Working Diagnosis:
Left Tibialis Anterior Split Tear

Treatment:
- Rest, ice, compression, elevation.
- Post-op boot for 8 weeks. 
- Ibuprofen 800 mg Q8H for 14 days.
- Physical therapy for 3 weeks to work on range of motion, dynamic and eccentric stretching, and pool running.

Outcome:
Repeat MRI six months post injury showed resolution of the linear high signal within the anterior tibialis tendon. Mild tendinosis is present at the distal anterior tibialis tendon. Case Photo #3

Author's Comments:
Anterior tibialis tendon (ATT) ruptures are relatively rare, with a 2009 review identifying fewer than 100 cases.[1]

Mechanism: Traumatic (Acute) vs. Spontaneous (Acute on Chronic)
Chronic degenerative changes are commonly seen at the rupture site, suggesting that rupture may be a clinical end-state. Systemic diseases and specific disorders are rarely the culprit (

Editor's Comments:
This case demonstrates an alternative and relatively rare diagnosis for anterior foot pain. Tears can occur traumatically (acute) or spontaneously (acute on chronic), and should be included in the differential for anyone with pain or swelling in the area of the anterior tibialis tendon. Diagnosis can be made by ultrasound or MRI. Treatment for partial tears is conservative, generally with good outcomes, as seen in this case with resolution on repeat MRI. Complete tears require surgical repair.

References:
1. F. Neumayer, Y.R. Djembi, A. Gerin, A.C. Masquelet. Closed Rupture of the tibialis anterior tendon: a report of 2 cases. J Foot Ankle Surg. 2009;48(4):457-461.
2. Jarvinen M, et al. Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports. 1997;(7):86-95.
3. Gallo RA, Kolman BH, Daffner RH, et al. MRI of tibialis anterior tendon rupture. Skeletal Radiol. 2004;(33):102-106.
4. Saadeh, K, Ackerman, S. Partial Tear of the Anterior Tibialis Tendon. Appl Radiol. 2007;36(3):38-41.

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