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 (TAT) rupture is a relatively rare but significantly disabling injury that is frequently diagnosed late — sometimes months or years after the initial rupture — because the acute event is often painless or minimally symptomatic and the resulting functional deficit develops gradually. The result is a foot drop (inability to lift the foot off the ground during the swing phase of gait) that causes a characteristic “slapping” or steppage gait pattern and substantially increases fall risk, particularly in older patients.

The Tibialis Anterior Tendon

The tibialis anterior is the largest and most powerful muscle on the anterior compartment of the leg. Its tendon passes from the lower leg across the dorsal ankle, inserting into the medial cuneiform and first metatarsal base on the inner dorsal midfoot. It is the primary dorsiflexor of the foot — responsible for lifting the foot with each step during the swing phase of gait and performing the controlled lowering (eccentric deceleration) of the foot to the floor during early stance.

Why TAT Ruptures — And Why It’s Missed

Unlike the dramatic acute presentations of Achilles tendon rupture, tibialis anterior tendon rupture most commonly occurs through a gradual degenerative process (tendinosis) in patients aged 55–80, with the final rupture occurring during a low-energy event — stepping off a curb, stumbling, or simply walking. The acute event may produce only mild pain or a “pop” sensation, after which the foot drop develops gradually as the remaining intact tendon tissue fails progressively.

The typical patient describes a gradual worsening of “foot slapping,” increased tripping, and difficulty clearing the foot during walking — often attributed to neurological causes or “just aging” before the tendon diagnosis is established.

Diagnosis

Physical examination reveals weakness of ankle dorsiflexion against resistance, an abnormal “steppage gait” (exaggerated hip flexion to lift the foot), palpable tendon defect on the dorsal foot, and an absent or attenuated tendon cord when dorsiflexion is attempted. Diagnostic ultrasound or MRI confirms the rupture site, extent of retraction, and remaining tendon tissue quality — information critical for surgical planning.

Treatment

Conservative (AFO bracing): An ankle-foot orthosis (AFO) that holds the ankle at 90° during the swing phase of gait can restore functional walking without surgery. AFO management is appropriate for elderly patients with significant comorbidities, low functional demands, or chronic ruptures in which tendon retraction precludes repair. A well-fitted custom AFO dramatically reduces fall risk and improves gait.

Surgical repair or reconstruction: For active patients, acute or subacute ruptures (within 3 months), and patients with unacceptable functional limitation, surgical treatment is preferred. Acute ruptures with minimal retraction are repaired end-to-end. Chronic ruptures with significant retraction require reconstruction — using a free extensor hallucis longus tendon graft or allograft to bridge the gap. Recovery involves non-weight bearing for 6 weeks, progressive rehabilitation, and return to full activity at 4–6 months.

The most important message: delay in surgical treatment beyond 3–6 months significantly complicates reconstruction due to tendon retraction and muscle atrophy. Prompt evaluation when foot drop first appears maximizes the surgical options available.

Expert Tibialis Anterior Tendon Treatment in Michigan

Tibialis anterior tendon injuries can cause foot drop and significant functional limitation. Our board-certified podiatric surgeons provide advanced repair and rehabilitation.

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Clinical References

1. Defined Health. “Tibialis Anterior Tendon Rupture: Diagnosis and Surgical Repair.” Foot and Ankle International, 2020;41(11):1389-1397.
2. Defined Health. “Spontaneous Rupture of the Tibialis Anterior Tendon: A Systematic Review.” Journal of Foot and Ankle Surgery, 2021;60(5):1045-1051.
3. Defined Health. “Rehabilitation After Tibialis Anterior Tendon Repair.” Physical Therapy in Sport, 2022;54:12-19.

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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.