Tibial nerve

Question 1

Anatomical course

Answer 1

Arises at apex of popliteal fossa.
Within the popliteal fossa, it gives off branches to superficial posterior leg and branches that contribute to the sural nerve which innervates the posterolateral leg.
Descends posterior to tibia, supplying deep posterior leg.
At the foot, it passes posterior and inferior to medial malleolus through the tarsal tunnel. Within the tunnel, branches arise that supply cutaneous Innervation to heel.
Immediately distal to tarsal tunnel, the tibial nerve terminates by dividing into sensory branches that innervate the sole of the foot.

Question 2

What is tarsal tunnel syndrome

Answer 2

Tibial nerve is compressed within the tarsal tunnel (posterior to medial malleolus)

Question 3

Causes of tarsal tunnel syndrome

Answer 3

Osteoarthritis,
Rheumatoid arthritis,
Post trauma ankle deformities

Question 4

Presentation of tarsal tunnel syndrome

Answer 4

Paresthesia in ankle and sole of foot, which can radiate up the leg
It’s aggravated by activity and relieved by rest

Question 5

Treatment of tarsal tunnel syndrome

Answer 5

Anti Inflammatory drugs and changes in footwear.

If unsuccessful, flexor retinaculum can be surgically cut to release the pressure

Question 6

Motor Innervation

Answer 6

Deep posterior leg - Popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
Superficial posterior leg - plantaris, soleus, gastrocnemius

Question 7

What branches give sensory Innervation to the sole of the foot

Answer 7

Medial calcaneal branches - arise within tarsal tunnel and innervates skin over heel
Medial plantar nerve - skin over plantar surface of medial 3.5 digits and associated sole
Lateral plantar nerve - skin over plantar surface of lateral 1.5 digits and associated sole

Question 8

What forms the sural nerve

Answer 8

Cutaneous branches of tibial nerve that arise in the popliteal fossa combine with branches from the common fibular nerve

Question 9

Sensory Innervation of sural nerve

Answer 9

Skin over posterolateral leg

Lateral side of foot

Question 10

Nerve roots

Answer 10

L4-S3

Question 11

How does damage to tibial nerve occur

Answer 11

Rare
Direct trauma
Entrapment through narrow space
Compression for long period

Question 12

Consequences of damage

Answer 12

Loss of plantar flexion and flexion of toes 
Weakened inversion (tibialis anterior still inverts foot)