Tibial Nerve

Description[edit|edit source]

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

The tibial nerve provides innervation to the muscles of the lower leg and foot. Specifically: triceps surae (the two headedgastocnemiusandsoleus),plantaris,Popliteus,tibialis posterior,flexor digitorum longusandflexor 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 thefootlevel (just after the heel) the tibial nerve divides into themedial plantar nerve(MPN) and thelateral 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. Thesural nerveis a cutaneous branch of the tibial nerve that supplies the skin of the legs and feet.^[3]

Function[edit|edit source]

Motor[edit|edit source]

• At thepopliteal fossa, branches of the tibial nerve supply medial and lateral heads ofgastrocnemius,soleus,plantarisand popliteus muscles. The popliteus branch goes on to supplytibialis posterior muscle, superior and inferior tibiofibular joint,tibiaand the interosseous membrane of leg.^[1]
• Posterior branches of the tibial nerve supplytibialis posterior,flexor digitorum longus,flexor hallucis longus, and deep part ofsoleus.^[1]

Sensory[edit|edit source]

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

• Medialsural nervesupplies 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 surfacecalcaneus.
• Articular branches are to theknee(3 in total) andankle 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 fossaregion. Injury may occur due to e.g.:
   • Space occupying lesion
   • Laceration injury
   • Posteriordislocation 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 thesoleus musclemay 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 andfibula.
   • 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 theanklecausestarsal tunnel syndrome.On examination it presents as pain and paresthesia in the sole of thefoot.^[6]
   • Tibial nerve block done for certain operations of thefoot.^[8]
3. Sole of foot:
   • Abnormal pressure at the ball of thefootcan irritate the first plantar digital nerve causingMorton's neuroma/Metatarsalgia.

Assessment and Treatment[edit|edit source]

更详细的评估和管理of conditions mentioned above, see the following pages:

• Tarsal Tunnel Syndrome
• Morton's Neuroma/Metatarsalgia.

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) orheatmay 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]