Nerves of the Foot

Topic updated on 08/01/16 5:54pm
Branches of the Tibial nerve
  • Medial calcaneal nerve
    • innervates
      • plantar medial heel
  • Medial plantar nerve
    • innervates
      • Abductor Hallucis
      • FHB
      • FDB
      • lumbircals to 2nd and 3rd toes
    • at risk
      • proper branch of medial plantar nerve at risk with medial-plantar approach to the tibial sesamoid
  • Lateral plantar nerve
    • innervates (everything else)
      • adductor hallucis
      • quadratus plantae
      • all interossei muscles
      • lateral two lumbricals
      • abductor digiti minimus (via Baxter's nerve - the first branch of LPN
        • Baxter`s nerve
          • courses anterior to the medial tubersosity between the QP and FDB
    • provides sensation to 
      • plantar lateral foot
      • lateral fourth toe
      • fifth toe
  • Physical exam
    • injury to lateral/medial plantar nerve leads to weak or absent MTP flexion (intrinsic minus)
Sural Nerve
  • Provides dorsal sensory in 4th web space (70-80% of time)
  • Most vulnerable during
    • extensile lateral approach to calcaneus
    • screw placement for stress fx of proximal 5th MT
    • Achilles tendon repair - especially percutaneous technique
Deep peroneal Nerve
  • Innervates EDB, and EHB in foot
  • Provides sensation to the first dorsal webspace
  • Found compressed beneath inferior retinaculum in anterior tarsal tunnel syndrome
  • Lateral branch
    • most vulnerable during removal of calcaneonavicular bar
    • during approach for reduction of Lisfranc injury
  • Injury
    • injury leads to weak or absent EDB and EHB function
      • this can be seen with trauma or CMT
Superficial Peroneal Nerve
  • Medial branch
    • dorsomedial aspect of hallux
      • most vulnerable during bunion surgery   
  • Lateral cutaneous branch
    • emerges from deep fascia 12-15 cm proximal to tip of lateral malleolus
    • most vulnerable with
      • arthroscopic anterolateral portal
      • ORIF of distal fibula fx (especially Weber C)
Saphenous Nerve
  • Supplies sensation to 
    • medial side of foot


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