Tibial Nerve

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Leana Louw and Rucha Gadgil

Description[edit | edit source]

The tibial nerve is the larger terminal branch of the two main muscular branches of the sciatic nerve.[1]

The tibial nerve provides innervation to the muscles of the lower leg and foot. Specifically: triceps surae (the two headed gastocnemius and soleus), plantaris, Popliteus, tibialis posterior, flexor digitorum longus and flexor hallucis longus.[2][3] It also has articular and cutaneous branches.[4]

[5]

Root[edit | edit source]

Anterior parts of the L4-S3 rami.[1]

Branches[edit | edit source]

At the foot level (just after the heel) the tibial nerve divides into the medial plantar nerve (MPN) and the lateral plantar nerve (LPN).[2] The MPN supplies muscular branches to the big toe and the two toes next to it, and the LPN the other two toes. The sural nerve is a cutaneous branch of the tibial nerve that supplies the skin of the legs and feet.[3]

Tibial Nerve.png

Function[edit | edit source]

Motor[edit | edit source]

Sensory[edit | edit source]

Branches of the tibial nerve supply sensory innervation to the following:[1]

  • Medial sural nerve supplies skin on lower half back of leg and skin of foot laterally to the little toe.
  • Medial calcaneal nerve supplies skin on posterior and inferior surface calcaneus.
  • Articular branches are to the knee (3 in total) and ankle joint.

Clinical relevance[edit | edit source]

Injury to the tibial nerve can cause motor loss and altered sensation and pain to any of the areas it supplies, depending on site of involvement.

  1. Popliteal fossa region. Injury may occur due to e.g.:
    • Space occupying lesion
    • Laceration injury
    • Posterior dislocation of the knee[6]
    • Entrapment in soleus arch: Soleus arch entrapment neuropathy can occur with sports that make special demands on the calf muscles. Swelling and hypertrophy of the soleus muscle may cause its tendinous arch to compress the popliteal artery and vein as well as the tibial nerve. This can cause chronic mechanical damage to the nerve and the artery and vein may become occluded.[7] This is requires surgical release and has a good outcome.
    • Fractures of the tibia and fibula.
    • Local trauma to the posterior lower leg.
  2. Medial malleolus level:
    • Compression of the tibial nerve in the osseofibrous tunnel below the flexor retinaculum of the ankle causes tarsal tunnel syndrome. On examination it presents as pain and paresthesia in the sole of the foot.[6]
    • Tibial nerve block done for certain operations of the foot.[8]
  3. Sole of foot:

Assessment and Treatment[edit | edit source]

For more details on the assessment and management of conditions mentioned above, see the following pages:

Entrapment in soleus arch[edit | edit source]

Physiotherapy post surgical release would include:

  • Neural mobilisation (e.g. flossing techniques)
  • Strengthening and muscle flexibility graded exercises
  • Coordination and balance training
  • Electrotherapeutic techniques (e.g. TENS) or heat may be used for pain relief.

The video below gives a good overview of the nerve and use of flossing techniques for the tibial nerve

[9]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 Moore KL, Dalley AF, Agur AMR. Clinial oriented anatomy. Philadelphia: Wolters Kluwer, 2010.
  2. 2.0 2.1 KenHub. Tibial nerve. Available from: https://www.kenhub.com/en/library/anatomy/tibial-nerve (last accessed 17/3/2019).
  3. 3.0 3.1 Healthline. Tibial nerve. Available from: https://www.healthline.com/human-body-maps/tibial-nerve#1 (last accessed 17/03/2019).
  4. Wikipedia. The tibial nerve. Available from: https://en.wikipedia.org/wiki/Tibial_nerve (last accessed 18/03/2019).
  5. nabi lebraheim. Nerves of the lower leg 3D. Available from: https://www.youtube.com/watch?v=yPJ9sxUubRI (last accessed 17/03/2019).
  6. 6.0 6.1 Earth's Lab. Tibial nerve. Available from: https://www.earthslab.com/anatomy/tibial-nerve/ (last accessed 18/03/2019).
  7. Thetter O. Entrapment Syndrome by the Tendinous Arch of the Soleus Muscle (“Soleus Syndrome”). In: Heberer G, Van Dongen RJAM, editors. Vascular Surgery. , Berlin/Heidelberg: Springer, 1989.
  8. Wassef MR. Posterior tibial nerve block: a new approach using the bony landmark of the sustentaculum tali. Anaesthesia 1991;46(10):841-4.
  9. Brian Abelson. Flossing the Tibial Nerve. Available from: https://www.youtube.com/watch?v=Ak6IHdIjnVA (last accessed 18/03/2019).