Morphometric evaluation of the tibialis anterior muscle tendon

Purpose The tendon insertion sites of the tibialis anterior muscle (TAM) are particularly important for ruptures and drop foot surgery procedures. The anatomical relationship between the morphometry of the TAM’s tendon (TAT), medial malleolus (MM), and tibialis posterior muscle tendon (TPT) has not yet been elucidated. This study aimed to examine the morphometric features of TAT, TPT, and MM and their relationships with sex and sides. Methods Dissections were performed on the dorsal and medial surfaces of 25 (15 males, 10 females) fixed lower extremities. The study has been approved by the Board of Ethics of Mersin University (Approval number: 2023/500). Bony structures were exposed together with the tendons and extensions of the TAM. MM height and width, inter-tendon distances, and tendon angles were measured. Additionally, the width, length, thickness, and cross-sectional area (CSA) of TATs and TPTs were recorded. Results It was found that TAT could have a minimum of 1 and a maximum of 3 slips in different combinations. The width of TAT (TATw) and the inter-tendon distances along the MM were found to be significantly greater in males than in females. TATw and MM widths were greater on the left feet compared to the right. A moderate negative correlation was also observed between TAT thicknesses and MM angulation. Strong positive correlations were found between the distances between TAT and TPTs at different levels of MM. Conclusion Understanding the morphometric features of TAT and its relationship with MM may optimize tendon transfer techniques for foot drop treatment. These findings contribute to improving surgical accuracy, anchorage placement, and graft sizing in reconstructive procedures.