before going back to running, hiking or field sports. A sports injury assessment helps set a safe plan for returning to activity that is right for you.

Can tibialis anterior tendonitis come back after surgery?

As with any tendon surgery, no operation can guarantee the problem will never return. However, published results for cleaning out and repairing the tendon — with a big toe tendon transfer where needed — show good, long-lasting results and high patient satisfaction in most cases.

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

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

Book a Consultation

If you have burning pain or swelling over the top or inner side of the middle of your foot that has not settled with rest, seeing a specialist can make a real difference to how well you do.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Foot & Ankle Surgeon serving London and North London. Being seen early gives you the widest choice of treatments and the best chance of a straightforward recovery.

This guide gives general information about tibialis anterior tendonitis. It is not a substitute for being assessed in person. Everyone is different, and your treatment should always be discussed with a specialist foot and ankle surgeon.

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Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 17 August 2026