MSK - The Tibial Nerve

Question 1

What are the nerve roots of the Tibial Nerve?

Answer 1

L4-S3

Question 2

What are the sensory innervations of the tibial nerve?

Answer 2

Innervates the skin of the posterolateral side of the leg, lateral side of the foot, and the sole of the foot

Question 3

What are the motor innervations of the tibial nerve?

Answer 3

Innervates the posterior compartment of the leg

Question 4

The tibial nerve arises at what landmark of the lower limb?

It is a branch of what nerve?

Answer 4

Popliteal Fossa

Sciatic Nerve

Question 5

As the tibial nerve travels through the popliteal fossa, it gives off branches to what muscle group and nerve?

Answer 5

Muscles in the superficial posterior compartment of the leg

Gives rise to branches that contribute towards the sural nerve, which innervates the posterolateral aspect of the leg

Question 6

As the tibial nerve continues its course down the leg posterior to the tibia it supplies what group of muscles?

Answer 6

Deep muscles of the posterior leg

Question 7

At the foot, the tibial nerve passes what bony landmark and through what structure?

Answer 7

Passes posteriorly and inferiorly to the medial malleolus, through a structure known as the tarsal tunnel

Question 8

What is the tarsal tunnel covered by?

What arises in the tunnel from the tibial nerve?

Answer 8

Flexor Retinaculum

Branches arise from the tibial nerve to supply cutaneous innervation to the heel

Question 9

How and where does the tibial nerve terminate?

Answer 9

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

Question 10

What is tarsal tunnel syndrome?

Answer 10

Where the tibial nerve is compressed within the tarsal tunnel

Question 11

What are the three main causes of tarsal tunnel syndrome?

Answer 11

Osteoarthritis

Rhuematoid arthritis

Post-trauma ankle deformities

Question 12

How does tarsal tunnel syndrome clinically present?

How is it aggrevated and relieved?

Answer 12

Patients complain of paresthesia in the ankle and sole of the foot, which can radiate up the leg slightly

Aggrevated by activity

Relieved by rest

Question 13

What are the non-surgical treatment options of tarsal tunnel syndrome?

Answer 13

Can be treated conservatively by anti-inflammatory drugs and changes in footware

Question 14

What are the surgical treatment options of tarsal tunnel syndrome?

Answer 14

Cutting of the flexor retinaculum which relieves the pressure

Question 15

The tibial nerve innervates all muscles of the posterior compartment of the leg

What muscles are in the deep compartment?

Answer 15

Popliteus

Flexor Hallucis Longus

Flexor digitorum Longus

**Tibialis Posterior **

Question 16

The tibial nerve innervates all muscles of the posterior compartment of the leg

What muscles are in the superficial compartment?

Answer 16

Plantaris

Soleus

Gastrocnemius

Question 17

Where does the tibial nerve give off cutaneous branches?

These branches combine with branches of the common fibular nerve to form what nerve?

Answer 17

Popliteal fossa

The Sural Nerve

Question 18

What is the sensory innervation of the sural nerve?

Answer 18

Skin of the posterolateral side of the leg and the lateral side of the foot

Question 19

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

Answer 19

Medial calcaneal branches

Medial Plantar Nerve

Lateral Plantar Nerve

Question 20

Where do the medial calcaneal branches arise and where do they innervate?

Answer 20

Arise within the tarsal tunnel, and innervate the skin over the heel

Question 21

Where does the medial plantar nerve innervate?

Answer 21

Innervates the plantar surface of the medial three and a half digits, and the associated sole area

Question 22

Where does the lateral medial nerve innervate?

Answer 22

Innervates the plantar surface of the lateral one and a half digits, and the associated sole area

Question 23

Label the cutaneous innervation to the sole of the foot

Answer 23

Question 24

How might damage to the tibial nerve arise?

Answer 24

Direct trauma

Entrapment through narrow space

Compression for long period of time

Question 25

How would damage to the tibial nerve clinically present?

Answer 25

Loss of plantar flexion, loss of flexion of toes and weakened inversion (The tibialis anterior can still invert the foot)