Ankle extensor compartment injury

Last revised by Dr Henry Knipe on 26 Apr 2022

Ankle extensor compartment injuries are infrequently reported in the medical literature in contrast to the other ankle pathology. 

The incidence of ankle extensor tendon abnormalities is unclear ref.

The ankle extensor compartment contains (from medial to lateral) ref:

The most common tendon injuries are to tibialis anterior followed by extensor hallucis longus and extensor digitorum longus tendons 4.

Ankle extensor tendon tears may be visualized on MRI as intrasubstance signal abnormality on T2-weighted images, abnormal tendon diameter, or both.

Acute partial tears can be associated with edema and various form of tendon shape including increased tendon diameter, longitudinal tear along the long axis of the tendon and sometimes splitting the tendon into separate fiber bundles. In cases of chronic partial tears, the decreased diameter of the remaining tendon, and retraction and scarring of the torn fibers can also be seen 5,6.

Almost all ankle extensor injuries compartment are underdiagnosed and prompt treatment is required for a good prognosis 1-3. Conservative treatment is indicated for less severe cases of extensor tendinopathy. Early diagnosis followed by surgical repair of complete rupture of the tibialis anterior tendon significantly increased patients' function because this tendon provides 80% of dorsiflexion strength although some dorsiflexion deficit remains in most patients after anterior tibial tendon repair 7-9.

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Cases and figures

  • Case 1: isolated tear of extensor digitorum longus tendon
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  • Case 2: tibialis anterior tendon rupture
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  • Case 3: tibialis anterior tendinosis
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