Background: Closed tibialis anterior tendon rupture is an uncommon condition typically occurring in the middle aged to elderly patient. Diagnosis may be delayed due to unfamiliarity with the problem by the treating physician. Materials and Methods: We treated seven patients (4 males aged 54 to 80; 3 females aged 43 to 82) with this problem. Four patients had a history of systemic corticosteroid use and one had had a local steroid injection. Four of the seven patients were managed with direct operative repair and one with a non-anatomical repair to the talar neck. Two patients were managed nonoperatively of whom one subsequently required late surgical reconstruction. Patients were reviewed clinically and completed a Foot and Ankle Outcome Score (FAOS). Followup ranged from 12 months to 12 years. Results: In the operative group four patients had no functional limitations from the injury and one had mild ankle weakness. One in the nonoperative group required salvage surgery four years after rupture. At followup the mean FAOS was 85 (range, 64 to 98) in the operative group and 52 (range, 28 to 75) in the nonoperative group. Conclusion: A ruptured tibialis anterior tendon is a rare condition. There is an association with systemic steroid use as well as local steroid injection. Early diagnosis allows operative repair by various techniques leading to predictably good results. Our experience supports operative repair even in the elderly patient. Level of Evidence: IV, Retrospective Case Series
