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Tibial nerve

The main nerve of the back of the leg and the sole of the foot. Where it runs, what it supplies, how it slides, where it and its branches get squeezed, and what studies report about recovery.

Region
Lower leg
Updated
October 5, 2026
Reviewed
October 5, 2026 · how entries are checked

Function

Where it starts and what it supplies

The sciatic nerve is the large nerve that runs from the lower back down the back of the thigh. It typically splits behind the knee into the tibial nerve and the common fibular nerve5. The tibial nerve’s fibres come from the spinal nerve roots labelled L4 to S36.

The tibial nerve supplies the muscles of the back of the leg2:

  • the gastrocnemius, soleus and plantaris in the calf2;
  • the popliteus, a small muscle at the back of the knee2;
  • the tibialis posterior, a deep calf muscle2;
  • the two long muscles that bend the toes2.

Together these muscles point the foot down, turn the sole inward and bend the toes2. Besides these muscle branches it gives rise to the medial sural cutaneous nerve, the medial calcaneal nerve and the two plantar nerves6.

Its path from knee to sole

The nerve runs down behind the knee and passes deep to the gastrocnemius and soleus7. It then travels down the leg beside the posterior tibial blood vessels to the ankle7.

Engraving of the back of the right hip, thigh, knee and leg with the nerves drawn in yellow. The sciatic nerve runs down the back of the thigh and divides above the knee into the tibial nerve and the common peroneal nerve. The tibial nerve continues straight down behind the knee, gives off the medial sural cutaneous nerve, passes under the calf muscles and runs down the leg between the deep flexor muscles to the inner side of the ankle, where the medial calcaneal branch leaves it for the heel. The common peroneal nerve slants to the outer side of the knee and gives off the peroneal anastomotic branch.
Nerves of the back of the leg, with the tibial nerve running to the heelHenry Vandyke Carter, in Henry Gray, Anatomy of the Human Body (1918), Fig. 832. Public domain, via Wikimedia Commons. (source, Public domain)

At the ankle it runs through the tarsal tunnel, a passage of bone and fibrous tissue1. The tunnel’s bony walls include the calcaneus (heel bone), the talus (ankle bone) and the medial malleolus, the bony bump on the inner ankle1. Its roof is the flexor retinaculum, a band stretched from that bump to the heel bone8. Three tendons and the nerve’s blood vessels share the tunnel, among them the tibialis posterior tendon1.

The medial calcaneal nerve leaves at the ankle, pierces the retinaculum and supplies skin on the back and underside of the heel7.

How it divides in the foot

Inside the tunnel the nerve typically divides into the medial and lateral plantar nerves2. These supply the small muscles of the foot and the skin of the sole2.

Engraving of the sole of the foot with the surface muscles removed and the nerves drawn in yellow. Near the heel the tibial nerve has divided into the medial plantar nerve, on the big-toe side, and the lateral plantar nerve, which crosses towards the little-toe side over the quadratus plantae muscle. The medial plantar nerve fans out into branches that run forward between the metatarsals to the big toe and the next three toes. The lateral plantar nerve sends branches to the fourth and little toes and gives off a deep branch that turns back across the sole.
The medial and lateral plantar nerves in the sole of the footHenry Vandyke Carter, in Henry Gray, Anatomy of the Human Body (1918), Fig. 833. Public domain, via Wikimedia Commons. (source, Public domain)
  • The medial plantar nerve supplies four sole muscles, including the abductor hallucis, and the skin of the inner three and a half toes2.
  • The lateral plantar nerve supplies the quadratus plantae, the abductor digiti minimi, the adductor hallucis, the interossei and one more sole muscle2.
  • The inferior calcaneal nerve drives the abductor digiti minimi and sometimes the flexor digitorum brevis, and carries feeling from the heel bone’s covering1.

The inferior calcaneal nerve is often called Baxter’s nerve1. One paper describes the origin of the nerve to abductor digiti minimi as variable9. A review notes that in most feet each of these branches runs in its own channel of bone and fibrous tissue8. That, it says, is why one branch can be squeezed alone8.

How it slides and stretches

Walking asks the nerve to adapt as the ankle bends up and the foot rolls inward10. A review of studies in living people found joint movement slid the tibial nerve 0.7 to 5.2 mm11. Three studies in living people give mean slides10,12,13.

Mean slide (mm)Ankle from pointed down to pulled up, standing on the foot2.99 Active pulling up of the foot, measured behind the knee2.18 Forward bending, measured behind the knee12.2
Mean slide (mm). Bars start at zero; the table below gives each value with its source.
MovementWho was measuredMean slide (mm)
Ankle from pointed down to pulled up, standing on the foot16 people without symptoms2.9910
Active pulling up of the foot, measured behind the kneeHealthy individuals2.1812
Forward bending, measured behind the knee24 healthy subjects12.213

With the hip bent first, the slide from the ankle was about three times smaller12.

Dorsiflexion is pulling the foot and toes up toward the shin. In 20 healthy adults, the nerve grew stiffer as the ankle moved further into it14. In ten cadavers, nerve strain (stretch as a share of resting length) at the ankle rose 3.9% on average with dorsiflexion3. It was higher with the knee straight or the hip bent first3.

Breakdown

In the tarsal tunnel

A 2024 scoping review, which maps the research on a topic, defines tarsal tunnel syndrome as a compressive neuropathy, a nerve problem caused by squeezing15. It affects the tibial nerve, or one of its heel or plantar divisions, inside the tunnel15. One narrative review describes it as uncommon next to other such problems, often missed, and sometimes mistaken for plantar fasciitis8.

Sources differ on how often a cause is found1,16. One review states that no exact cause is identified in 20% to 40% of cases1. A 2022 review reports that the syndrome most often has no known cause16. Causes the two reviews list include injury, cysts and other lumps, swollen veins, and whole-body illness1,16. Described risk factors include female sex, taking part in sport, diabetes and an underactive thyroid16.

In 10 cadaver specimens, mean tunnel pressure was 2 mmHg (millimetres of mercury) with the foot pointed slightly down and not turned17. It was 32 mmHg with the sole turned fully outward and 17 mmHg with it turned fully inward17.

One case series, a report on patients without a comparison group, covered 18 people operated on for sport-related tarsal tunnel syndrome18. The triggers were activities that load the ankle heavily, such as sprinting and jumping18. Their predisposing features included flatfoot, extra muscles and bony fragments around the tunnel18.

A narrative review states the syndrome has been reported as more frequent in avid runners, especially where the foot rolls in too far8. Another notes that little is published on how often sport causes foot and ankle nerve problems1. The cases reported most often involve running and dancing1.

Above the ankle

A review lists trapping sites above the ankle: at the inner gastrocnemius, under the arch of the soleus, and after a popliteus tear1. Squeezing under the soleus arch is called soleal sling syndrome, and a literature review calls it rare and under-recognised19.

Forward knee dislocations, usually from the knee being forced past straight, carry a high risk of pulling injury to the nerve1.

Branches in the heel and arch

A review lists places where Baxter’s nerve can be trapped, including between two sole muscles and at a ligament1. Bony heel spurs and tears of the plantar fascia can also press on it1. One paper states that the inner heel pain this produces may not be distinguishable from plantar fasciitis heel pain20.

Atrophy is wasting of a muscle. Among 602 consecutive patients having foot and ankle MRI (a scan showing soft tissue), 6.3% had fatty atrophy of the abductor digiti minimi alone21. That finding is a reported marker of this nerve being trapped21. In 69 heels that had this nerve surgically released, the pain had begun during sport in 3422.

A 1978 paper gave the name “jogger’s foot” to trapping of the medial plantar nerve in the arch23. A review names two common sites, one being the knot of Henry, where two long toe tendons cross1.

Between the toes

The authors of one meta-analysis define Morton’s neuroma as a compressive neuropathy24. The nerve involved is the common plantar digital nerve, most often in the third space between the toes24. In 253 UK general practices in 2000, new presentations ran at 50.2 per 100,000 men and 87.5 per 100,000 women yearly25. A narrative review describes the typical person as a woman in her late 40s or early 50s26. It adds that many are active, and that running and dancing can be associated with it26.

The same review states that high-heeled or narrow shoes usually make the pain worse26. In 68 people with the neuroma and 32 without, it was strongly associated with restricted ankle dorsiflexion27.

Thickened nerves are also found in feet without symptoms28,29.

  • MRI of 70 people without symptoms showed a presumed Morton neuroma in 30%28.
  • Ultrasound, a scan made with sound waves, of 48 volunteers with symptom-free forefeet showed a nerve thickening over 5 mm in 54%29.
  • Under the microscope, one comparison found the nerve looked the same in people without symptoms as in patients30. Loss of myelin, the fibres’ fatty wrap, was more common in patients30.

Recovery

The general course

A review of nerve tissue states that most nerve compressions are the mildest grade of injury, neurapraxia31. Another describes neurapraxia as a temporary signal block that clears fully within 12 weeks once myelin is restored32. Where fibres themselves are damaged, regrowth is slow, about 1 mm a day, and often incomplete32.

What studies of trapped nerves report

Group studiedWhat was reported
Tarsal tunnel syndrome, 32 observational studies in a scoping reviewAfter care, excellent or good results in 75.3% of cases, fair or poor in 24.7%15
18 patients operated on for sport-related tarsal tunnel syndromeMost could return to the same sport; mean follow-up 58.6 months18
15 runners who had 21 nerve releases in the foot and ankle, one surgeonGood to excellent results in each of the 15, who returned to their earlier level of running33
69 heels with long-lasting heel pain that had Baxter’s nerve surgically released89% excellent or good; pain fully gone in 83%; average follow-up 49 months22
99 consecutive patients who had a Morton’s neuroma removed63% pain-free six months after surgery; 10 patients dissatisfied34

A narrative review gives a wider range for tarsal tunnel surgery, with reported success from 44% to 96%8. The scoping review judged its 32 studies low quality15. For Morton’s neuroma, a systematic review of 25 studies of non-surgical approaches found no high-quality evidence for any single one24.

After a tibial nerve injury

A systematic review of 19 studies covered 677 patients who had surgery after tibial nerve injury4. Those operated on within 7 months were more likely to regain useful muscle power than those operated on later4. Gunshot wounds were the most common cause, and people injured in sport had the highest share of good outcomes4.

In 119 patients with nerves fully divided by missile wounds, repair did significantly worse with gaps over 5 cm or surgery delays over 4 months35.

Connections

Muscles it drives

The nerve supplies the gastrocnemius and the soleus36,37. Through its plantar branches it reaches the small muscles of the foot2,38. In healthy people walking and running, numbing the tibial nerve stopped the small sole muscles from contracting39. The joints at the front of the foot could not then stiffen enough for a normal push-off39.

Stretches that load it

In cadavers with the knee straight, dorsiflexion moved and strained the nerve at hip angles from 0 to 90 degrees40. In 41 healthy adults, a stiffer tibial nerve went with a smaller maximum dorsiflexion angle41. Calf muscle stiffness was not significantly related to that angle41.

In six cadavers, bending the toe joints back raised strain by 0.4% in the tibial nerve and 2.0% in the medial plantar nerve42. Related stretch pages: calf stretch, soleus stretch, plantar fascia stretch3,41,42.

Tibial nerve supplies

Tibial nerve supplies, through its plantar branches,

Tibial nerve leaves the sciatic nerve alongside

Tibial nerve shares the tarsal tunnel with

Tibial nerve has a heel branch whose pain can resemble

Tibial nerve is loaded by

Sources

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  2. Dev V D, U S (2025). An Anatomical Study on the Tibial Nerve Bifurcation Level in Relation to the Malleolar-Calcaneal Axis and Its Clinical Significance.. Cureus. doi:10.7759/cureus.86511 PMID 40698204
  3. Alshami AM, Babri AS, Souvlis T, Coppieters MW (2008). Strain in the tibial and plantar nerves with foot and ankle movements and the influence of adjacent joint positions.. Journal of applied biomechanics. doi:10.1123/jab.24.4.368 PMID 19075306
  4. Garg SP, Hassan AM, Patel AA, Perez MM, Stoehr JR, Ketheeswaran S, Chappell AG, Galiano RD, Ko JH (2021). Outcomes of Tibial Nerve Repair and Transfer: A Structured Evidence-Based Systematic Review and Meta-Analysis.. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. doi:10.1053/j.jfas.2021.07.001 PMID 34366221
  5. Liyew WA, Abebe S (2026). Anatomical variation of the sciatic nerve division in the cadaver studies: a systematic review and meta-analysis.. Anatomy & cell biology. doi:10.5115/acb.25.139 PMID 41851007
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  8. Rodríguez-Merchán EC, Moracia-Ochagavía I (2021). Tarsal tunnel syndrome: current rationale, indications and results.. EFORT open reviews. doi:10.1302/2058-5241.6.210031 PMID 35839088
  9. Rodrigues RN, Lopes AA, Torres JM, Mundim MF, Silva LL, Silva BR (2015). Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging.. Radiologia brasileira. doi:10.1590/0100-3984.2013.0028 PMID 26811554
  10. Carroll M, Yau J, Rome K, Hing W (2012). Measurement of tibial nerve excursion during ankle joint dorsiflexion in a weight-bearing position with ultrasound imaging.. Journal of foot and ankle research. doi:10.1186/1757-1146-5-5 PMID 22397397
  11. Silva A, Manso A, Andrade R, Domingues V, Brandão MP, Silva AG (2014). Quantitative in vivo longitudinal nerve excursion and strain in response to joint movement: A systematic literature review.. Clinical Biomechanics. doi:10.1016/j.clinbiomech.2014.07.006 PMID 25168082
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  13. Shum GL, Attenborough AS, Marsden JF, Hough AD (2013). Tibial nerve excursion during lumbar spine and hip flexion measured with diagnostic ultrasound.. Ultrasound in medicine & biology. doi:10.1016/j.ultrasmedbio.2012.11.023 PMID 23465136
  14. Kawanishi K, Nariyama Y, Anegawa K, Tsutsumi M, Kudo S (2022). Changes in tibial nerve stiffness during ankle dorsiflexion according to in-vivo analysis with shear wave elastography.. Medicine. doi:10.1097/md.0000000000029840 PMID 35777040
  15. Haq II, Banerjee AA, Arshad Z, Iqbal AM, Bhatia M (2024). The management of tarsal tunnel syndrome: A scoping review.. Journal of clinical orthopaedics and trauma. doi:10.1016/j.jcot.2024.102489 PMID 39101044
  16. Vij N, Kaley HN, Robinson CL, Issa PP, Kaye AD, Viswanath O, Urits I (2022). Clinical Results Following Conservative Management of Tarsal Tunnel Syndrome Compared With Surgical Treatment: A Systematic Review.. Orthopedic reviews. doi:10.52965/001c.37539 PMID 36072502
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  35. Roganović Z, Pavlićević G, Petković S (2005). Missile-induced complete lesions of the tibial nerve and tibial division of the sciatic nerve: results of 119 repairs.. Journal of neurosurgery. doi:10.3171/jns.2005.103.4.0622 PMID 16266043
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  40. Bueno-Gracia E, Estébanez-de-Miguel E, López-de-Celis C, Shacklock M, Caudevilla-Polo S, González-Rueda V, Pérez-Bellmunt A (2020). Effect of ankle dorsiflexion on displacement and strain in the tibial nerve and biceps femoris muscle at the posterior knee during the straight leg raise: Investigation of specificity of nerve movement.. Clinical biomechanics (Bristol, Avon). doi:10.1016/j.clinbiomech.2020.105003 PMID 32335471
  41. Mukai H, Umehara J, Saeki J, Yanase K, Wang Z, Tateuchi H, Ichihashi N (2026). Tibial nerve stiffness is related to maximum angle of ankle dorsiflexion.. Journal of biomechanics. doi:10.1016/j.jbiomech.2025.113050 PMID 41187609
  42. Alshami AM, Babri AS, Souvlis T, Coppieters MW (2007). Biomechanical evaluation of two clinical tests for plantar heel pain: the dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis.. Foot & ankle international. doi:10.3113/FAI.2007.0499 PMID 17475147

Every source the library cites

Changes

  • First published.