Tibial nerve

The Tibial Nerve (n. tibialis; internal popliteal nerve) the larger of the two terminal branches of the sciatic, arises from the anterior branches of the fourth and fifth lumbar and first, second, and third sacral nerves.

It descends along the back of the thigh and through the middle of the popliteal fossa, to the lower part of the Popliteus muscle, where it passes with the popliteal artery beneath the arch of the Soleus. It then runs along the back of the leg with the posterior tibial vessels to the interval between the medial malleolus and the heel, where it divides beneath the laciniate ligament into the medial and lateral plantar nerves. In the thigh it is overlapped by the hamstring muscles above, and then becomes more superficial, and lies lateral to, and some distance from, the popliteal vessels;opposite the knee-joint, it is in close relation with these vessels, and crosses to the medial side of the artery. In the leg it is covered in the upper part of its course by the muscles of the calf; lower down by the skin, the superficial and deep fasciæ. It is placed on the deep muscles, and lies at first to the medial side of the posterior tibial artery, but soon crosses that vessel and descends on its lateral side as far as the ankle. In the lower third of the leg it runs parallel with the medial margin of the tendo calcaneus.

The branches of this nerve are: articular, muscular, medial sural cutaneous, medial calcaneal, medial and lateral plantar.

Articular branches (rami articulares), usually three in number, supply the knee-joint; two of these accompany the superior and inferior medial genicular arteries; and a third, the middle genicular artery. Just above the bifurcation of the nerve an articular branch is given off to the ankle-joint.

Muscular branches (rami musculares), four or five in number, arise from the nerve as it lies between the two heads of the Gastrocnemius muscle; they supply that muscle, and the Plantaris, Soleus, and Popliteus. The branch for the Popliteus turns around the lower border and is distributed to the deep surface of the muscle. Lower down, muscular branches arise separately or by a common trunk and supply the Soleus, Tibialis posterior, Flexor digitorum longus, and Flexor hallucis longus; the branch to the last muscle accompanies the peroneal artery; that to the Soleus enters the deep surface of the muscle.

The medial sural cutaneous nerve (n. cutaneus suræ medialis; n. communicans tibialis) descends between the two heads of the Gastrocnemius, and, about the middle of the back of the leg, pierces the deep fascia, and unites with the anastomotic ramus of the common peroneal to form the sural nerve.

The sural nerve (n. suralis; short saphenous nerve), formed by the junction of the medial sural cutaneous with the peroneal anastomotic branch, passes downward near the lateral margin of the tendo calcaneus, lying close to the small saphenous vein, to the interval between the lateral malleolus and the calcaneus. It runs forward below the lateral malleolus, and is continued as the lateral dorsal cutaneous nerve along the lateral side of the foot and little toe, communicating on the dorsum of the foot with the intermediate dorsal cutaneous nerve, a branch of the superficial peroneal. In the leg, its branches communicate with those of the posterior femoral cutaneous.

The medial calcaneal branches (rami calcanei mediales; internal calcaneal branches) perforate the laciniate ligament, and supply the skin of the heel and medial side of the sole of the foot.

The medial plantar nerve (n. plantaris medialis; internal plantar nerve), the larger of the two terminal divisions of the tibial nerve, accompanies the medial plantar artery. From its origin under the laciniate ligament it passes under cover of the Abductor hallucis, and, appearing between this muscle and the Flexor digitorum brevis, gives off a proper digital plantar nerve and finally divides opposite the bases of the metatarsal bones into three common digital plantar nerves.

The Lateral Plantar Nerve (n. plantaris lateralis; external plantar nerve) supplies the skin of the fifth toe and lateral half of the fourth, as well as most of the deep muscles, its distribution being similar to that of the ulnar nerve in the hand. It passes obliquely forward with the lateral plantar artery to the lateral side of the foot, lying between the Flexor digitorum brevis and Quadratus plantæ and, in the interval between the former muscle and the Abductor digiti quinti, divides into a superficial and a deep branch. Before its division, it supplies the Quadratus plantæ and Abductor digiti quinti.