Tibial Nerve Entrapment

  • Michael N. Brown
  • Beth S. Pearce
  • Andrea M. Trescot
  • Helen W. Karl


The posterior tibial nerve is a portion of the sciatic nerve that runs down the posterior leg into the foot. It can be entrapped at two major sites: behind the knee at the proximal edge of the soleus muscle and at the ankle in the tarsal tunnel. The small terminal branches of the tibial nerve can be entrapped in the distal ankle and foot and are discussed in other chapters. Posterior tibial nerve entrapment can lead to pain and dysesthesias in the calf and sole of the foot, as well as dysfunction of the foot flexors and intrinsic muscles.


Tibial nerve Posterior tibial nerve Tarsal tunnel syndrome Soleal sling syndrome Foot pain 

Supplementary material

Video 73.1

Physical exam of the tarsal tunnel (MOV 36606 kb)

Video 73.2

Landmark-directed injection of the tarsal tunnel (MOV 24462 kb)


  1. 1.
    Mastaglia FL, Venerys J, Stokes BA, Vaughan R. Compression of the tibial nerve by the tendinous arch of origin of the soleus muscle. Clin Exp Neurol. 1981;18:81–5.PubMedGoogle Scholar
  2. 2.
    Erickson SJ, Quinn SF, Kneeland JB, Smith JW, Johnson JE, Carrera GF, et al. MR imaging of the tarsal tunnel and related spaces: normal and abnormal findings with anatomic correlation. AJR Am J Roentgenol. 1990;155(2):323–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Delfaut EM, Demondion X, Bieganski A, Thiron MC, Mestdagh H, Cotten A. Imaging of foot and ankle nerve entrapment syndromes: from well-demonstrated to unfamiliar sites. Radiographics. 2003;23(3):613–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Lopez-Ben R. Imaging of nerve entrapment in the foot and ankle. Foot Ankle Clin. 2011;16(2):213–24.CrossRefPubMedGoogle Scholar
  5. 5.
    Heimkes B, Posel P, Stotz S, Wolf K. The proximal and distal tarsal tunnel syndromes. An anatomical study. Int Orthop. 1987;11(3):193–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Mackinnon SE, Dellon AL. Homologies between the tarsal and carpal tunnels: implications for surgical treatment of the tarsal tunnel syndrome. Contemp Orthop. 1987;14(4):75–8.Google Scholar
  7. 7.
    Franson J, Baravarian B. Tarsal tunnel syndrome: a compression neuropathy involving four distinct tunnels. Clin Podiatr Med Surg. 2006;23(3):597–609.CrossRefPubMedGoogle Scholar
  8. 8.
    Keck C. The tarsal-tunnel syndrome. J Bone Joint Surg Am. 1962;44A:180–2.CrossRefGoogle Scholar
  9. 9.
    Lam SJS. A tarsal-tunnel syndrome. Lancet. 1962;2:1354–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Dellon AL. The four medial ankle tunnels: a critical review of perceptions of tarsal tunnel syndrome and neuropathy. Neurosurg Clin N Am. 2008;19(4):629–48, vii.CrossRefPubMedGoogle Scholar
  11. 11.
    Nagaoka M, Matsuzaki H. Ultrasonography in tarsal tunnel syndrome. J Ultrasound Med. 2005;24(8):1035–40.CrossRefPubMedGoogle Scholar
  12. 12.
    Taguchi Y, Nosaka K, Yasuda K, Teramoto K, Mano M, Yamamoto S. The tarsal tunnel syndrome. Report of two cases of unusual cause. Clin Orthop Relat Res. 1987;217:247–52.Google Scholar
  13. 13.
    Radin EL. Tarsal tunnel syndrome. Clin Orthop Relat Res. 1983;181:167–70.Google Scholar
  14. 14.
    Wittmayer BC, Freed L. Diagnosis and surgical management of flexor digitorum accessorius longus-induced tarsal tunnel syndrome. J Foot Ankle Surg. 2007;46(6):484–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Imai K, Ikoma K, Imai R, Fujiwara H, Kido M, Hara Y, et al. Tarsal tunnel syndrome in hemodialysis patients: a case series. Foot Ankle Int. 2013;34(3):439–44.CrossRefPubMedGoogle Scholar
  16. 16.
    Goodgold J, Kopell HP, Spielholz NI. The tarsal-tunnel syndrome. Objective diagnostic criteria. N Engl J Med. 1965;273(14):742–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Baghla DP, Shariff S, Dega R. Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report. J Med Case Rep. 2010;4:66.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Meadows JR, Finnoff JT. Lower extremity nerve entrapments in athletes. Curr Sports Med Rep. 2014;13(5):299–306.CrossRefPubMedGoogle Scholar
  19. 19.
    McCrory P, Bell S, Bradshaw C. Nerve entrapments of the lower leg, ankle and foot in sport. Sports Med. 2002;32(6):371–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Kinoshita M, Okuda R, Yasuda T, Abe M. Tarsal tunnel syndrome in athletes. Am J Sports Med. 2006;34(8):1307–12.CrossRefPubMedGoogle Scholar
  21. 21.
    Kennedy JG, Baxter DE. Nerve disorders in dancers. Clin Sports Med. 2008;27(2):329–34.CrossRefPubMedGoogle Scholar
  22. 22.
    Schon LC, Baxter DE. Neuropathies of the foot and ankle in athletes. Clin Sports Med. 1990;9(2):489–509.PubMedGoogle Scholar
  23. 23.
    Murphy PC, Baxter DE. Nerve entrapment of the foot and ankle in runners. Clin Sports Med. 1985;4(4):753–63.PubMedGoogle Scholar
  24. 24.
    Lee MS, Vanore JV, Thomas JL, Catanzariti AR, Kogler G, Kravitz SR, et al. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg. 2005;44(2):78–113.CrossRefPubMedGoogle Scholar
  25. 25.
    Barker AR, Rosson GD, Dellon AL. Pressure changes in the medial and lateral plantar and tarsal tunnels related to ankle position: a cadaver study. Foot Ankle Int. 2007;28(2):250–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Trepman E, Kadel NJ, Chisholm K, Razzano L. Effect of foot and ankle position on tarsal tunnel compartment pressure. Foot Ankle Int. 1999;20(11):721–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Bracilovic A, Nihal A, Houston VL, Beattie AC, Rosenberg ZS, Trepman E. Effect of foot and ankle position on tarsal tunnel compartment volume. Foot Ankle Int. 2006;27(6):431–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Dellon AL. The Dellon approach to neurolysis in the neuropathy patient with chronic nerve compression. Handchir Mikrochir Plast Chir. 2008;40(6):351–60.CrossRefPubMedGoogle Scholar
  29. 29.
    Driban JB, Swanik CB, Barbe MF. Anatomical evaluation of the tibial nerve within the popliteal fossa. Clin Anat. 2007;20(6):694–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Dellon AL, Mackinnon SE. Tibial nerve branching in the tarsal tunnel. Arch Neurol. 1984;41(6):645–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Havel PE, Ebraheim NA, Clark SE, Jackson WT, DiDio L. Tibial nerve branching in the tarsal tunnel. Foot Ankle. 1988;9(3):117–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Williams EH, Williams CG, Rosson GD, Dellon LA. Anatomic site for proximal tibial nerve compression: a cadaver study. Ann Plast Surg. 2009;62(3):322–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Ghosh SK, Raheja S, Tuli A. Potential sites of compression of tibial nerve branches in foot: a cadaveric and imaging study. Clin Anat. 2013;26(6):768–79.CrossRefPubMedGoogle Scholar
  34. 34.
    Horwitz MT. Normal anatomy and variations of the peripheral nerves of the leg and foot. Application in operations for vascular diseases: study of one hundred specimens. Arch Surg. 1938;36(4):626–36.CrossRefGoogle Scholar
  35. 35.
    Louisia S, Masquelet AC. The medial and inferior calcaneal nerves: an anatomic study. Surg Radiol Anat. 1999;21(3):169–73.CrossRefPubMedGoogle Scholar
  36. 36.
    Dellon AL, Kim J, Spaulding CM. Variations in the origin of the medial calcaneal nerve. J Am Podiatr Med Assoc. 2002;92(2):97–101.CrossRefPubMedGoogle Scholar
  37. 37.
    Singh G, Kumar VP. Neuroanatomical basis for the tarsal tunnel syndrome. Foot Ankle Int. 2012;33(6):513–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Redborg KE, Antonakakis JG, Beach ML, Chinn CD, Sites BD. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34(3):256–60.CrossRefPubMedGoogle Scholar
  39. 39.
    Gray AT. Atlas of ultrasound-guided regional anesthesia. 2nd ed. Philadelphia: Elsevier Saunders; 2013.Google Scholar
  40. 40.
    Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg Off J Eur Soc Foot Ankle Surg. 2012;18(3):149–52.CrossRefGoogle Scholar
  41. 41.
    Kinoshita M, Okuda R, Morikawa J, Jotoku T, Abe M. The dorsiflexion-eversion test for diagnosis of tarsal tunnel syndrome. J Bone Joint Surg Am. 2001;83-A(12):1835–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Mastaglia FL. Tibial nerve entrapment in the popliteal fossa. Muscle Nerve. 2000;23(12):1883–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Iida T, Kobayashi M. Tibial nerve entrapment at the tendinous arch of the soleus: a case report. Clin Orthop Relat Res. 1997;334:265–9.CrossRefGoogle Scholar
  44. 44.
    Williams EH, Rosson GD, Hagan RR, Hashemi SS, Dellon AL. Soleal sling syndrome (proximal tibial nerve compression): results of surgical decompression. Plast Reconstr Surg. 2011;129(2):454–62.CrossRefGoogle Scholar
  45. 45.
    Chhabra A, Williams EH, Subhawong TK, Hashemi S, Soldatos T, Wang KC, et al. MR neurography findings of soleal sling entrapment. AJR Am J Roentgenol. 2011;196(3):W290–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Kashani SR, Moon AH, Gaunt WD. Tibial nerve entrapment by a baker cyst: case report. Arch Phys Med Rehabil. 1985;66(1):49–51.PubMedGoogle Scholar
  47. 47.
    Baxter D. Compressive neuropathies of the foot and ankle. Oper Tech Sports Med. 1994;2(1):18–23.CrossRefGoogle Scholar
  48. 48.
    Abouelela AA, Zohiery AK. The triple compression stress test for diagnosis of tarsal tunnel syndrome. Foot (Edinb Scotl). 2012;22(3):146–9.CrossRefGoogle Scholar
  49. 49.
    Fujita I, Matsumoto K, Minami T, Kizaki T, Akisue T, Yamamoto T. Tarsal tunnel syndrome caused by epineural ganglion of the posterior tibial nerve: report of 2 cases and review of the literature. J Foot Ankle Surg. 2004;43(3):185–90.CrossRefPubMedGoogle Scholar
  50. 50.
    Lam SJ. Tarsal tunnel syndrome. J Bone Joint Surg (Br). 1967;49(1):87–92.Google Scholar
  51. 51.
    Hochman MG, Zilberfarb JL. Nerves in a pinch: imaging of nerve compression syndromes. Radiol Clin N Am. 2004;42(1):221–45.CrossRefPubMedGoogle Scholar
  52. 52.
    Duran-Stanton AM, Bui-Mansfield LT. Magnetic resonance diagnosis of tarsal tunnel syndrome due to flexor digitorum accessorius longus and peroneocalcaneus internus muscles. J Comput Assist Tomogr. 2010;34(2):270–2.CrossRefPubMedGoogle Scholar
  53. 53.
    Mondelli M, Morana P, Padua L. An electrophysiological severity scale in tarsal tunnel syndrome. Acta Neurol Scand. 2004;109(4):284–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Patel AT, Gaines K, Malamut R, Park TA, Toro DR, Holland N, et al. Usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome: an evidence-based review. Muscle Nerve. 2005;32(2):236–40.CrossRefPubMedGoogle Scholar
  55. 55.
    Dellon AL, Keller KM. Computer-assisted quantitative sensorimotor testing in patients with carpal and cubital tunnel syndromes. Ann Plast Surg. 1997;38(5):493–502.CrossRefPubMedGoogle Scholar
  56. 56.
    Tassler PL, Dellon AL. Pressure perception in the normal lower extremity and in the tarsal tunnel syndrome. Muscle Nerve. 1996;19(3):285–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Dellon AL. Deciding when heel pain is of neural origin. J Foot Ankle Surg. 2001;40(5):341–5.CrossRefPubMedGoogle Scholar
  58. 58.
    Rose JD, Malay DS, Sorrento DL. Neurosensory testing of the medial calcaneal and medial plantar nerves in patients with plantar heel pain. J Foot Ankle Surg. 2003;42(4):173–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Donovan A, Rosenberg ZS. MRI of ankle and lateral hindfoot impingement syndromes. AJR Am J Roentgenol. 2010;195(3):595–604.CrossRefPubMedGoogle Scholar
  60. 60.
    Huntoon MA, Huntoon EA, Obray JB, Lamer TJ. Feasibility of ultrasound-guided percutaneous placement of peripheral nerve stimulation electrodes in a cadaver model: part one, lower extremity. Reg Anesth Pain Med. 2008;33(6):551–7.PubMedGoogle Scholar
  61. 61.
    Huntoon MA, Burgher AH. Ultrasound-guided permanent implantation of peripheral nerve stimulation (PNS) system for neuropathic pain of the extremities: original cases and outcomes. Pain Med. 2009;10(8):1369–77.CrossRefPubMedGoogle Scholar
  62. 62.
    Gondring WH, Shields B, Wenger S. An outcomes analysis of surgical treatment of tarsal tunnel syndrome. Foot Ankle Int. 2003;24(7):545–50.PubMedGoogle Scholar
  63. 63.
    Barker AR, Rosson GD, Dellon AL. Outcome of neurolysis for failed tarsal tunnel surgery. J Reconstr Microsurg. 2008;24(2):111–8.CrossRefPubMedGoogle Scholar
  64. 64.
    Martinoli C, Court-Payen M, Michaud J, Padua L, Altafini L, Marchetti A, et al. Imaging of neuropathies about the ankle and foot. Semin Musculoskelet Radiol. 2010;14(3):344–56.CrossRefPubMedGoogle Scholar
  65. 65.
    Beltran LS, Bencardino J, Ghazikhanian V, Beltran J. Entrapment neuropathies III: lower limb. Semin Musculoskelet Radiol. 2010;14(5):501–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Michael N. Brown
    • 1
  • Beth S. Pearce
    • 2
  • Andrea M. Trescot
    • 3
  • Helen W. Karl
    • 4
  1. 1.Interventional Regenerative Orthopedic Medicine InstituteSeattleUSA
  2. 2.Orthopaedic Associates of St. AugustineSt. AugustineUSA
  3. 3.Pain and Headache CenterAnchorageUSA
  4. 4.Department of Anesthesiology and Pain MedicineUniversity of Washington, Seattle Children’s HospitalSeattleUSA

Personalised recommendations