About the tibialis anterior muscle

The tibialis anterior muscle (also known as tibialis anticus) is the largest of the four muscles in the anterior lower leg. It is the strongest foot dorsiflexor and is prone to overuse from excessive walking or running. It is an essential muscle to consider for cases of shin splints or weak/stiff ankles.

Tibialis anterior trigger points can refer pain along the muscle from the upper anterior/lateral shin down through the front of the medial ankle and down to the top of the big toe. Anterior tibialis trigger points also cause shin splint pain and cause foot drop, or difficulty dorsiflexing the foot (lifting the front of the foot).

The tibialis anterior is an important muscle for walking and running because of its impact on moving the foot and ankle. It is most active during heel strike and then also during toe off. If the tibialis anterior is not functioning then foot drop or toe dragging will result because the foot is not able to dorsiflex.

Read more to learn about tibialis anterior trigger points and how acupuncture and dry needling can help relieve thigh shin, ankle, and big toe pain naturally.

Tibialis anterior origin and insertion

Tibialis anterior origin:

The anterior tibialis origin is at the lateral condyle of the tibia, and the proximal/lateral surface of the tibia and interosseus membrane

Tibialis anterior insertion:

The anterior tibialis insertion is under the foot at the medial cuneiform and the base of the first metatarsal (big toe)

Since the anterior tibialis muscle passes through the ankle joint and goes to the big toe, it serves to act on the foot and ankle. One one side, the tibialis anterior tendon starts at the distal one third of the tibia. One the other side, it passes across the anterior ankle and top of the foot to to the medial cuneiform bone and under the big toe at the base of the first metatarsal joint. The anterior tibialis tendon is the most medial on the ankle and foot.

Tibialis anterior action

• Invert foot

• Dorsiflex foot

The tibialis anterior function is to bring the big toe and the knee closer together - which means that it both inverts and dorsiflex the foot.

Synergists and antagonists of the anterior tibialis

Tibialis anterior synergists:

• Foot dorsiflexion: extensor digitorum longus, peroneus tertius, extensor hallucis longus

• Foot inversion: tibialis posterior, flexor digitorum longus, flexor hallucis longus, extensor hallucis longus

  The three primary foot dorsiflexors of the foot are the tibialis anterior (which also inverts the foot), the extensor digitorum longus (which also everts the foot), and the peroneus tertius. They are assisted by the extensor hallucis longus.

Tibialis anterior antagonists:

• Gastrocnemus, soleus, tibialis posterior, peroneus longus/brevis, flexor digitorum longus, flexor hallucis longus, plantaris (foot plantar flexion)

• Peroneus longus/brevis, extensor digitorum longus (foot eversion)

Tibialis Anterior Trigger Points

Main complaints related to tibialis anterior trigger points include:

• Anterior Ankle Pain

• Anterior Leg Pain

• Dorsal Forefoot Pain

• Dorsal Great Toe Pain

• Shin Splint Type Pain

The tibialis anterior muscle is referred to as the “foot drop muscle” by Travell & Simons since it is the strongest dorsiflexion muscle in the foot. When it is not functioning, the foot is unable to dorsiflex fully and it stayed “dropped” and can even drag on the ground when walking.

The peroneus longus is the most commonly associated trigger point with the anterior tibialis muscle. The extensor hallucis longus and extensor digitorum longus can also develop trigger points with the anterior tibialis since they work together to dorsiflex the foot.

Anterior Tibialis Trigger Point Locations

Tibialis anterior trigger points tend to be in the upper one third of the muscle and they refer pain down along the muscle with primary pain referral to the front of the ankle and to the dorsal part of the medial foot and big toe.

Signs and symptoms of tibialis anterior trigger points

• Pain in anteromedial ankle and big toe

• Weak dorsiflexion when walking

• Dragging of the foot or foot drop

• Ankle weakness

What causes tibialis anterior pain and trigger points?

• Overuse or trauma

• High volume of walking or running

• Ankle sprain

• Anterior compartment syndrome

• Calf muscle tightness which leads to overuse of tibialis anterior

• Excessive driving that involves prolonged foot dorsiflexion

Tibialis trigger points have a similar referral pattern to some other muscles in the lower leg and foot so it is important to differentiate these trigger points based on patient history and physical examination. The extensor hallucis longus pain referral pattern is most similar, followed by the extensor digitorum longus, extensor digitorum brevis, extensor hallucis brevis, and extensor digitorum longus. The peronus tertius muscle pain referral can also feel like the anterior ankle pain from anterior tibialis trigger points.

Tibialis anterior tendonitis and shin splints treatment

Trigger point acupuncture and dry needling can provide myofascial release in the tibialis anterior by identifying the taut bands of muscle that create pain associated with shin splints, ankle and foot pain, big toe pain, and tibialis anterior tendonitis. Trigger point therapy with an acupuncture needle helps to relax the muscle to restore function, improve range of motion, and reduce pain.

Your acupuncturist will palpate for taut bands of muscle to find trigger points in the affected muscle and release them using an acupuncture needle. Other modalities like electroacupuncture, cupping, gua sha, and tui na can also help with thigh and knee pain symptoms.

Over to you

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Sources:

• Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual (Vol. 2). London: Lippincott Williams & Wilkins.

• Biel, A., & Dorn, R. (2010). Trail guide to the body: A hands-on guide to locating muscles, bones and more. Boulder, CO: Books of Dicovery.

• Janda, Vladimír. “Muscle Function Testing.” (1983).

• Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark; Tibialis anterior tendinous tissue plays a key role in energy absorption during human walking. J Exp Biol 1 June 2019; 222 (11): jeb191247.

• Juneja P, Hubbard JB. Anatomy, Bony Pelvis and Lower Limb, Tibialis Anterior Muscles. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

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