For the purposes of this review, we will follow the course of the posterior tibial nerve.
For the purposes of this review, we will follow the course of the posterior tibial nerve. The tibial nerve originates from L4-S3 and is a division of the sciatic nerve. The tibial nerve will course through the posterior thigh, through the popliteal fossa, and finally under the soleus until it reaches the foot.
The four distal branches of the tibial nerve are the medial plantar nerve, lateral plantar nerve, inferior branch of lateral plantar nerve, and medial calcaneal nerve. Due to the large area of distribution of the tibial nerve and its branches, there are many locations where the nerve can become entrapped. As a result, entrapment neuropathy can cause a wide constellation of symptoms.
The difficulty in diagnosis for providers lies in teasing out whether the etiology of foot pain is due to an entrapment neuropathy or one of a wide variety of other pathologies affecting the foot like plantar fasciitis. This review will focus on the tibial nerve and its most commonly affected branches. Tarsal Tunnel Syndrome The tarsal tunnel is the distal portion of the deep posterior compartment of the lower extremity and is located behind the medial malleolus.
There are two tarsal tunnel syndromes, with one being anterior tarsal tunnel syndrome and the other known as the tarsal tunnel syndrome. Anterior tarsal tunnel syndrome is due to compression of the deep peroneal nerve and the tarsal tunnel syndrome is due to compression of the posterior tibial nerve. Most commonly, the posterior tibial nerve is compressed at the level of the medial malleolus as it passes under the flexor retinaculum.
The role of the posterior tibial nerve is to innervate the muscles of the foot and provide sensation to the plantar surface. Compression of the nerve can occur due to bone spurs, fractures, ganglia cysts, tumors, or foot deformities. Foot deformities, like having a hindfoot valgus, can also stretch the tibial nerve causing symptoms.
If you are experiencing symptoms that may be related to common entrapment neuropathies of the lower extremity, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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