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Septic or suppurative tenosynovitis is the infection of a tendon sheath in which the potential space between the parietal visceral layers of the tendon become distended due to microbial invasion. These infections typically involve the flexor muscles in the hand. This report is of a 46-year-old female intravenous heroin user who was found to have septic tenosynovitis of the anterior tibialis tendon with partial rupture. She was treated with intravenous antibiotic therapy and underwent multiple irrigation and debridements. This review covers the diagnosis, common imaging features, and treatment of septic tenosynovitis and tibialis anterior rupture. This is the first documented case of tibialis anterior rupture secondary to septic tenosynovitis in the literature.