The posterior tibial nerve

It is the distal side of the tibial nerve because it moves around the medial malleolus within the tarsal tunnel. Anatomically, the arrangement could be a continuation of its parent leg bone nerve in a particular region of the distal extremity. It doesn't represent a constituent of the tibial nerve or a unique structure. Consequently, some texts can refer to it because of the tibial nerve. Moreover, there's no anterior extent nerve at the amount of the foot or ankle joint. However, thanks to its clinical significance, several authors and texts seek advice from the structure because of the posterior tibial nerve. The tibial nerve is each a motor and sensory nerve and is the most essential distal extension of the is and could be a branch of the lumbosacral plexus carrying spinal roots L4, L5, S1, S2, and S3. within the distal thigh, the tibial nerve splits from the sciatic nerve, passes through the popliteal fossa, runs underneath the arch of the soleus, and continues distally on its undersurface to finally descend posterior to the medial malleolus, where it earns the distinction of the posterior tibial nerve, and into the foot as the medial and lateral plantar branches. The posterior tibial nerve will be simply entrapped in tarsal tunnel syndrome and may be controlled with anesthesia to provide nerve blockade

The posterior tibial nerve could be a combined motor and sensory nerve and goes around the medial malleolus and underneath the flexor retinacula within the tarsal tunnel. Distal to the medial malleolus, it divides into its terminal branches: lateral plantar, medial plantar, and calcaneal. These branches give sensory innervation to the plantar foot: the first calcaneal branch provides the medial region heel whereas the medial and lateral region nerves innervate the remainder of the sole. Proximally, the articular branch of its origin, the tibial nerve, bears sensory data from the knee joint, and the sural nerve branch, which runs distally with the small saphenous vein and anastomoses with a peroneal nerve branch, terminates because the lateral dorsal cutaneous nerve of the foot with this distal portion being a vicinity of the posterior tibial nerve. Motor innervation by the posterior leg bone nerve gets directed to the intrinsic plantar musculature. Specifically, the medial branch innervates the first lumbrical, flexor hallucis brevis, flexor digitorum brevis, and abductor hallucis, whereas the lateral branch provides the plantar muscles of the foot. The posterior tibial nerve isn't accountable for any reflexes

The tibial nerve provides motor innervation to the deep muscles of the posterior leg. Muscles innervated are the gastrocnemius, popliteus, soleus, tibialis posticus, tibialis posterior digitorum longus, flexor hallucis longus, abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, foot lumbricals, quadratus plantae, flexor digiti minimi, adductor hallucis, foot interossei, abductor digiti minimi. The posterior tibial nerve as a distinguishable entity delivers motor innervation to the intrinsic muscles of the plantar foot.

Tarsal tunnel syndrome conjointly referred to as posterior tibial nerve neuralgia or tibial nerve pathology refers to an entrapment neuropathy of the posterior tibial nerve at intervals in the network of the tarsal tunnel that is found inferior and posterior to the medial malleolus. The contents of the tarsal tunnel are the tendons of the posterior tibialis, flexor digitorum longus, and flexor hallucis longus muscles alongside the posterior tibial artery, vein, and nerve (L4-S3). The causes of this syndrome divide into either extrinsic causes as well as post-surgical scarring, valgus or varus hindfoot, diabetes, lower extremity edema, poorly fitting shoes, trauma, or intrinsic causes. The clinical manifestations occur thanks to compression of the posterior tibial nerve or its distal branches (the lateral or medial plantar nerve), and therefore the designation is clinical. Pain is often remarked directly over the tarsal tunnel and radiates to the plantar foot’s arch. it's commonplace for the pain to present as shooting or sharp with accompanying plantar numbness and/or paresthesia on the course of the posterior tibial nerve or pain with eversion or flexion. Management is variable counting on the cause and may be cured by operative or nonoperative solutions.

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9- image contributed from Ozari's Kinesiotherapy Clinic