Tibialis Anterior Muscle Strain: Causes, Symptoms, Treatment

The Tibialis Anterior Muscle is located on the anterior compartment of the leg. Anterior compartment consists of 4 muscles and Tibialis anterior muscle is the largest in size among these four muscles.1 The tibialis anterior muscle is the strongest dorsiflexor and helps to lift the foot from the ground.¹ The Tibialis Anterior Muscle also facilitates flexion of the foot upwards and extension of the toes. The Tibialis Anterior Muscle originates from the outer surface of the tibia and inserts into the first metatarsal bone in the foot which is located behind the big toe. Any type of Strain or Injury to the Tibialis Anterior Muscle will result in the inability of the patient to flex the foot and extend the toes resulting in difficulty with ambulation. An injury to this muscle can also put excess pressure on the ankles resulting in them getting weak causing imbalance when walking. The patient will also find it difficult to negotiate stairs and indulge in recreational activities like dancing, running, jogging and the like.

The muscle gets its blood supply from the anterior tibial artery, medial tarsal artery, and branches of the dorsal pedal artery.²

Tibialis anterior muscle receives sensory and motor nerves from the deep peroneal nerve. The deep peroneal nerve is a terminal branch of sciatic nerve.³

Repeated use of the lower leg while playing football can cause tibialis anterior muscle strain. The leg pain over the shin or lower leg is also known as medial tibial stress syndrome. Injury or stress of tibialis anterior muscle causes medial tibial stress syndrome.4 Injury resulting in tibialis anterior muscle strain is observed after fall, repeated use of lower leg and direct impact over the muscle by moving object. Tibialis Anterior Muscle Strain or Injury causes the following symptoms:

• Pain in the big toe can be a sign or symptoms of tibialis anterior muscle strain
• Pain in the front of the ankle and shin
• Swelling along the shinbone
• Ankle weakness

Dropfoot Abnormality- Peroneal nerve injury causes drop-foot abnormality. Such symptoms occasionally observed in patients suffering from traumatic tibialis anterior muscle strain and peroneal injury.⁵

Some of the activities that may result in Strained Tibialis Anterior Muscle are:

1. Repeated use of tibialis anterior muscles causes muscle strain. Such injury is seen in soccer or rugby player.
2. Running or walking on uneven surfaces may result in a Tibialis Anterior Muscle Strain.
3. Tripping on carpet
4. Tripping while going up or down the staircase.
5. Foot or ankle joint injury frequently causes stress on the tibialis anterior muscle. Individual may feel moderate to severe pain once he or she stops using cane or walker for ambulation^[4]

There are also certain medical conditions that may result in a strained tibialis anterior muscle. These medical conditions are:

• Malnourishment
• Dehydration
• Obesity
• Anterior compartment syndrome
• Use of shin splints
• Diabetic neuropathy
• Hammertoe deformity
• Claw toe deformity and
• Gout.

1. Conservative Treatment

   1. Adequate rest
   2. Heat therapy
   3. Cold treatment
   4. Compression wraps

2. Medication

   1. NSAIDS
   2. Muscle relaxants

3. Physical Therapy

4. Cortisone Injection

1. Conservative Treatment for Tibialis Anterior Muscle Strain –

   The pain and muscle inflammation of the Tibialis Anterior Muscle Strain responds to rapid conservative therapy. The severe pain and muscle strain associated with muscle tear may not respond to conservative therapy. The MRI and ultrasound images help to differentiate the type of injury such as presence or absence of muscle tear. Conservative treatment is recommended for sprain that is not associated with a muscle tear.

   Following Are The Choices Of Conservative Treatment For Tibialis Anterior Muscle Strain:-

   Adequate Rest:

   The tibialis muscle strain causes inflammation of affected muscles. The intensity and spread of inflammation are less severe if the patient is taking adequate rest. Rest is advised for 2 to 4 weeks depending on the severity of symptoms like pain. The patient is advised to use cane, walker or wheelchair for ambulation.

   Heat Therapy to Treat Tibialis Anterior Muscle Strain:

   1. The heat treatment helps to reduce pain and soft tissue swelling. Heat therapy is given by applying a heating pad over the most painful area of the leg. In a few cases if the patient is scheduled for physical therapy then infra-red therapy is used as heat treatment.
   2. Ice Therapy- The ice treatment helps to prevent bleeding and also swelling. The cold therapy is also known as cryotherapy. Cryotherapy is provided by applying ice directly over the most painful area. Alternatively, the patient may wrap frozen jelly in a plastic bag around the pain area of the leg. The treatment is advised for 15-20 minutes two to three times a day.
   3. Wrap: Compression wraps are also quite beneficial in the treatment of Tibialis Anterior Muscle Strain. Compression wrap includes ace bandage that is applied with adequate pressure around the injured leg. It also helps in calming down the swelling and inflammation associated with Strained Tibialis Anterior Muscle.

2. Medications to Treat Tibialis Anterior Muscle Strain:-

   1. NSAIDS- Non-steroidal anti-inflammatory medications are prescribed for muscle inflammation and pain. The muscle sprain responds to NSAIDs therapy. NSAIDs used are Motrin, Naproxen and Celebrex.
   2. Tylenol- Tylenol is used for mild to moderate pain. Tylenol does not work for inflammation.
   3. Muscle Relaxants– Occasional Tibialis Anterior Muscle Strain causes muscle spasm. Muscle spasm is treated with muscle relaxants. Muscle relaxant is frequently prescribed are Soma, Baclofen, and Skelaxin.

3. Physical Therapy

   Physical therapy is recommended for pain and prevents muscle stiffness during the initial phase. In the later phase of the disease, once the pain is less severe than physical therapy is advised for muscle atrophy and muscle weaknesses.

4. Cortisone Injection-

   Pain and muscle stiffness is often treated with trigger point injection. The medication injected is cortisone. The needle is inserted in most tender muscle mass. Medications are carefully injected in tender muscle.

Consult your primary care physician or visit Emergency Room if you see hard to firm swelling and pain over the front of the leg. You do not want to ignore fracture and muscle tears.

If you see bruises and discoloration then also you should consult your physician to stop bleeding within the muscle mass.

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