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Tibialis posterior

Contents

Anatomy

 

Tibialis posterior - posterior view
Tibialis posterior - foot - inferior view
Tibialis posterior - foot - posteromedial view

General information

  • This section is strictly limited to anatomy, you might be looking for clinical relevant information which is found under the clinical chapters -- muscles section, click here to go to that page

Position

  • Deep

Origin

  • Proximal 2/3 of posterlateral part of tibia
  • Proximal 2/3 of posteromedial part of fibula
  • Interosseus membrane
  • Adjacent septa and deep fascia

Insertion

  • Tuberositas naviculare
  • Cuneiforme mediale, intermedius and lateral
    • Plantar aspect
  • Cuboideum
    • Plantar aspect
  • Base of 2-4 metatarsal
    • Plantar aspect

Main function

  • Ankle
    • Plantar flexion
  • Tarsal joints
    • Inversion

Nerve innervation

  • Segmental
    • L4-L5
  • Peripheral
    • Tibial nerve

Arterial supply

  • Posterior part of tibial artery

Palpation

  • Patient position
    • Supine
  • The muscle and a large part of the tendon is deep in the calf, but distal parts of the tendon is easily available for palpation
  • Ask the patient to invert and plantarflex the foot
  • 3 tendons are often very easily detected posteriorly to the medial malleolus during this movement
    • Tibialis anterior
    • Flexor digitorum longus
    • Flexor hallucis longus
  • Of the 3, the tibialis posterior is the closest to the medial malleolus

Strength test

  • Patient position
    • Supine
  • Grab the calf with your one hand to stabilize the patient's leg
  • Hold around the medial- and plantar side of the patient's foot with your other hand and give resistance towards dorsiflexion and eversion so that the patient is giving force towards plantarflexion and inversion
  • Note that if the toes are markedly flexed during the testing, then this may indicate that the patient is compensating by using the flexor hallucis longus and flexor digitroum longus and that the tibialis posterior may be weak