What are the other Names for this Condition? (Also known as/Synonyms)

• Tibial Nerve Neuropathy

What is Tibial Nerve Dysfunction? (Definition/Background Information)

• Tibial Nerve Dysfunction is damage to the tibial nerve which is responsible for sensation and movement in the calf and foot. The condition is more likely to occur in adults over 40 years of age
• It is caused by sustaining a heavy impact to the posterior tibial tendon or through overuse (such as occurring through sports participation)
• The predisposing factors for Tibial Nerve Dysfunction may include high-impact sports, climbing stairs, and running. Individuals with hypertension and those who are diabetic are also at risk
• The signs and symptoms of Tibial Nerve Dysfunction may include pain on the inside of the foot or ankle, pain that gets worse during activity and spreading to the outside of the ankle
• Complications of Tibial Nerve Dysfunction may include inability to walk due to pain, partial to complete loss of feeling in the foot, and mild to severe foot deformity
• Tibial Nerve Dysfunction is treated symptomatically for pain and swelling of the feet. In some cases, a surgery may be required. The prognosis of Tibial Nerve Dysfunction may vary, but is good with early diagnosis and treatment
• The condition may be prevented by reducing the risk of blunt force injury that occur from falling or high impact sports and through the use of suitable protective sports gear

Who gets Tibial Nerve Dysfunction? (Age and Sex Distribution)

• Tibial Nerve Dysfunction is more likely to occur in adults over the age of 40 years
• Females are more likely to be affected than males
• All races and ethnic groups can be affected and no preference is seen

What are the Risk Factors for Tibial Nerve Dysfunction? (Predisposing Factors)

The risk factors for Tibial Nerve Dysfunction may include:

• Walking and running
• High impact sports
• Climbing stairs
• Hiking
• Obesity
• Diabetics
• Individuals with hypertension are also at risk for Tibial Nerve Dysfunction

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Tibial Nerve Dysfunction? (Etiology)

Tibial Nerve Dysfunction may be caused by sustaining a high impact force to the feet. Overuse of the posterior tibial tendon may also cause the condition, which may be due to activities such as:

• Walking and running
• High impact sports
• Climbing stairs
• Hiking

What are the Signs and Symptoms of Tibial Nerve Dysfunction?

Tibial Nerve Dysfunction usually affects only one foot, but both feet may be involved. The signs and symptoms of the condition may include:

• Pain on the inside of the foot or ankle
• Swelling, redness, and warmth on the inside of the ankle
• Ankle that rolls inward
• Toes and feet that turn out
• Pain that gets worse during physical activity putting stress on the feet
• Pain that is localized to the ankle area (outer aspect), which worsens over time and spreads outside the ankle

How is Tibial Nerve Dysfunction Diagnosed?

A diagnosis of Tibial Nerve Dysfunction is made by the following observations and tests:

• A careful physical examination and assessment of complete medical history
• The healthcare provider may look for signs such as:
  • Swelling in the posterior tibial tendon
  • Limited side to side range of motion
  • Reduced flexion of toes towards the shin bone
  • Inability to curl toes
  • Collapsed arch
  • Heel shifting outwards
  • Inability to stand on tiptoes, particularly with the affected foot
• Examination of the toes may reveal abnormalities in the fourth and fifth toe
• X-rays or CT scans of the affected region to rule out arthritis
• MRI scans and ultrasound scans may also be used to help diagnose Tibial Nerve Dysfunction

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Tibial Nerve Dysfunction?

Possible complications of Tibial Nerve Dysfunction include:

• Arthritis of the ankle or foot
• Inability to walk due to pain
• Partial to complete loss of feeling in the affected foot
• Recurring leg injuries
• Mild to severe foot deformity
• Worsening posture
• Muscle atrophy due to foot immobilization following treatment
• Emotional stress that can affect the quality of life

How is Tibial Nerve Dysfunction Treated?

The treatment of Tibial Nerve Dysfunction is undertaken based on the severity of the condition and assessment of the signs and symptoms. The condition is often treatable without surgery.

The following measures may be used in the treatment of Tibial Nerve Dysfunction:

• Reduction of pain and swelling
  • Applying ice to the sore area
  • Taking non-steroidal anti-inflammatory medications
  • Resting; avoiding running or playing high impact sports until the affected leg heels
• Providing foot support
  • Ankle brace to support the damaged tendon around the ankle joint
  • Custom orthotics to improve one’s posture
• Immobilization of the foot for 6-8 weeks may be recommended in some cases. However, this may lead to muscle atrophy

If Tibial Nerve Dysfunction is severe and does not resolve using the above non-surgical treatment methods, then the following invasive surgical procedures may be necessary:

• Lengthening of the calf muscle
• Removing damaged tendon areas
• Replacing the posterior tibial tendon with another tendon
• Cutting and moving bones (osteotomy)
• Joint fusion to correct flatfoot

How can Tibial Nerve Dysfunction be Prevented?

The prevention of Tibial Nerve Dysfunction includes considering the following steps:

• Reducing the risk of blunt force injury that can occur from falls or high impact sports
• Using protective sports gear while participating in high impact sports
• Excessively exercising without appropriate recovery may result in damage to the muscles, tendon, and nerves of the leg, particularly to the posterior tibial tendon. This can increase the risk of Tibial Nerve Dysfunction. Thus, limiting overuse and damage to the posterior tibial tendon during the following activities can help:
  • Excessive walking and running
  • Climbing stairs
  • Long hikes without adequate rest

Your healthcare provider can recommend the correct amount and duration of exercises and the techniques for performing the same correctly.

What is the Prognosis of Tibial Nerve Dysfunction? (Outcomes/Resolutions)

• The prognosis of Tibial Nerve Dysfunction when diagnosed and treated early is usually very good with a complete recovery expected in a majority of individuals
• In some cases, there may be a partial or total loss of sensation and/or mobility in the foot
• Nerve pain may cause discomfort and last for a long period of time

Additional and Relevant Useful Information for Tibial Nerve Dysfunction:

The tibial nerve is a lower branch of the sciatic nerve. Nerve damage in Tibial Nerve Dysfunction usually comes from damage to the myelin sheath, a structure which insulates and protects the nerves. Damage to this structure may reduce or even prevent signals from being sent through the nerve.