Tibial nerve

Tibial nerve of man

The tibial nerve ("shin nerve ") is one of the two main branches of the sciatic nerve .

Nerve course

On the thigh, the tibial nerve (or already the sciatic nerve) sends branches to some of the thigh muscles:

• Musculus biceps femoris (exclusively caput longum; caput breve is innervated by the N. peroneal (fibularis) communis )
• Semitendinosus muscle
• Semimembranosus muscle

Then it pulls to the hollow of the knee, from there to the calf between the heads of the gastrocnemius muscle and sends muscle branches for motor innervation:

• Gastrocnemius muscle
• Soleus muscle
• Plantaris muscle
• Popliteus muscle
• Musculus tibialis posterior (in animals: Musculus tibialis caudalis )
• Musculus flexor digitorum longus (in animals: Musculus flexor digitorum medialis )
• Musculus flexor hallucis longus (in animals: Musculus flexor digitorum lateralis ).

In animals it also innervates the flexor digitorum pedis superficialis muscle .

The continuous main stem of the tibial nerve is still a road to sensitive supply to the skin of the calf, the cutaneous nerve surae medialis (with animals: cutaneous nerve surae caudalis ), who with the communicating branch of the lateral sural cutaneous nerve to sural nerve united, and then pulls past the heel hump ( tuber calcanei ) to the sole of the foot. Since the sural nerve lies relatively superficially under the skin of the lower leg and removal results in only a slight loss of sensitivity, it is often used as an interposal to bridge larger nerve defects.

On the inside of the ankle, the nerve with the vena and arteria tibialis posterior runs through the tarsal tunnel and can be narrowed here ( tarsal tunnel syndrome ).

Division into two plantar nerves

The bifurcation, the division of the tibial nerve into the two foot branches, lies in the area of ​​the tarsal tunnel or below it

• Lateral plantar nerve and
• Medial plantar nerve .

This division is on average 1 - 2 cm above the tip of the inner malleolus in the tarsal tunnel, but can also take place up to 3 cm below or up to 14 cm above the tip of the inner ankle.

The plantar nerves take on the sensitive supply of the sole of the foot and the motor innervation of the short toe muscles. The nerve branches that run between the metatarsals to the toes can occasionally be affected by a neuralgia known as Morton's neuralgia ( interdigital neuralgia ).

Heel nerves

In the area of ​​the bifurcation of the tibial nerve in the two plantar nerves in the area of ​​the tarsal tunnel behind the medial ankle, several heel nerves also arise:

The inferior calcaneus nerve is usually laid out individually and in most cases arises as the first branch from the lateral plantar nerve. In about 10%, however, it arises higher directly from the tibial nerve. A joint departure of the inferior calcaneus nerve and the medial calcaneus nerve from the tibial nerve has also rarely been observed. The inferior calcaneus nerve usually runs medial to the quadratus plantae muscle and laterally of the abductor hallucis muscle , which it innervates, to the sole of the foot (plantarward). It then pivots laterally and runs below (plantar side) the medial process of the heel bone and above (dorsal) the flexor digitorum brevis muscle further towards the outside of the foot, where it usually innervates the abductor digiti minimi muscle . The sensitive innervation area of the nerve comprises the medial periosteum of the medial process of the calcaneus, the plantar fascia and the skin on the sole of the foot in the heel and metatarsal area as well as on the inner ankle . In the area of ​​the plantar fascia, a nerve compression syndrome can occur, which has been described as Baxter neuropathy , which is why the inferior calcaneus nerve is sometimes called "Baxter nerve" in English.

The medial calcaneus nerve is single in 38%, double in 46%, and rarely multiple. In the tarsal tunnel, it is usually behind and above the inferior calcaneus and is thicker. An anatomical study showed that 64% of the medial calcaneus nerve originates directly from the tibial nerve above the bifurcation, rarely directly at the level of the bifurcation, and 27% originates from the lateral plantar nerve. A range between 1 cm below and 3 cm above the tip of the inner malleolus was specified as the height of the separation. The nervus calcaneus medialis is usually a purely sensory nerve for the inside of the hindfoot and the longitudinal arch, without motor innervation. It rarely takes over the innervation of the abductor hallucis muscle , on which it runs superficially, from the inferior calcaneus nerve.

Tibial paralysis

If the tibial nerve is paralyzed , a person can no longer stand on their toes because the calf muscles and toe flexors fail. The result is a claw foot and heel foot . In addition, the sensitivity goes to the above. Areas lost.

In animals, tibial paralysis manifests itself in stretched toes and bent ankle.

literature

• Franz-Viktor Salomon: nervous system, systema nervosum. In: Franz-Viktor Salomon, Hans Geyer, Uwe Gille (Ed.): Anatomy for veterinary medicine. Enke, Stuttgart 2004, ISBN 3-8304-1007-7 , pp. 464-577.

Individual evidence

1. ↑ Beom Suk kim, Phil Woo Choung, Soon Wook Kwon, Im Joo Rhyu, Dong hwee Kim: Branching Patterns of medial and inferior calcaneal nerves around the tarsal tunnel Annals of Rehabilitation Medicine 2015, Volume 39, Volume 1, Pages 52-55; DOI: 10.5535 / arm.2015.39.1.52
2. ↑ S. Louisiana, AC Masquelet: The medial and inferior calcaneal nerves: an anatomic study. In: Surgical and radiologic anatomy. Vol. 21, No. 3, 1999, pp. 169-173, PMID 10431329 .
3. ↑ F. Govsa, O. Bilge, MA Özer: Variations in the origin of the medial and inferior calcaneal nerves. Arch Orthop Trauma Surg. 2008, year 126, volume 1 from January 2006, pages 6-14
4. ↑ S. louisia, AC Masquelet: The medial and inferior calcaneal nerves: an anatomic study Surg Radiol Arch 1999, volume 21, volume 3, pages 169-173

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