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Tibial nerve dysfunction

Definition

Tibial nerve dysfunction is a loss of movement or sensation in the foot from damage to the tibial nerve.

Alternative Names

Neuropathy - posterior tibial nerve; Tarsal tunnel syndrome

Causes, incidence, and risk factors

Tibial nerve dysfunction is an unusual form of peripheral neuropathy. It occurs when there is damage to the tibial nerve, one of the lower branches of the sciatic nerve of the leg. The tibial nerve supplies movement and sensation to the calf and foot muscles.

A problem in function with a single nerve group, such as the tibial nerve, is called mononeuropathy. The usual causes are:

  • Direct trauma
  • Pressure on the nerve for a long period of time
  • Pressure on the nerve from nearby body structures

Entrapment createes pressure on the nerve where it passes through a narrow structure.

The damage may destroy the myelin sheath that protects and insulates the nerve, or part of the nerve cell (the axon). This damage reduces or prevents the movement of impulses through the nerve.

The tibial nerve is often injured by pressure from a ligament on the inner part of the ankle. Injury or disease of structures near the knee may also damage the tibial nerve. The tibial nerve may also be affected by diseases that damage many nerves, such as diabetes.

In some cases, no cause can be found.

Symptoms

  • Sensation changes in the bottom of the foot and toes, including burning sensation, numbness, tingling, or other abnormal sensation, or pain  
  • Weakness of foot muscles
  • Weakness of the toes or ankle

Signs and tests

An examination of the legs will be done to diagnose tibial nerve dysfunction. The health care provider will also take a medical history.

Signs include:

  • Inability to curl the toes, push the foot down, or twist the ankle inward
  • Weakness

In severe cases, the foot muscles may become very weak and the foot may be deformed.

Tests for tibial nerve dysfunction may include:

Other tests that may be ordered include blood tests and imaging tests, such as ultrasound or MRI.

Treatment

Treatment is aimed at restoring feeling and strength to the foot and toes. In some cases, no treatment is needed, and patients will recover on their own. Severe loss of sensation may lead to toe or foot sores (ulcers) and infections.

Surgery to enlarge the tarsal tunnel or transfer the nerve helps reduce pressure on the tibial nerve and may benefit some people.

Over-the-counter analgesics may be helpful for mild pain (neuralgia). Other medicines may be prescribed to help control severe pain.

Physical therapy exercises may help some people maintain muscle strength.

Job counseling, therapy, changes, or retraining may be recommended.

Expectations (prognosis)

If the cause of the tibial nerve dysfunction can be found and successfully treated, patients can recover fully. Some people may have a partial or complete loss of movement or sensation. Nerve pain may be uncomfortable and last for a long period of time.

Complications

  • Deformity of the foot (mild to severe)
  • Movement loss in the toes (partial or complete)
  • Repeated or unnoticed injury to the leg
  • Sensation loss in the toes or foot (partial or complete)

Calling your health care provider

Call for an appointment with your health care provider if symptoms of tibial nerve dysfunction are present. Early diagnosis and treatment increases the likelihood that symptoms can be controlled.

Prevention

Prevention is variable depending on the cause of the nerve damage.

References

Katitji B, Koontz D. Disorders of the peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, PA:Elsevier Saunders; 2012:chap 76.

Shy ME. Peripheral neuropathies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 428.


Review Date: 2/27/2013
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles and Department of Anatomy, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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