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2. W H A T ’ S I N S I D E
• Introduction
• Origin and course
• Innervation
• Roots
• Motor level functions
• Sensory level functions
• Clinical relevance
• Tarsal tunnel syndrome in detail

3. I N T R O D U C T I O N
• The tibial nerve is the
larger terminal branch
of the two main
muscular branches of
the sciatic nerve

4. O R I G I N A N D C O U R S E
The tibial nerve typically arises in the lower third of the posterior thigh as the
larger terminal branch of the sciatic nerve, close to the apex of the popliteal
fossa
tibial nerve descends through the popliteal fossa, lateral to the popliteal
vessels. As the nerve approaches the distal aspect of the popliteal fossa, it
becomes medial to the popliteal vessels and passes deep to heads of the
gastrocnemius muscle

5. I N N E R V A T I O N
• The tibial nerve provides innervation to the muscles of the lower leg and
foot. triceps surae (the two headed gastocnemius and soleus), plantaris,
Popliteus, tibialis posterior, flexor digitorum longus and flexor hallucis
longus. also has articular and cutaneous branches

7. R O O T S
• Roots arises from Last two lumbar vertebrae and first three sacral
vertebrae
• The roots are from ventral part of the as mentioned above
• The root value is L4 L5 S1 S2 & S3
• Arises from sacas we see brachial plexus in upper limb

8. M O T O R L E V E L F U N C T I O N S
• At the popliteal fossa, branches of the tibial nerve supply medial and lateral
heads of gastrocnemius, soleus, plantaris and popliteus muscles. The
popliteus branch goes on to supply tibialis posterior muscle, superior and
inferior tibiofibular joint, tibiaand the interosseous membrane of leg
• Posterior branches of the tibial nerve supply tibialis posterior, flexor
digitorum longus, flexor hallucis longus, and deep part of soleus.

9. S E N S O R Y L E V E L F U N C T I O N S
Branches of the tibial nerve supply sensory innervation to the following:
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.

10. C L I N I C A L R E L E V A N C E : P O P L I T E A L F O S S A
I N J U R Y
• Popliteal fossa region. Injury may occur due to e.g.:
• Space occupying lesion
• Laceration injury
• Posterior dislocation of knee
• 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.[ This is requires surgical release and
has a good outcome.
• Fractures of the tibia and fibula.
• Local trauma to the posterior lower leg.

11. C L I N I C A L R E L E V A N C E I N J U R Y A T T H E M E D I A L
M A L L E O L U S L E V E L
• 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.
• Tibial nerve block done for certain operations of the foot

12. T A R S A L T U N N E L S Y N D R O M E ( T T S
Tarsal Tunnel Syndrome (TTS) is a rare compressive neuropathy of
the tibial nerve or one of its branches as they pass under the flexor
retinaculum
Symptoms include pain radiating into the foot, usually, this pain is worsened
by walking (or weight-bearing activities). An examination may reveal Tinel’s
sign over the tibial nerve at the ankle, weakness, and atrophy of the small
foot muscles or loss of sensation in the foot.[

13. The tarsal tunnel is a channel between the medial malleolus, talus, calcaneus and the flexor
retinaculum – a fibrous sheet that runs from the medial malleolus to the calcaneus. The tunnel
contains
• Tibialis posterior tendon
• Flexor digitorum longus tendon
• Posterior tibial artery & vein
• Tibial nerve (yellow in the image)
• Flexor hallucis longus tendon
The tibial nerve divides into two terminal branches - the medial and lateral plantar nerves - as it passes
through the tarsal tunnel. The medial calcaneal nerve branches from the tibial nerve at or superior to
the flexor retinaculum.

15. T I N E L ’ S S I G N & T E S T
Tinel's test is used to test for compression neuropathy, commonly in
diagnosing carpal tunnel syndrome.
It is performed by lightly tapping (percussing) over the nerve to elicit a
sensation of tingling or "pins and needles" in the distribution of the nerve.] The
Tinel sign is the tingling or prickling sensation elicited by the percussion of an
injured nerve trunk at or distal to the site of the lesion. The sign also indicates
nerve regeneration.
Positive test: The test is positive when a tingling or prickling sensation is felt
in the distribution of the nerve.