Treating Tibialis Anterior Trigger Points - Dr. Jonathan Kuttner M.D.
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The tibialis anterior trigger point typically causes pain in the front of the shin, ankle and on the big toe
The pain in the big toe can often be mistaken for gout, and the metabolic condition that causes gout may also irritate the trigger points in the lower leg muscles.
In most cases however, these trigger points are related to sports/overuse issues, and are often present in long distance drivers.
Tibialis Anterior - Common Trigger Point Site
[Latin tibia, pipe or ute/shinbone; anterior, before]
Lateral condyle of tibia. Upper half of lateral surface of tibia. Interosseous membrane.
Medial and plantar surface of medial cuneiform bone. Base of 1st metatarsal.
Deep peroneal nerve, L4, 5, S1.
BASIC FUNCTIONAL MOVEMENT
Example: walking and running (helps prevent foot from slapping onto ground after heel strikes; lifts foot clear of ground as leg swings forward).
Tibialis Anterior - Typical Referred Pattern
TRIGGER POINT REFERRED PAIN PATTERNS
Anteromedial vague pain along shin, with zone of pain 3–5 cm in ankle joint (anterior), culminating in great-toe pain (whole toe).
Ankle pain/tenderness, pain in great toe, shin splints (anterior tibial compartment syndrome), foot dragging, ankle weakness (children), gout toe, turf toe, falls, balance issues.
Direct trauma, twisted ankle, ill-fitting boots/shoes, poor orthotics, walking on uneven surfaces, stubbing great toe, overload (e.g. walking, car pedals).
Lumbar discopathy. Arthritic toes. Anterior tibial compartment syndrome. Shin splints (anterior). Varicose veins. Gout.
Extensor hallucis longus, peroneus tertius, extensor hallucis brevis, extensor digitorum brevis/longus, flexor hallucis longus, 1st dorsal interosseous.
Self Help - Pressure tools can be useful but be aware of varicose veins
GENERAL ADVICE TO PATIENTS
Self-massage techniques can be helpful. Be careful if there are varicose veins. Balls, hooks, and pressure tools can generally be used, as the muscle is fairly superficial.
Avoid long car journeys and use of pedals. Regularly change running surface/ shoes. Avoid walking (prolonged) on sloping surfaces.
Have stretch program (heat/warmth/cold). Adjust car seat. Use wedge under heel of foot for car pedal.
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Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.
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Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.
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Trigger Point Therapy Master Course
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