Rupture of anterior tibialis tendon

My 21 year old son was practicing hitting with his softball team (rubber cleats) and when he went to swing the bat, his foot stayed in the same position but his leg turned.  He ruptured his anterior tibialis tendon.  Three different orthopaedic surgeons told me this was very rare and they had not seen this before my son.  They sent me to a foot/ankle specialist who also had not seen it previously, but he had several different ideas on how to repair it. Everything depended on what he found when he operated.  Surgery was yesterday and we were very lucky.  The tendon had pulled out from underneath where it attached to the muscle so he could attach tendon to tendon.  This was the best case scenario.  He is home, flat on his back, no weightbearing for about 8 weeks, then minimal, then physical therapy.  This is a young man who is a natural athlete and plays several types of sports all year long.  He now has 6 months with no sports (January, 2009).  He is very good at baseball/softball/basketball, snowboards, plays volleyball, canoes, swims, etc, etc, etc.  When I asked why this happened, they all said "bad luck".  I can accept that if that is what it was, I just don't want to worry about it happening to the other leg, or any other tendon when he pulls up for a jump shot or dives for a ball.  I love watching him play as much as he loves to play and my heart aches for him as he cannot swim all summer--can't really enjoy the summer.  Is it really that rare an occurance so I shouldn't have to worry about it happening again?  Please set a mother's heart and mind at ease.  Thank you so much.  I have a CD of his MRI if helpful.

[Dr Santos]

How are you? How is your son? I'm sorry to hear about his inability to do sports for the next few months. Indeed, rupture of the anterior tibialis tendon is a rare event. This often occurs insidiously, with subtle clinical findings and delayed diagnosis. It occurs more commonly in 45 year-old and above males, though there are studies that show that this happens in young athletic male and in both sexes. Case reports in the literature reveal a total of only 49 cases up to the year 2000. With regular follow-up and physical therapy, he will be back on his feet in no time at all. Here are some studies about rupture of the anterior tibialis tendon that all indicate this as a rare occurence:
http://podiatry.wordpress.com/2007/08/26/
http://www.ajronline.org/cgi/reprint/167/2/351.pdf
http://www.springerlink.com/content/w65xlb1ugxdjctp1/
http://www.ncbi.nlm.nih.gov/pubmed/9872465

I hope this helps. Take care and keep us posted.

[Kathy424]

Thank you for the reference material.  It was very interesting and helpful. Caleb had the repair of his anterior tibialis tendon done at Munson Medical Center in Traverse City, MI by Dr. Norman Licht on June 18, 2008.  He is on his 2nd cast, no weight bearing, and due for a change at the end of July.  Hopefully, some weight bearing at that time, and then physical therapy when that one comes off.  He is doing better, pain is much better.  The worst part is claustrophobia with the cast!!  Dr. Licht has been great!  We were very lucky as the rupture of the tendon occurred at the proximal end but left some tendon still attached so the repair was done attaching the two ends of the tendon.  So far, so good. By February, his basketball game should be as good as ever!
One other question, because Caleb is 6'1" and about 161 lbs. with long legs, is there any concern about his left leg having the same problem?  He is a sports-aholic--he'd rather be playing some kind of ball than eating or sleeping.  Should he build up the muscles in his legs?  He is in good shape as far as speed and stamina.  Just a thought!  Thanks for everything!  Kathy Helsley

[ActiveActuary]

Thanks for the references you provided in a previous post.  I am a 46 year old male athlete who was sidelined 6 weeks ago by a freak accident.  A large, sharp object fell on my lower leg and severed my anterior tibialis tendon about 2-3 cm above the ankle.

My doctor says recovery will take time, and that I'm still about 2 weeks shy of beginning weight-bearing physical therapy.  He's a highly respected orthopedic surgeon, but he's discussing a non-athletic recovery.  I'm growing concerned about the atrophy in my calf and the inability to flex or rotate my foot.  Can you answer a couple of questions:

1)  How long will it be before I can run (or even jog) again?
2)  Will I be able to return to competitive endurance events or will the injury permanently impair my speed and/or stamina?

Thank you, ActiveActuary

[dfman]

I am a 69 year old male, walking 3 miles (in 45 minutes) 6 days a week before breakfast.  I lift weights for about 90 minutes 3 days per week, and I have a large flower garden that I care for continually.  Earlier this spring, I started having pain on my morning walks in my right foot in the arch area.  I cut back and finally stopped my walking, as any extended walking cause residual pain.  One morning, after my wife had returned from the hospital with lung cancer surgery, I awakened around 5:00 AM, stretched and felt a sudden and painful pop on the top of my foot near the ankle.  When I got out of bed, the foot was beginning to swell, and was still painful to move, but not so much with weight.  Due to some additional health problems that my wife had, I put off seeing about it for about 1 month.  The foot was still slightly swollen, but all discoloration had gone away.  I was diagnosed with a ruptured Anterior Tibialis Tendon.  I was referred to an orthopedic surgeon, who admitted that this was indeed rare, he had never performed the surgery and could not find anyone else that had performed it.  He thought that he could make the repair in about 30 minutes, I would be in a case, non weight bearing for about 2 weeks, and a gradual resumption of weight bearing activity.  
After 2 hours on the operating table, he told my wife that the rupture was much worse than he thought, and I would not be able to put weight on the foot for 4 weeks.
I went back for my 2 week post op visit yesterday.  The ends of the tendon could not be sewn back together.  Apparently, I had been having tendonitis, that had caused the fibers of the tendon to slowly break away.  Every time, he started to stitch the ends together, the thread (?) would slip right through the tissue.  He drilled a hole in a bone and anchored the tendon through the hole, and as a safety measure, attached it to a tendon over my big toe.  He now tells me that I have another 4 weeks of non-weight bearing, therapy, etc.
The son of Kathy24 has my sympathy.  It is agony to watch a child not be able to do the things that he or she truly loves.  I sure hope that he is able to return to all of his athletic endeavors.
In the meantime, my flower gardens are being sadly neglected!

[jburd01]

Like  ActiveActuary post on Jul 31, 2008 at 05:53PM my wife also had a freak accident 2 weeks ago where she dropped a glass pitcher and severed her anterior tibilias and EHL which were repaired surgically about 4 hours after the accident.  Her doctor  has her in a CAM walker, weight bearing as tolerated and doing pasive dorsiflexion and active planter flexion.  Reading above posts (6 week NWB, f/b 2 wks PWB) Is this too quick?  HOW IS ActiveActuary doing now (if you read this AA!)