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I hate to admit it but I smacked the front of my ankle into a steel support on a construction project I was working on. I went to the clinic but they didn't find anything wrong. Now two months later, I find out I actually ruptured my tibialis anterior tendon. I'm scheduled for surgery but with all the delays, they can't guarantee me a perfect result. How could this have been missed two months ago?

The tibialis anterior is the muscle along the front of the lower leg that dorsiflexes the foot. Dorsiflexion means the tendon pulls the ankle up toward the face. The tibialis anterior can tear partially or rupture fully as a result of trauma. Trauma includes lacerations (cuts) or blunt trauma of some sort. The description of your injury would fall under the category of blunt trauma. Delays can occur because at first, the problem isn't obvious. Other muscles and tendons take over for the damaged tibialis anterior. Motion appears normal but symptoms eventually develop. Patients report ankle weakness. There may be a visible mass that can be felt along the front of the ankle. This is where the ruptured tendon has pulled back and bunched up. The weakness can result in changes in the way the person walks. Once the diagnosis has been made, then surgery is advised. Even if it is somewhat delayed, studies show good results after the tendon has been repaired or reconstructed. A direct repair (reattaching the torn end of the tendon to the bone) isn't as likely after two months. The tendon retracts far enough that the surgeon can't pull it back down all the way. Instead, a tendon graft is taken from some other tendon in the foot or ankle and used to reconstruct the tibialis anterior. The tendon graft is called interpositional as it help bridge the gap between the end of the ruptured tendon and the bone. There will be a post-operative period of immobilization in a cast. This is followed by a rehab program. Weight-bearing is gradually allowed as patients progress from a cast to a hinged-ankle boot. Motion is restricted somewhat until the boot is no longer needed. The end results can be very satisfactory with return of motion, strength, and function. As with any surgical procedure, complications or postoperative problems are possible. This doesn't happen very often. Your surgeon will go over with you any precautions and risk factors that might increase your chances for problems. But as the old saying goes, don't borrow trouble before it comes your way.

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