📌 Tibial Nerve Anatomy in the Tarsal Tunnel

https://youtube.com/shorts/ZrOE59qxC2s

 

Why it matters
Tarsal tunnel symptoms vary widely because tibial nerve anatomy and branching are highly variable.
Accurate MRI-based localization is critical for diagnosis and surgical planning.

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Tibial nerve: course
The tibial nerve is the largest branch of the sciatic nerve, traveling with the posterior tibial vessels.
It runs deep to the soleus and enters the tarsal tunnel beneath the flexor retinaculum, where it is referred to as the posterior tibial nerve (PTN).

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Tarsal tunnel anatomy
A fibro-osseous canal extending from the posteromedial ankle to the plantar foot.
• Roof: flexor retinaculum ± abductor hallucis
• Floor: talus and calcaneus
• Contents: TP, FDL, FHL tendons and the posterior tibial neurovascular bundle
Nerves lie deep to vessels, with the medial plantar nerve anterior to the lateral plantar nerve.

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Terminal branching
Within or near the tunnel, the PTN typically trifurcates into:
• Medial calcaneal nerve (MCN)
• Medial plantar nerve (MPN)
• Lateral plantar nerve (LPN)

The level of branching is variable and directly influences symptom distribution.

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Key clinical pearls
• MCN origin is highly variable → explains presence or absence of heel pain
• Isolated MPN or LPN compression is possible due to compartmentalization
• Baxter’s nerve arises from the LPN and is a key cause of chronic heel pain
• MRI must define where the nerve branches, not just whether it is compressed

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Take-home message
In tarsal tunnel imaging, branching anatomy is the diagnosis.
Know the normal variants before calling pathology.

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#TarsalTunnel, #TibialNerve, #FootAnkleMRI, #MSKRadiology, #OrthopedicImaging, #HeelPain, #BaxtersNerve, #PlantarNerve, #AnkleAnatomy, #RadiologyEducation

https://open.spotify.com/episode/0054mwlSfrUHLn2trjBjwj?si=TSYEMIiKSOSzQDJH8BHT7Q

📌 Tibial Nerve Anatomy in the Tarsal Tunnel