What is the anatomy of the tibial nerve relevant to a posterior tibial nerve block?

Updated: Jun 14, 2018
  • Author: Heather Tassone, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

Understanding the arborization of the tibial nerve is crucial to a successful posterior tibial nerve block. [7, 8] The posterior tibial nerve arises from the sciatic nerve and courses down the posterior thigh and posteromedial lower leg, as shown in the image below.

The posterior tibial nerve courses down the poster The posterior tibial nerve courses down the posterior calf.

These nerves supply the intrinsic muscles of the foot, excluding the extensor digitorum brevis. They also supply sensory innervation to the plantar surface of the foot, as shown in the images below.

Medial and lateral plantar nerves after branching Medial and lateral plantar nerves after branching from the posterior tibial nerve.
Cutaneous innervation by the medial and lateral br Cutaneous innervation by the medial and lateral branches of the posterior tibial nerve.

At the level of ankle, the posterior tibial nerve can be found midway between the medial malleolus and the heel. [9] The nerve lies beneath the flexor retinaculum between merging tendons and vessels, which have an anterior to posterior progression of tibialis posterior tendon, flexor digitorum tendon, posterior tibial artery, posterior tibial nerve, and flexor hallucis longus tendon (see the image below).

The tibialis posterior tendon, flexor digitorum te The tibialis posterior tendon, flexor digitorum tendon, posterior tibial artery, posterior tibial nerve, and flexor hallucis longus tendon at the ankle level.

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