Tibial Nerve

What is the tibial nerve?

Your tibial nerve is a peripheral nerve that supplies movement and feeling (sensory function) to parts of the back (posterior) of your lower leg and foot. It’s one of two branches of your sciatic nerve — the largest peripheral nerve in your body.

All of your peripheral nerves — including your tibial nerves — are branches of other nerves in your body that originate from your spinal cord. If your spinal cord is the trunk of a tree, your peripheral nerves are its branches or roots.

Nerves are like cables that carry electrical impulses between your brain and the rest of your body. These impulses help you feel sensations (like touch and temperature) and move your muscles.

You have a tibial nerve in each of your legs. It’s called “tibial” because the tibia (your shin bone) is in your lower leg.

What is the function of the tibial nerve?

The function of your tibial nerve is to supply movement (motor) and sensory information between your brain and parts of your lower leg and foot.

The motor branch of your tibial nerve stimulates 21 muscles. It makes it possible to:

• Extend your hip (like when you stand and extend your leg behind you).
• Bend your knee.
• Turn your foot inward, like standing pigeon-toed.
• Press your foot down and away from your body, like standing on or pointing your toes.
• Wiggle all your toes except your big (first or great) toe.

The sensory branch of your tibial nerve provides touch, pain and temperature sensations for the skin on the:

• Outer side of the back of your lower leg (your calf).
• Sides of your heel.
• Outer sides of your foot.
• Bottom (underside) of your foot.

Where is the tibial nerve?

To understand your tibial nerve, it helps to know where it starts and ends. Your tibial nerve is one of two branches of your sciatic nerve, which branches off of your spinal cord in your lower spine. Your sciatic nerve can have some naturally occurring variations or differences in how it separates into branches. For most people, their sciatic nerve travels through their pelvis undivided. For others, their sciatic nerve branches into two nerves within their pelvis near the piriformis muscle.

Let’s assume your sciatic nerve divides below your pelvis. In this case, your tibial nerve starts above your knee in the back of your leg. From there, it:

• Travels downward and branches off to provide motor information for your large calf muscle (gastrocnemius muscle).
• Continues downward near the midline of the back of your leg. It combines with another nerve to form the sural nerve, which provides feeling to the outer side of the back of your lower leg.
• Enters the soleus muscle and tibialis posterior muscle of the bottom part of your lower leg.
• Once your tibial nerve reaches your foot, it passes through the tarsal tunnel. The tarsal tunnel is a narrow passageway made of bone and soft tissue. This structure protects nerve fibers as they round the bend from your leg to your foot.
• Near the tarsal tunnel, the tibial nerve branches off to innervate (provide function to) your toes and the bottom of your foot.

What happens when the tibial nerve is damaged?

Certain conditions and symptoms can develop if your tibial nerve experiences damage. They include:

• Tarsal tunnel syndrome: Your tibial nerve runs through the tarsal tunnel. Damage to your tibial nerve in this area — typically due to nerve compression — causes tarsal tunnel syndrome. It leads to nerve pain in the inside of your ankle or the bottom of your feet and usually affects one side. It is, however, a very uncommon cause of foot pain.
• Tibial compartment syndrome: Excessive pressure (typically from swelling) from the muscles that surround your tibial nerve can decrease blood flow to it, affecting its functioning. Tibial compartment syndrome causes weakness and sensory issues in your foot and ankle.

Nerve compression is the most common way tibial nerve damage develops. Other causes of damage include:

• Trauma: Severe injuries, like a bone fracture (broken bone) or a deep cut, can damage your tibial nerve.
• Tumor or other abnormal mass that pushes on the tibial nerve.
• Surgical complications: The tibial nerve’s location near other important structures increases the risk of injury during surgery. These procedures include hip replacement and knee replacement, among others.
• Diabetes-related neuropathy: Long-term high blood sugar can lead to nerve damage. This may affect your tibial nerve, but usually affects multiple nerves at the same time

When should I call my healthcare provider?

You should contact your healthcare provider if you notice symptoms of tibial nerve dysfunction, including:

• Burning sensation.
• Difficulty moving part of your leg or foot (changes in your range of motion).
• Muscle weakness or tightening.
• Numbness.
• Sensation of pins and needles.
• Sharp pain.
• Tingling.

How can I take care of my tibial nerve?

You can’t always prevent tibial nerve damage. But taking the following steps can help:

• Seek prompt medical attention for conditions affecting your leg or foot.
• Wear supportive footwear, especially if you have flat feet. This condition increases your risk for tarsal tunnel syndrome.
• Eat nutritious foods, especially those with vitamin D and vitamin B12. These vitamins support nerve health.
• Manage chronic conditions that can damage nerves, like diabetes and high blood pressure.
• Seek help to quit smoking. Tobacco use slows blood flow to your nerves.
• Reach and maintain a weight that’s healthy for you.
• Decrease stress through meditation, physical activity or other healthy techniques.
• Reduce alcohol consumption, as alcohol is directly toxic to nerves.