As the lead medical contributor at Tell Me More Golf, I am going to provide important information regarding tibialis anterior tendonitis or tibialis anterior tendinopathy, which is an overuse injury that causes pain and inflammation in the tibialis anterior muscle and tibialis anterior tendon in the front of the shin and ankle.   

Tibialis anterior tendonitis most often impacts active individuals who participate in high impact or repetitive activities such as running and golf.  In golfers, tibialis anterior tendonitis usually impacts the leading leg due to the repetitive rotational stress caused by the golf swing. 

In this article, I will discuss common causes, symptoms, treatments, and prevention strategies to help keep you on the course.  

WHERE IS THE TIBIALIS ANTERIOR TENDONITIS LOCATED?

Tibialis anterior tendonitis is located along the front of the lower leg, running from the front of your shin, to the front of the ankle. 

CAUSES AND SYMPTOMS

CAUSES 

The primary cause of tibialis anterior tendonitis or tendinopathy is overuse.  This overuse causes increased stress and strain to the tibialis anterior tendon, which leads to inflammation, small tears, and degeneration of the tendon. 

• Participating in repetitive activities that require repetitive movement including golfing.  This can occur in golfers regardless of skill level. When golfing, the lead leg is required to first rotate outward during the backswing, then quickly, and forcefully rotate inward as your swing progresses through ball contact and follow through. 
• Walking up and down hills including the normal changes in terrain that are all over golf courses. 
• Improper footwear. 
• Anatomical abnormalities of the feet such as high or flat arches.  
• People over the age of 40, due to reduced blood flow and elasticity of the tendon

SYMPTOMS

Common symptoms of tibialis anterior tendonitis include:

• Pain in the front of your ankle where it meets your foot.  This pain is usually worse with activity and improves with rest
• Redness and swelling in the front of your ankle
• Weakness with dorsiflexion of the ankle which is when you try to lift your foot and toes upward. In severe cases, the weakness can lead to foot drop
• Stiffness or limited range of motion of your ankle and foot
• Difficulty performing physical activity such as walking, running, and golfing. 

TIBIALIS ANTERIOR TENDONITIS TREATMENT

It is always recommended to consult with a healthcare professional prior to starting treatment. In most instances, tibialis anterior tendonitis can be managed conservatively, without the need for surgery.  Conservative treatments that can be effective for tibialis anterior tendonitis include: 

• Medication including the use of nonsteroidal anti inflammatory medication
• Applying ice to the injured area after activity to reduce pain and swelling
• Resting from the activity that causes pain
• In more severe cases, your healthcare provider may recommend immobilization with the use of a walking boot
• Wearing proper footwear with adequate support 
• Use of arch supports
• Strengthening exercises and stretching to address impairments that may be contributing to tibialis anterior tendonitis
• Attending physical therapy to improve strength and flexibility of your ankle with a program that is customized to your needs 
• Corticosteroid injections to reduce inflammation. 

TIBIALIS ANTERIOR TENDONITIS EXERCISES 

SEATED TOE RAISES

1. Sit with your feet flat on the floor directly beneath your toes
2. While keeping your heels firmly placed on the ground, raise your toes off of the ground. 
3. Hold for 3 to 5 seconds
4. Repeat 20 times

WALL TOE RAISES

1. Stand with your back against the wall
2. Walk your feet about 6 inches away from the wall
3. Slowly raise your toes, keeping your back in contact with the wall
4. Hold for 10 seconds
5. Repeat 20 times

HEEL WALKING

1. While standing, raise your toes up off of the floor.  
2. Begin walking forward, by taking small steps, but touch only your heels to the ground
3. Walk between 10 to 15 steps (space permitting), turn around and repeat.  That is 1 lap
4. Perform 5 to 10 laps

HEEL RAISES

1. Stand with your feet together.  
2. Raise up onto your toes by lifting your heels off of the ground
3. Focus on keeping the weight through your big toes 
4. Hold for 3 to 5 seconds
5. Repeat 20 times

KNEELING ANTERIOR TIBIALIS STRETCH

1. Kneel on all fours, with your hand directly beneath your shoulders and your knees beneath your hips. 
2. Point your toes behind you so that the tops of your feet are touching the floor
3. Rock your hips backwards towards your heels until a stretch is felt in the front of your ankle and lower leg
4. Hold for between 15 to 20 seconds
5. Repeat 5 times. 

STANDING CALF STRETCH

1. Stand facing a wall from 3 feet away. Take one step toward the wall with your right foot.
2. Place both hands on the wall. Bend your right knee.
3. Lean forward, keeping the left leg straight and the left heel on the floor.
4. Hold for 15 to 20 seconds. Repeat 2 to 3 times, or as instructed.
5. An additional technique is to hold the stretch for 5 seconds and then, in a stretched position, contract the calf muscle by pushing into the wall for 5 seconds. Repeat 2 to 3 times.
6. Switch legs and repeat.

ARCH LIFTS

1. Sit with your foot flat on the floor
2. Draw the base of your big toe towards your heel, lifting the medial arch of your foot up. 
3. Make sure that you heel your big toe, heel and the ball of your foot on the floor during the exercise
4. Hold for 3 to 5 seconds
5. Perform for 1 to 2 minutes. 

PREVENTING TIBIALIS ANTERIOR TENDONITIS 

There are measures that you can take to prevent tibialis anterior tendonitis from occurring or recurring:

• Perform a proper warm-up prior to performing physical activity.  This includes stretching and exercise. 
• Improve strength and flexibility of your feet and ankles to allow your body to better withstand the stresses of swinging a golf club
• Use of proper footwear and arch supports, especially if you have flat feet
• Correct any faults that may be present in your golf swing.  Consulting with a coach or club professional 
• Listen to your body.  If you are experiencing pain when golfing, take some time off and consult a healthcare professional such as a physical therapist   

TIBIALIS ANTERIOR TENDONITIS RECOVERY TIME 

Depending on the severity of your injury, tibialis anterior tendonitis recovery time will vary, but most people can expect full recovery between 4 and 12 weeks.  If you try treatment on your own and your symptoms do not improve after 2  weeks, you should contact your healthcare provider.

TIBIALIS ANTERIOR TENDONITIS SURGERY 

If conservative treatment does not improve your symptoms, or if the injury to the tissue is too severe, your doctor may recommend surgery for your tibialis anterior tendonitis.  

Surgical intervention and options include:

• Tendon Repair is a procedure where the damaged portion of the tendon is repaired with sutures and if necessary reattached to the bone
• Tendon Transfer may be performed if the tendon has torn completely, and the remaining parts may not be long enough to be sewn back together. Tendon transfer surgery involves moving a healthy tendon from another part of the body to replace the damaged tibialis anterior tendon.
• Debridement surgery involves removing damaged and injured tissue from the injured area to promote healing.
• Recovery time from surgery is generally 6 months but will vary depending on the procedure performed, the health and age of the individual, and the extent or severity of the injury. 

CONCLUSION

Tibialis anterior tendonitis is a common but preventable ailment that impacts golfers.  Proper warm up, mechanics, and footwear can all help prevent you from developing anterior tibialis tendonitis.  If you do develop it,  performing simple exercise including stretching and strengthening, taking some time off, and being patient can help to speed up your recovery process and get your back on the course.  

Jason Bretcko

TellMeMoreGolf.com Lead Medical Contributor

Dr. Jason Bretcko brings over 15 years of clinical experience as a qualified and seasoned physical therapist, specializing in orthopedics. Alongside his professional expertise, Dr. Bretcko is also an enthusiastic recreational golfer. Certified in Astym and Applied Functional Science (CAFS), he seamlessly integrates his clinical proficiency with a profound understanding of golf. Dr. Bretcko is dedicated to assisting golfers in overcoming strength and mobility challenges associated with common golfing injuries such as back pain, golfer’s elbow, knee pain, and hip discomfort. His holistic approach aims at enhancing golfers’ function and performance, guiding them towards a successful return to the course.

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