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Tibialis Anterior Injuries

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Tibialis Anterior Injuries – How to treat your shin and ankle pain.

By Doug James – Physiotherapist and Podiatrist – intraining running injury clinic

If you’ve ever had shin muscle soreness, or pain on the top of your foot, there is a chance it might have been due to an injury to the Tibialis Anterior (TA).

The TA muscle has an important role in running and walking. It assists the Posterior Tibialis muscle to control from rolling inwards too quickly or too far.  It also helps by lifting the foot upwards, and to control how quickly the foot is lowered from this position.  Without this muscle working well, you would be far more likely to trip over.

The TA is a large muscle located on the outer side of the bony ridge running down the front of your shin starting just below the knee. At the lower third of the length of the shin the TA muscle becomes a tendon that passes over the front of the ankle, the top of the foot and then attaches to two bones on the inner side of the foot at the high part of the arch.

When considering the anatomy of the ankle, there are up to 8 muscles* that assist with plantarflexing the foot (the movement that allows us to push off when walking or push up on to tip toe)(*fun fact: the plantaris muscle is absent in 7-20% of limbs, likely becoming less common due to its decreased role in humans since evolving from our tree dwelling days). Conversely, there are only 4 muscles that help with lifting the foot upwards, however their job is relatively easier as they only need to contend with gravity rather than bodyweight. The TA is by far the largest of these muscles, and can be prone to a number of different injuries.

Compartment Syndrome

Compartment Syndrome is when excessive pressure builds up within a muscle. This is usually due to an excessive amount of blood and metabolic waste being trapped within a tight muscle fascia (wrapping) that can’t expand sufficiently, and the body unable to clear the fluid build-up adequately. This can happen in underconditioned athletes (and often new military recruits) that have dramatically increased their training. This injury is quite painful, and in some cases requires surgery to fix, particularly when circulation or nerve function is affected. Compromise to nerve function or circulation can result in temporary or permanent foot drop, which as the name suggests, results in an inability to lift the foot. There are a number of other reasons why this may happen so it is important to have this examined urgently.

Thankfully many compartment syndrome cases respond well to reduced training and a more gradual build up. Changing footwear, and use of orthotics can also help improve symptoms in some cases.

Tibialis Anterior Tendinosis

The TA is a relatively long muscle with a similarly long tendon. This muscle is active (and sometimes overactive) during a large portion of the walking and running cycle and therefore has a higher-than-average risk of overuse and injury. Athletes that are newer to running are often under-conditioned for the stress that running will place on this muscle and tendon. Poor foot strength or joint instability (hypermobile / overly flexible joints) may lead to an overreliance on the TA muscle to stabilise your arch and foot position. Also worth considering is whether your shoes are too flexible, or too stiff as these can also play a role in injury development. The amount of training undertaken, rest between sessions, and training terrain are also worth examining. Running up and down hills can lead to a dramatic increase in how much the muscle has to work, particularly on the downhill component where the TA needs to control the rate at which the foot is being lowered down.

Tendon Compression Injuries

Because the TA tendon passes over the front of the ankle and top of the foot, compression injuries such as tendinitis (inflamed tendon), tendinosis (chronically inflamed tendon), and/or tenosynovitis (inflammation of the tendon sheath) can develop from shoe laces overly tight shoe laces. Reducing the lace tightness can help, though sometimes altering the lacing pattern is necessary to better eliminate the pressure to allow the tendon to heal.

Things to watch (and listen) for

While heel striking is completely common (and normal) when running, landing on your heel a long way in front of your centre of gravity usually results in an excessive amount of both lifting and lowering required from the Tibialis Anterior muscle. As such it may be prone to overuse injuries. If you are a particularly noisy runner that makes a “slapping” sound when the front of your foot hits the ground you could be wearing shoes that don’t suit your foot and/or have a weak TA muscle. Thankfully, these things can be fairly easily remedied, and are discussed below. A stiff ankle joint may also be to blame, though this often takes some work to address.

Ways to manage your Tibialis Anterior injury

Assuming your TA injury isn’t a medical emergency (cold, limp foot, or unrelating shin pain hours after exercise – if this is you, please go to the Emergency Department at your nearest hospital) a reduction in training load is an important first step. Taping your foot and/or massaging your shin can help to give some short term symptom relief. From there it pays to improve the strength in the muscle and tendon through conditioning exercises. It’s also worth seeing a sports podiatrist to check that your running technique and footwear aren’t contributing to the issues. Simple changes here can make a big improvement in how comfortable your shins can be while exercising. If you’ve been dealing with a sore shin muscle book in to see the injury experts at the intraining running injury clinic.

Doug James Colour 2020

Doug James – Physiotherapist and Podiatrist

Doug James is a qualified physiotherapist and podiatrist with a special interest in running and sports injuries. He combines the two treatment approaches to achieve successful outcomes for clients of all abilities from non-athletes to elite athletes. Bachelor of Podiatry (honours), Master of Physiotherapy Studies. Doug has undertaken further training in dry needling, Pilates, and Rocktape and may incorporate these as necessary during treatment. Doug is also a keen runner having completed the New York Marathon.