Anterior tibial tendon insertion: an anatomical study

Anatomical variations of the anterior tibial tendon insertion were studied by dissection in 44 normal feet of 22 embalmed adult cadavers. Three types of insertion were found. The most common insertion (56.8%) was a division of the tendon into two slips, equal in width, the one slip being inserted into the first cuneiform and the other slip into the base of the first metatarsal. The next most common (27.3%) was a division of the tendon into a large slip, inserted into the first cuneiform, and a small slip, inserted into the base of the first metatarsal. The third type, and least common tendon insertion (15.9%), was by a single slip into the first cuneiform only. Knowledge of these anatomical variations will assist surgeon in performing anterior tibial tendon transposition for recurrent congenital clubfoot.