0:00

The tibial nerve, uh, will, uh,

0:03

supply all the posterior compartment muscles of the calf

0:07

and the majority of the motor innovation of the foot

0:10

and sensation to the sole of the foot.

0:12

It travels with the posterior tibial artery

0:15

and vein approximately in the calf.

0:17

It's between the mul and lateral head of the gastroc muscle,

0:20

and more distally will become deep to the,

0:24

uh, soleus muscle.

0:26

Because of its deep location, it's rare to have, uh,

0:30

entrapment neuropathies of the tibial nerve

0:32

because it's relatively protected.

0:35

This is, uh, uh, uh, 25-year-old athlete

0:39

who had deep calf pain that was interfering with his, uh,

0:44

game and a DVT study was negative.

0:47

And on MRI, you can see the cystic, uh,

0:50

structure in the popal fossa,

0:52

which was elongated here on the sagittal images.

0:55

On the coronal images, it, it was sending a little, uh,

0:58

tail laterally,

1:00

and that was actually communicating with the, uh,

1:03

proximal tibial fibrillary joint.

1:05

So this, uh, he had surgery

1:08

and this was a tibial intra intraoral ganglion cyst.

1:11

Much less common than the intraoral ganglion cyst

1:15

that we see in the recurrent branch

1:17

of the common perineal nerve.

1:20

The tibial nerve, uh, as at the level of the ankle.

1:23

Some people call it the posterior tibial nerve.

1:26

So this it as it enters the tarsal tunnel.

1:29

It's a fibro osseous canal that contains the flexor tendons,

1:34

the artery and vein, and the tibial nerve.

1:38

And it's a site where it can be compressed

1:41

in the inferior aspect of the tarsal tunnel.

1:44

The tibial nerve will divide, will trifurcate into a medial

1:48

and lateral plantar branches

1:50

and a medial, uh, calcaneal branch.

1:54

This is a patient who had a burning sensation along the,

1:58

uh, sole of the foot.

2:00

And on MRI you could see some scar tissue in the expected

2:04

location of the tibial nerve.

2:05

Now, the tibial nerve can also be compressed by, uh,

2:08

a hematoma or ganglion s varicosities

2:12

or, um, a tumor.

2:15

And, uh, one thing to consider also are,

2:18

uh, accessory muscles.

2:20

So this is an accessory, uh, the flexor

2:23

accessory's longest muscle, uh, within the tarsal tunnel

2:27

that crowds the structures of the tarsal tunnel.

2:29

And this is easy to overlook

2:31

because it's a muscle that has a normal single intensity,

2:36

and you can follow it here more distally.

2:39

So patients with these, with accessory muscles, uh, can, uh,

2:44

become symptomatic if there is a secondary process

2:47

that happens like an injury or tight footwear

2:51

and then they become, uh, symptomatic.

2:54

This is another example of a patient

2:56

who had a low line soleus,

2:59

A very fleshy and robust, uh, soleus muscle.

3:03

And you can see how it crowds the, uh,

3:05

structures in the tarsal tunnel.

3:08

So the tip nerve will trifurcate in the middle calcaneal

3:12

nerve medial plantar nerve and lateral plantar nerve.

3:16

The middle plantar nerve will supply only four muscles, uh,

3:20

the abductor lysis

3:21

and flexor Dior brevis muscles proximally,

3:24

and the flexor lysis brevis

3:26

and first lumbar co more distally.

3:28

And it'll provide sensory innovation

3:31

to the medial aspect of the foot.

3:34

The lateral plantar nerve will innerate all the remaining

3:37

muscles of the foot

3:38

and it will give rise to an important, uh, nerve.

3:41

The inferior calcaneal nerve

3:43

or Baxter nerve,

3:44

which will supply the abductor GT minimal muscle.

3:47

And the, uh, lateral plantar nerve will give a sense

3:51

sensation to the lateral, uh, midfoot and forefoot.

3:54

So this drawing shows the territory of innervation, uh,

4:00

of this, uh, plantar aspect of the foot.

4:02

So the medial plantar nerve here, the lateral plantar nerve,

4:05

and a narrow band laterally provided by the sal nerve.