Posterior Tibial Nerve, Pathway, Anatomy

1. Tibial Nerve
By: Dr.Chaman Lal
B.S.PT, PPDPT, Dip. in sports Injuries, MPPS(PAK),
PG in Clinical Electroneurophysiology (AKUH),
Registered.EEGT (USA),
Member of ABRET, AANEM & ASET (USA).
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Posterior Tibial By Dr Chaman Lal (CK)

2. Posterior Tibial
 The tibial nerve also known as posterior
tibial nerve is the largest nerve branch of
sciatic division.
 The anterior divisions of L4 ,L5 ,S1,S2 & S3
unites to form Tibial Nerve.
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3. Tibial Nerve
Course:
 Descends through
popliteal fossa to
posterior compartment
of leg, accompanied
with posterior tibial
vessels.
 Passes deep to flexor
retinaculum (through
the tarsal tunnel,
behind medial
malleolus) to reach the
sole of foot where it
divides into 2 terminal 7/14/2022
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5. The popliteus
(L4,L5,S1) ,
muscle in the leg is
used to unlock the
knee by laterally
rotating the femur
on the tibia during a
closed chain
movement (such as
one with the foot in
contact with the
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7. In the popliteal
fossa the nerve
gives off
branches to
GASTROCNEMI
US , is involved
in standing,
walking, running
and jumping.
Along with the
soleus muscle it
forms the calf
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Lal (CK)

8. The soleus is
a powerful
muscle in the
back part of the
lower leg (the
calf). It runs
from just below
the knee to the
heel, and is
involved in
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9. Cont’d
Below the soleus muscle the tibial
nerve lies close to the tibia bone
and supplies the tibialis posterior,
the flexor digitorum longus and
the flexor hallucis longus.
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10.  Below the soleus
muscle the nerve
lies close to the
tibia and supplies
the Tibialis
posterior.
 The Tibialis
posterior is the
most center of all
the leg muscles.
 It is the key
stabilizing muscle
of the lower leg.
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11. Muscular
Branches
1. Muscles of posterior
compartment of leg
(Planter flexors of
ankle, Flexors of toes
2. Intrinsic muscles of
sole.
3. ONE Invertor of foot
(tibialis posterior).
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12. Flexor digitorum
longus is situated
on the tibial side of
the leg. At its origin
it is thin and
pointed, but it
gradually increases
in size as it
descends. This
muscle serves to
curl the second,
third, fourth, and
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Posterior Tibial By Dr Chaman
Lal (CK)

13. Flexor hallucis
longus.
(L5,S1,S2) The
Flexor hallucis
longus is situated
on the fibular side
of the leg. It arises
from the inferior
two-thirds of the
posterior surface
of the body of the
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14. Tibial nerve cont’d . . .
 The nerve passes into the foot running posterior
to the medial malleolus. Here it is bound down
by the flexor retinaculum in company with the
posterior tibial artery
 The tibial nerve, a major artery, veins, and
tendons travel in a bundle along this pathway,
through the tarsal tunnel.
 In the tunnel, the nerve splits into three different
paths. One nerve (calcaneal) continues to the
heel, the other two (medial plantar nerve and
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15. Cutaneous innervation
The sural nerve is joined by fibres
from tibial and common peroneal
nerve and runs down the calf to
supply the lateral and posterior skin
of the distal third of the leg .
The skin overlapping over the lateral
melleolus and lateral aspect of the
foot and little toe.
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17. Medial plantar nerve
 The medial planter nerve also gives off articular,
cutaneous and muscular branches.
 Cutaneous branches supplies skin of the sole, foot,
including the digit branches of the hallux, the seconds,
third and half of the fourth toe.
 Muscular branches supply the
 Abductor hallucis,
 Flexor digitorum brevis,
 Flexor brevis and
 First lumbrical.
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18. Sensory innervations Motor innervations
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19. Lateral Planter Nerve:-
 The lateral plantar nerve (external plantar nerve)
is a branch of the tibial nerve, in turn a branch of the
sciatic nerve and supplies the skin of the fifth toe and
lateral half of the fourth, as well as most of the deep
muscles, its distribution being similar to that of the
ulnar nerve in the hand.
 Muscular branches supply most deep muscles of
the foot including
 Flexor digitorium accessories
 Abductor digiti minimi( quinti)
 Flexor digiti minimi brevis
 Second to fourth lumbricals and adductor hallucis.
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22. Entrapment of tibial nerve:-
 Tarsal tunnel syndrome is caused by
compression of the tibial nerve or its b
ranches in the tarsal tunnel.
 The tibial nerve entrapment and injury in
the foot and ankle may be a source of
great pain and functional impairment.
 Tibial nerve problem In the foot and ankle
may cause difficulties with weight bearing
and non weight bearing activities, sleep
and footwear. 7/14/2022
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23. Motor Nerve Study:-
It is recorded from the abductor
hallucis muscle.
It is stimulated from the ankle and
knee.
The normative values are 5.8msec
for distal latencies, 41msec for the
conduction velocity, 4mV for the
amplitudes and 56msec for the F-
wave latencies. 7/14/2022
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26. Anatomical Path of Mixed Planter
Nerves
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Posterior Tibial By Dr Chaman
Lal (CK)

27. Mixed Planter recording
Technique.
Medial planter Mixed Nerve-
 Recording Electrodes are placed at medial
ankle.
 Site: G1 placed above and posterior to the
medial malleolus.
 G2 placed 3-4cm proximally.
 G 3 in between active recording and
stimulating electrodes.
 Distance:- Distance between recording
and stimulating electrode should be 14 cm.
 Stimulation: Stimulate while placing
cathode at the base of big toe.
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28. Medial planter sensory stimulation
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29. Lateral planter Mixed Nerve
study
Lateral planter Mixed study :-
 Recording Electrodes are placed at medial
ankle.
 Site: G1 placed above and posterior to the
medial malleolus.
 G2 placed 3-4cm proximally.
 G 3 in between active recording and
stimulating electrodes.
 Distance:- Distance between recording
and stimulating electrode should be 14 cm.
 Stimulation: Stimulate while placing
cathode at the base of little toe. 7/14/2022
29 Posterior Tibial By Dr Chaman Lal (CK)

30. Lateral planter sensory stimulation
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31. A smile is an inexpensive
way to improve your looks.
Thanks
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31 Posterior Tibial By Dr Chaman Lal (CK)