Posted: 3/8/2022
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Tibial Nerve Anatomy Animation USMLE Step 1 : Origin, Course, Branches, Tarsal tunnel syndrome

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Tibial Nerve Anatomy Animation: Origin, Course, Branches, Tarsal tunnel syndrome
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The tibial nerve is a major peripheral nerve of the lower limb. It has several cutaneous and motor functions in the leg and foot.

In this video, we shall look at the anatomy of the tibial nerve – its anatomical course, functions, and clinical correlations.

Nerve roots: L4-S3
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Sensory: Innervates the skin of the posterolateral leg, lateral foot, and the sole of the foot.
Motor Innervates the posterior compartment of the leg and the majority of the intrinsic foot muscles.

Anatomical Course
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The tibial nerve is a branch of the sciatic nerve, and arises at the apex of the popliteal fossa. It travels through the popliteal fossa, giving off branches to muscles in the superficial posterior compartment of the leg. Here, the tibial nerve also gives rise to branches that contribute towards the sural nerve, which innervates the posterolateral aspect of the leg.

The tibial nerve continues its course down the leg, posterior to the tibia. During its descent, it supplies the deep muscles of the posterior leg.

At the foot, the nerve passes posteriorly and inferiorly to the medial malleolus, through a structure known as the tarsal tunnel. This tunnel is covered superiorly by the flexor retinaculum. Within this tunnel, branches arise from the tibial nerve to supply cutaneous innervation to the heel

Immediately distal to the tarsal tunnel, the tibial nerve terminates by dividing into sensory branches, which innervate the sole of the foot.

Motor Functions
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The tibial nerve innervates the muscles of the posterior leg and the majority of the intrinsic foot muscles.

Posterior Compartment of the Leg
The muscles of the posterior compartment of the leg are organised into a superficial and deep compartment. They are all innervated by the tibial nerve.

Superficial:
Plantaris – plantarflexion of the ankle.
Soleus – plantarflexion of the ankle.
Gastrocnemius – flexion of the knee and plantarflexion of the ankle.
Deep:
Popliteus – “unlocks” the knee by laterally rotating the femur on the tibia.
Flexor hallucis longus – flexion of the great toe and plantarflexion of of the ankle
Flexor digitorum Longus – flexion of digits 2-5 and plantarflexion of the ankle.
Tibialis posterior – inversion of the foot and plantarflexion of the ankle.

Intrensic foot
The medial and lateral plantar branches of the tibial nerve provide innervation to all the intrinsic muscles of the foot (exept the extensor digitorum brevis, which is innervated by the deep fibular nerve).

Sensory Functions
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In the popliteal fossa, the tibial nerve gives off cutaneous branches. These combine with branches from the common fibular nerve to form the sural nerve. This sensory nerve innervates the skin of the posterolateral side of the leg and the lateral side of the foot.

The tibial nerve also supplies all the sole of the foot via three branches:

Medial calcaneal branches: These arise within the tarsal tunnel, and innervate the skin over the heel.
Medial plantar nerve: Innervates the plantar surface of the medial three and a half digits, and the associated sole area.
Lateral plantar nerve: Innervates the plantar surface of the lateral one and a half digits, and the associated sole area.

Tarsal tunnel syndrome
Compression of the tibial nerve or its terminal branches will lead to an entrapment syndrome known as tarsal tunnel syndrome. This syndrome results in pain and sensory disturbances that affects the sole of the foot, and can cause palsies of the intrinsic foot muscles. This can also result from severe nerve trauma connected to fractures of the tibial shaft or medial malleolus.

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