Overview

The tibial nerve is one of the major nerves of the lower limb, responsible for transmitting signals between the spinal cord and the muscles of the calf and foot. Originating from the sciatic nerve in the posterior thigh, it runs down the back of the leg and supplies sensation to the heel and sole of the foot while also controlling key movements such as plantar flexion and toe flexion.

A Tibial Nerve Injury occurs when this nerve is compressed, stretched, or damaged due to trauma, entrapment, or underlying medical conditions. Such an injury can severely affect mobility, balance, and gait, leading to chronic pain and functional limitations.

At DMPhysios, a physiotherapy clinic in Noida specializing in spine and sports conditions, the focus is on patient-centered rehabilitation, addressing not just the injury but also the root cause and movement dysfunctions associated with tibial nerve injury.

Symptoms 

The clinical presentation of a tibial nerve injury depends on the site and severity of the damage. Common symptoms include:

• Pain or burning sensation along the inner ankle, heel, or sole of the foot.
• Numbness or tingling (paresthesia) in the sole or toes.
• Weakness in foot and toe flexion (difficulty curling toes or pushing off while walking).
• Difficulty in plantarflexion, making walking or running challenging.
• Atrophy (wasting) of calf muscles over time.
• Altered gait – The person may drag the foot or limp due to reduced strength.
• Reduced reflexes in the ankle or Achilles tendon.

In chronic cases, tibial nerve injury can lead to severe sensory loss or deformities in the foot due to muscle imbalance.

Types of Tibial Nerve Injury

While the mechanism and severity may vary, tibial nerve injuries are commonly categorized based on the site or nature of the damage:

1. Proximal Tibial Nerve Injury

This occurs near the popliteal fossa (behind the knee) often due to direct trauma, fractures, or surgical complications. It leads to extensive motor and sensory loss in the lower leg and foot.

2. Tarsal Tunnel Syndrome

A common entrapment type of tibial nerve injury, occurring where the nerve passes through the tarsal tunnel near the medial ankle. Compression here causes pain, tingling, and burning sensations in the foot, often mistaken for plantar fasciitis.

3. Distal Tibial Nerve Branch Injury

The medial and lateral plantar nerves, branches of the tibial nerve, can be affected individually. This causes localized numbness or weakness in parts of the foot such as the big toe or little toe region.

4. Traumatic Tibial Nerve Injury

Results from direct trauma such as road traffic accidents, sports injuries, or fractures of the tibia. This may include partial or complete nerve disruption.

Causes

Several underlying conditions or events can lead to a tibial nerve injury, including:

1. Fractures or dislocations of the tibia, ankle, or foot bones.
2. Compression or entrapment in the tarsal tunnel or due to tight footwear.
3. Sports injuries, especially in activities involving repetitive ankle movement or impact (e.g., football, running).
4. Surgical complications, such as during knee arthroplasty or ankle repair procedures.
5. Prolonged immobilization or incorrect posture, leading to pressure on the posterior leg.
6. Space-occupying lesions, such as ganglion cysts or lipomas compressing the nerve.
7. Systemic conditions like diabetes mellitus, which can predispose nerves to injury (diabetic neuropathy).

Risk Factors

Certain individuals are at higher risk of developing tibial nerve injury, including:

• Athletes (due to repetitive stress on the ankle and foot).
• People with diabetes, due to nerve vulnerability.
• Those with flat feet or foot deformities, which alter nerve pathway mechanics.
• Post-surgical patients after lower limb procedures.
• Workers with prolonged standing or squatting postures.

At DMPhysios, risk assessment forms a key part of patient evaluation to design preventive and rehabilitative programs specific to each individual’s needs and risk profile.

Treatment

The management of tibial nerve injury depends on its cause, severity, and duration. Early diagnosis and timely treatment greatly improve outcomes.

1. Medical Management

• Pain management using anti-inflammatory or neuropathic medications.
• Corticosteroid injections in cases of tarsal tunnel syndrome to reduce inflammation.
• Surgical decompression if conservative measures fail, particularly in entrapment syndromes or complete nerve severance.

However, the cornerstone of recovery for most patients remains physiotherapy, aimed at restoring nerve function, mobility, and strength, precisely where DMPhysios excels.

Physiotherapy Treatment

At DMPhysios, physiotherapy for tibial nerve injury is customized for every patient, focusing on a multi-phase rehabilitation approach that integrates pain relief, mobility restoration, and long-term functional recovery.

1. Acute Phase (Pain and Inflammation Control)

The goal during the initial phase is to reduce pain, inflammation, and mechanical stress on the nerve.

Modalities used at DMPhysios include:

• Cryotherapy (cold therapy): Reduces inflammation in the acute stage.
• TENS (Transcutaneous Electrical Nerve Stimulation): Helps manage nerve-related pain.
• Accelerated Healing Therapy: Promotes deep tissue healing and reduces nerve irritation.

Protective Strategies:

• Avoid activities that aggravate symptoms.
• Use of orthotic support or ankle braces to relieve pressure on the nerve.

2. Mobility and Range of Motion (ROM) Restoration

Once pain subsides, gentle mobility exercises are introduced to prevent stiffness and maintain joint integrity.

Examples include:

• Ankle circles and alphabet exercises to maintain ankle flexibility.
• Toe curls and extensions to stimulate nerve and muscle activity.
• Passive and active ROM movements guided by the therapist.

At DMPhysios, therapists ensure all exercises are performed within pain-free limits and adjusted according to nerve recovery status.

3. Strengthening Phase

When nerve regeneration begins and pain reduces, strengthening exercises are introduced to restore muscular support and prevent atrophy.

Key strengthening exercises include:

• Calf raises: To activate gastrocnemius and soleus muscles.
• Resistance band plantarflexion: Helps strengthen the ankle and stimulate the tibial nerve pathway.
• Toe grip exercises: Using marbles or towels to engage intrinsic foot muscles.
• Balance training: On wobble boards or foam pads to improve proprioception.

These are gradually progressed under supervision at DMPhysios, ensuring controlled load and alignment for safe recovery.

4. Neural Mobilization Techniques

One of the advanced physiotherapy interventions used at DMPhysios is nerve gliding or neural mobilization.

This involves controlled movements designed to enhance nerve flexibility and reduce entrapment.
For a tibial nerve injury, the tibial nerve glide includes dorsiflexion and eversion of the ankle while extending the knee, performed under therapist supervision to avoid overstretching.

5. Gait Training and Functional Rehabilitation

Once sufficient strength and control are regained, patients undergo gait retraining to correct walking patterns affected by the nerve injury.

• Heel-to-toe walking drills for coordination.
• Balance and proprioceptive re-education for stability.
• Treadmill walking under therapist observation to refine stride mechanics.

DMPhysios integrates sports-specific retraining for athletes recovering from tibial nerve injury, ensuring safe return to sport without recurrence.

6. Electrotherapy and Neuromuscular Re-education

For cases involving prolonged nerve dysfunction or muscle weakness, electrical muscle stimulation (EMS) is used to activate dormant muscles and encourage nerve reinnervation.

This is often paired with biofeedback techniques at DMPhysios to help patients consciously retrain muscle control and improve strength symmetry between both limbs.

7. Manual Therapy and Myofascial Release

Soft tissue tightness around the posterior leg and ankle can worsen nerve compression. Manual therapy techniques such as:

• Myofascial release,
• Trigger point therapy, and
• Deep tissue massage
  are applied to improve tissue mobility and relieve neural tension.

8. Home Exercise Program and Ergonomic Education

At DMPhysios, patients are empowered through individualized home exercise plans that continue progress outside the clinic. Education on posture, footwear, activity modification, and ergonomics is also a crucial part of preventing recurrence.

Prevention

While not all cases are preventable, adopting preventive strategies significantly reduces the risk of developing tibial nerve injury:

• Maintain healthy footwear that supports the arch and prevents compression around the ankle.
• Warm up properly before sports or exercise.
• Avoid repetitive ankle stress or poor biomechanics during training.
• Manage diabetes and systemic health conditions effectively.
• Perform regular stretching of calf muscles and ankle stabilizers.
• Seek early physiotherapy consultation at DMPhysios in Noida for any signs of nerve irritation or ankle discomfort before it progresses.

Conclusion

A Tibial Nerve Injury can cause considerable pain, weakness, and movement restriction, especially when left untreated. However, with accurate diagnosis, early physiotherapy, and structured rehabilitation, full recovery is possible.

At DMPhysios, Noida’s leading physiotherapy center for spine and sports conditions, treatment focuses on comprehensive, patient-centered rehabilitation, integrating manual therapy, electrotherapy, and tailored exercise programs to restore full function and prevent recurrence of tibial nerve injury.

If you or someone you know is experiencing symptoms of tibial nerve injury, don’t delay.
Reach out to DMPhysios today for expert care, evidence-based rehabilitation, and a guided recovery pathway designed just for you.