Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Tibialis anterior tendon rupture — complete or partial disruption of the primary dorsiflexor and invertor of the foot — is a rare but functionally significant injury that produces a characteristic ‘foot slap’ gait and inability to clear the forefoot during walking. Because it occurs most commonly in patients over 60 from chronic attritional degeneration rather than acute trauma, and because the presentation is gradual, tibialis anterior rupture is frequently diagnosed late — sometimes years after onset — when the patient presents for evaluation of ‘tripping’ or ‘dropping the foot.’

Anatomy, Mechanism, and Diagnosis

The tibialis anterior tendon courses from the anterior compartment of the leg beneath the superior and inferior extensor retinacula, inserting into the medial cuneiform and base of the first metatarsal — the primary dorsiflexor (80% of dorsiflexion strength) and a significant invertor of the foot. Attritional rupture: the most common mechanism — chronic tendinopathy at the zone of relative avascularity just proximal to the insertion (between the superior and inferior retinaculum) leads to progressive tearing; patients often report no specific injury event. Acute rupture: direct laceration or forced plantarflexion against resistance (stepping off a curb, stumbling). Clinical diagnosis: steppage gait (high-stepping to clear the foot, with forefoot slap on heel strike); the anterior ankle is visibly flattened at the tendon location; a palpable mass at the rupture site from the retracted proximal stump; active dorsiflexion weakness (the patient cannot raise the forefoot against gravity against resistance); the extensor digitorum longus and extensor hallucis longus tendons may compensate partially. MRI: confirms complete rupture, characterizes gap size and degree of proximal tendon retraction, and evaluates tendon quality for repair planning. The gap size and chronicity determine repair strategy.

Treatment

Conservative management (orthosis): ankle-foot orthosis (AFO) or posterior leaf spring orthosis restores foot clearance — appropriate for low-demand patients, elderly patients with high surgical risk, or chronic ruptures with poor tendon quality not amenable to repair. Surgical repair: primary end-to-end repair for acute ruptures with adequate tendon length and quality — excellent outcomes when performed within 6–8 weeks; reconstruction with allograft or ipsilateral extensor hallucis longus transfer for chronic ruptures with large gaps; 90% of patients achieve functional dorsiflexion after repair. Dr. Biernacki at Balance Foot & Ankle evaluates anterior ankle weakness with MRI and clinical examination and performs tibialis anterior tendon repair and reconstruction for complete ruptures. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

Book Online or call (810) 206-1402

Tibialis Anterior Tendon Repair in Michigan

Rupture of the tibialis anterior tendon causes foot drop and difficulty walking. Our podiatric surgeons offer both primary repair and tendon reconstruction to restore ankle dorsiflexion and normal gait mechanics after this uncommon but disabling injury.

Explore Tendon Repair Services | Book Your Appointment | Call (810) 206-1402

Clinical References

1. 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.
2. Ouzounian TJ, Anderson R. Anterior tibial tendon rupture. Foot Ankle Int. 1995;16(7):406-410.
3. Sammarco VJ, Sammarco GJ, Henning C, Chaim S. Surgical repair of acute and chronic tibialis anterior tendon ruptures. J Bone Joint Surg Am. 2009;91(2):325-332.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.