Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report

Management of Anterior Tibialis Tendon Ruptures

“…2,10,13 Diagnosis History Acute, traumatic AT tendon ruptures usually occur in younger patients who sustain injury via a penetrating object or a distal tibial or talus fracture fragment. [4][5][6]13 The AT tendon laceration can be missed on initial examination due to distracting injuries or lack of appropriate clinical suspicion. Atraumatic, degenerative AT tendon ruptures typically occur in individuals older than 45 years.…”

“…Patients who present acutely after blunt or penetrating trauma to the anterior ankle should undergo a thorough initial examination of the affected limb, including skin condition and integrity, neurovascular function, areas of tenderness or swelling, palpable tendon discontinuities, and loss of normal resting tension or abnormalities with foot and ankle range of motion. [4][5][6] In an open laceration, wound exploration and passive ankle positioning may reveal the torn tendon ends. Although the proximal AT tendon end (or other involved extensor tendon/s) is often retracted out of view, appreciation of a tendon void within its respective sheath can also indicate complete tendon laceration.…”

“…An untreated rupture can lead to gait impairment and progressive deformity, including loss of the medial longitudinal arch, equinus contracture, and lesser toe contractures.Traumatic injuries typically result from a direct laceration to the tendon (eg, a knife or a sharp bone fragment from a distal tibial or talus fracture) or a forcible plantar flexion moment applied to an eccentrically contracting AT muscle. [4][5][6] Atraumatic ruptures can have a variety of causes. Poor vascularity, underlying tendinopathy, and medical comorbidities (eg, diabetes mellitus, gout, systemic lupus erythematosus, conditions requiring long-term corticosteroid use, renal dysfunction, and inflammatory arthropathy) can contribute to attritional rupture.…”