The tibial nerve is a branch of the

sciatic nerve The sciatic nerve, also called the ischiadic nerve, is a large nerve in humans and other vertebrate animals which is the largest branch of the sacral plexus and runs alongside the hip joint and down the lower limb. It is the longest and widest si ...

. The tibial nerve passes through the

popliteal fossa The popliteal fossa (also referred to as hough, ">/sup> or kneepit in analogy to the cubital fossa) is a shallow depression located at the back of the knee joint. The bones of the popliteal fossa are the femur and the tibia. Like other flexion ...

to pass below the arch of soleus.

Structure

Popliteal fossa

The tibial nerve is the larger terminal branch of the sciatic nerve with root values of L4, L5, S1, S2, and S3. It lies superficial (or posterior) to the popliteal vessels, extending from the superior angle to the inferior angle of the

, crossing the popliteal vessels from lateral to medial side. It gives off branches as shown below: * Muscular branches - Muscular branches arise from the distal part of the popliteal fossa. It supplies the medial and lateral heads of

gastrocnemius The gastrocnemius muscle (plural ''gastrocnemii'') is a superficial two-headed muscle that is in the back part of the lower leg of humans. It runs from its two heads just above the knee to the heel, a three joint muscle (knee, ankle and subtalar ...

, soleus, plantaris and popliteus muscles. Nerve to popliteus crosses the popliteus muscle, runs downwards and laterally, winds around the lower border of the popliteus to supply the deep (or anterior) surface of the popliteus. This nerve also supplies the tibialis posterior muscle,

superior tibiofibular joint The proximal tibiofibular articulation (also called superior tibiofibular joint) is an arthrodial joint between the lateral condyle of the tibia and the head of the fibula. The contiguous surfaces of the bones present flat, oval facets cover ...

tibia The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it connects ...

bone, interosseous membrane of leg, and the

inferior tibiofibular joint The distal tibiofibular joint (tibiofibular syndesmosis) is formed by the rough, convex surface of the medial side of the distal end of the fibula, and a rough concave surface on the lateral side of the tibia. Below, to the extent of about 4 ...

. * Cutaneous branches - Tibial nerve also gives off a cutaneous nerve called the medial sural cutaneous nerve from the middle of the popliteal fossa and exits at the inferior angle. It supplies the skin of the lower half of the back of the leg and lateral border of the foot until the tip of the little toe. * Articular branches - There are three articular branches arises from the upper part of the fossa: superior medial genicular nerve (located on the surface of

medial condyle of femur The medial condyle is one of the two projections on the lower extremity of femur, the other being the lateral condyle. The medial condyle is larger than the lateral (outer) condyle due to more weight bearing caused by the centre of mass being ...

, middle genicular nerve (pierces the posterior capsule of the knee joint to supply the structures located in the intercondylar notch of the femur, and inferior genicular nerve (runs along the upper border of the popliteus to reach the medial condyle of tibia).

Back of the leg

At the inferior angle of the popliteal fossa, tibial nerve passes deep to the tendinous arch of soleus to enter the back of the leg. In the leg, it runs downwards and medially to reach the posteromedial side of the ankle, midway between the

medial malleolus A malleolus is the bony prominence on each side of the human ankle. Each leg is supported by two bones, the tibia on the inner side (medial) of the leg and the fibula on the outer side (lateral) of the leg. The medial malleolus is the promi ...

and medial tubercle of the calcaneum. It terminates deep to the flexor retinaculum at the origin of the abductor hallucis by dividing into medial and lateral plantar nerves to supply the foot. The tibial nerve gives off several branches to supply the back of the leg: * Muscular branches - Supplies tibialis posterior, flexor digitorum longus,

flexor hallucis longus The flexor hallucis longus muscle (FHL) is one of the three deep muscles of the posterior compartment of the leg that attaches to the plantar surface of the distal phalanx of the great toe. The other deep muscles are the flexor digitorum longus ...

, and deep part of soleus. * Cutaneus branches - The medial calcaneal nerve pierces the flexor retinaculum to supply the skin of the back and lower surface of the heel. * Articular branches - Supplies the ankle joint

Foot

In the foot, the nerve terminates by dividing into medial and lateral plantar branches. * Medial plantar nerve - It is the larger terminal branch of the tibial nerve. It passes between the abductor hallucis and flexor digitorum brevis to divide further into branches. Its distribution resembles to that of the distribution of

median nerve The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus. The median nerve originates from the lateral and medial cords of the brachial plexus, and has contr ...

in the hand. Its muscular branches supply the abductor hallucis, the flexor digitorum brevis, the flexor hallucis brevis and the first lumbrical. Cutaneous distribution of the medial plantar nerve supplies the medial sole and medial three and one half toes through four digital branches. Each digital branch give off a dorsal branch to supply the nail beds on the dorsum. This nerve also gives off articular branches to supply the bones of the tarsus and metatarsus. * Lateral plantar nerve - It is the smaller terminal branch of the tibial nerve. It courses laterally and forward until the base of fifth metatarsal bone, where it divides into superficial and deep branches. Its distribution resembles to the distribution of

ulnar nerve In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is c ...

in the hand. The main trunk of the nerve supplies two muscles: flexor digitorum accessorius and abductor digiti minimi. This nerve also supplies the skin of the sole. The ''superficial branch'' is divided into medial and lateral branches. The lateral branch supplies three muscles: flexor digiti minimi, 3rd and 4th

interossei {{short description, Muscles between certain bones Interossei refer to muscles between certain bones. There are many interossei in a human body. Specific interossei include: On the hands * Dorsal interossei muscles of the hand * Palmar inteross ...

, and the skin over the lateral side of the toe. The medial branch communicates with the medial plantar nerve and supplies the skin over the fourth interdigital cleft. The ''deep branch'' supplies the 2nd, 3rd, and 4th lumbricals, first and second plantar interossei and adductor hallucis.

Clinical Significance

Damage to the tibial nerve is rare, and is often a result of direct trauma, entrapment through narrow space or compression for long period of time. Damage results in loss of plantar flexion, loss of flexion of toes and weakened inversion (The tibialis anterior can still invert the foot).

Additional images

File:Tibial nerve.jpg, Tibial nerve File:Gray440_color.png, Cross-section through middle of left calf File:Gray826and831.svg, Cutaneous nerves of the right lower extremity. Front and posterior views File:Gray834.svg, Diagram of the segmental distribution of the cutaneous nerves of the sole of the foot File:Sacral plexus schematic.svg, A schematic of the sacral plexus with the origin of the tibial nerve shown (labeled at the bottom left) File:Tibial and fibular nerve.jpg, Tibial nerve File:Slide5i.JPG, Tibial nerve File:Slide6j.JPG, Tibial nerve

References

External links

* {{Authority control Nerves of the lower limb and lower torso