Posterior Tibial By Dr. Chaman Lal (CK).ppt

Posterior Tibial Nerve, Pathway, Anatomy

1. TibialNerve
By: Dr.Chaman Lal
B.S.PT, PPDPT, Dip. in sports Injuries, MPPS(PAK),
PG in Clinical Electroneurophysiology (AKUH),
Registered.EEGT (USA),
Member of ABRET, AANEM & ASET (USA).
1 7/14/2022Posterior Tibial By Dr Chaman Lal (CK)

2. Posterior Tibial
Thetibialnervealsoknownasposterior
tibialnerveisthelargestnervebranchof
sciaticdivision.
TheanteriordivisionsofL
4,L
5,S
1,S
2&S
3
unitestoformTibialNerve.
7/14/20222 Posterior Tibial By Dr Chaman Lal (CK)

3. Tibial Nerve
Course:
Descends through
popliteal fossa to
posterior compartment
of leg, accompanied
with posterior tibial
vessels.
Passes deep to flexor
retinaculum(through
the tarsal tunnel,
behind medial
malleolus) to reach the
sole of footwhere it
divides into 2 terminal
branches (Medial &
7/14/20223 Posterior Tibial By Dr Chaman Lal (CK)

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5. Thepopliteus
(L4,L5,S1),
muscleinthelegis
usedtounlockthe
kneebylaterally
rotatingthefemur
onthetibiaduringa
closed chain
movement(suchas
onewiththefootin
contactwiththe
ground).
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7. In the popliteal
fossa the nerve
gives off
branches to
GASTROCNEMI
US, is involved
in standing,
walking, running
and jumping.
Along with the
soleus muscle it
forms the calf
muscle.
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8. Thesoleusis
a powerful
muscleinthe
backpartofthe
lowerleg(the
calf).Itruns
fromjustbelow
thekneetothe
heel,andis
involved in
standing &
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9. Cont’d
Belowthesoleusmusclethetibial
nerveliesclosetothetibiabone
andsuppliesthetibialisposterior,
theflexordigitorumlongusand
theflexorhallucislongus.
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10. Below the soleus
muscle the nerve
lies close to the
tibia and supplies
the Tibialis
posterior.
The Tibialis
posterioris the
most center of all
the leg muscles.
It is the key
stabilizing muscle
of the lower leg.
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11. Muscular
Branches
1.Muscles of posterior
compartment of leg
(Planter flexors of
ankle, Flexors of toes
2.Intrinsic muscles of
sole.
3.ONE Invertor of foot
(tibialis posterior).
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12. Flexor digitorum
longusis situated
on the tibial side of
the leg. At its origin
it is thin and
pointed, but it
gradually increases
in size as it
descends. This
muscle serves to
curl the second,
third, fourth, and
fifth toes (flexion of
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13. Flexor hallucis
longus.
(L5,S1,S2)The
Flexor hallucis
longus is situated
on the fibular side
of the leg. It arises
from the inferior
two-thirds of the
posterior surface
of the body of the
fibula, with the
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14. Tibial nerve cont’d . . .
Thenervepassesintothefootrunningposterior
tothemedialmalleolus.Hereitisbounddown
bytheflexorretinaculumincompanywiththe
posteriortibialartery
Thetibialnerve,amajorartery,veins,and
tendonstravelinabundlealongthispathway,
throughthetarsaltunnel.
Inthetunnel,thenervesplitsintothreedifferent
paths.Onenerve(calcaneal)continuestothe
heel,theothertwo(medialplantarnerveand
lateralplantarnerve)continueontothebottom
ofthefoot.
7/14/202214 Posterior Tibial By Dr Chaman Lal (CK)

15. Cutaneous innervation
Thesuralnerveisjoinedbyfibres
fromtibialandcommonperoneal
nerveandrunsdownthecalfto
supplythelateralandposteriorskin
ofthedistalthirdoftheleg.
Theskinoverlappingoverthelateral
melleolusandlateralaspectofthe
footandlittletoe.
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17. Medial plantar nerve
The medial planter nerve also gives off articular,
cutaneous and muscular branches.
Cutaneous branches supplies skin of the sole, foot,
including the digit branches of the hallux, the seconds,
third and half of the fourth toe.
Muscular branches supply the
Abductor hallucis,
Flexor digitorum brevis,
Flexor brevis and
First lumbrical.
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18. Sensory innervations Motorinnervations
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19. Lateral Planter Nerve:-
Thelateralplantarnerve(externalplantarnerve)
isabranchofthetibialnerve,inturnabranchofthe
sciaticnerveandsuppliestheskinofthefifthtoeand
lateralhalfofthefourth,aswellasmostofthedeep
muscles,itsdistributionbeingsimilartothatofthe
ulnarnerveinthehand.
Muscularbranchessupplymostdeepmusclesof
thefootincluding
Flexordigitoriumaccessories
Abductordigitiminimi(quinti)
Flexordigitiminimibrevis
Secondtofourthlumbricalsandadductorhallucis.
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22. Entrapment of tibial nerve:-
Tarsaltunnelsyndromeiscausedby
compressionofthetibialnerveoritsb
ranchesinthetarsaltunnel.
Thetibialnerveentrapmentandinjuryin
thefootandanklemaybeasourceof
greatpainandfunctionalimpairment.
TibialnerveproblemInthefootandankle
maycausedifficultieswithweightbearing
andnonweightbearingactivities,sleep
andfootwear.
7/14/202222 Posterior Tibial By Dr Chaman Lal (CK)

23. Motor Nerve Study:-
Itisrecordedfromtheabductor
hallucismuscle.
Itisstimulatedfromtheankleand
knee.
Thenormativevaluesare5.8msec
fordistallatencies,41msecforthe
conductionvelocity,4mVforthe
amplitudesand56msecfortheF-
wavelatencies. 7/14/202223 Posterior Tibial By Dr Chaman Lal (CK)

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26. Anatomical Path of Mixed Planter
Nerves
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27. Mixed Planter recording
Technique.
MedialplanterMixedNerve-
RecordingElectrodesareplacedatmedial
ankle.
Site:G1placedaboveandposteriortothe
medialmalleolus.
G2placed3-4cmproximally.
G3inbetweenactiverecordingand
stimulatingelectrodes.
Distance:-Distancebetweenrecording
andstimulatingelectrodeshouldbe14cm.
Stimulation:Stimulatewhileplacing
cathodeatthebaseofbigtoe.
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28. Medial planter sensory stimulation
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29. Lateral planter Mixed Nerve
study
LateralplanterMixedstudy:-
RecordingElectrodesareplacedatmedial
ankle.
Site:G1placedaboveandposteriortothe
medialmalleolus.
G2placed3-4cmproximally.
G3inbetweenactiverecordingand
stimulatingelectrodes.
Distance:-Distancebetweenrecording
andstimulatingelectrodeshouldbe14cm.
Stimulation:Stimulatewhileplacing
cathodeatthebaseoflittletoe. 7/14/202229 Posterior Tibial By Dr Chaman Lal (CK)

30. Lateral planter sensory stimulation
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31. A smile is an inexpensive
way to improve your looks.
Thanks
7/14/202231 Posterior Tibial By Dr Chaman Lal (CK)