Learn how to palpate the tibial nerve at the ankle!
Learn how to palpate the medial tibia muscle attachments.
Posterior tibial artery. This is located 2 cm below and posterior to the medial malleolus where it passes beneath the flexor retinaculum between flexor digitorum longus and flexor hallucis longus.
Tibia nerve is the larger terminal branch of the sciatic nerve with root values of L4, L5, S1, S2, and S3. It lies superficial (or posterior) to the popliteal vessels, extending from the superior angle to the inferior angle of the popliteal fossa, crossing the popliteal vessels from lateral to medial side. It gives off branches as shown below:
Look the distal tendon of the tibialis anterior on the medial side of the ankle joint and foot; it is usually visible. Palpate the distal tendon by strumming perpendicular across it. Continue palpating the tibialis anterior proximally to lateral tibial condyle by strumming perpendicular to the fibers.
The sciatic nerve (from sacral plexus L4-S3) divides above the poplitel fossa into the posterior tibial nerve and common peroneal nerve. The posterior tibial nerve travels in the posterior leg with the posterior tibial artery, in the fascial plane between the superficial and deep muscle groups. It is a mixed sensory and motor nerve.
The tibial nerve is a branch of the sciatic nerve, and arises at the apex of the popliteal fossa. It travels through the popliteal fossa, giving off branches to muscles in the superficial posterior compartment of the leg.
The medial meniscus is larger and is more easily palpated on the medial tibial plateau. The menisci may be torn in varying degrees and severity due to the compression and shear forces put on them during quick directional change in motions and pivoting. The medial meniscus may be injured more frequently due to its attachment to the MCL.1,2,3,4,5
The tibialis posterior muscle is a relatively small, centrally located muscle present on the back side of the leg. This muscle is located between the two bones fibula and tibia in the lower leg and descends down to connect with the various other bones through the ankle.
A 22-gauge insulated needle is directed toward the posterior aspect of the tibia, posterior to the tibial artery pulsation (if palpable), seeking to obtain toes flexion at less than 0.5 mA. Five to 7 ml of local anesthetic is injected incrementally after negative aspiration of blood.