Anatomic site for proximal tibial nerve compression: A cadaver study

Primary compression of the tibial nerve beneath the fibromuscular sling of the origin of the soleus muscle is rarely discussed in the literature. To evaluate the location and characteristics of the soleal fibromuscular sling and its relationship to the tibial nerve, 36 cadaver limbs were dissected. The leg length, location of soleal fibromuscular sling, presence of a thickened fibrous band at the soleal sling, and narrowing in the tibial nerve were recorded. The average leg length was 47.8 cm (SD ± 4.16). The fibromuscular soleal sling was 9.3 cm (SD ± 1.44) distal to the medial tibial plateau. Although 56% (20/36) of specimens had a fibrous band, only 8% (3/36) demonstrated a focal narrowing directly under this fascial sling. This study demonstrates that the fibromuscular sling of the soleus muscle may act as a potential compression site of the tibial nerve. These findings offer insight and potential hope for those patients who have persistent plantar numbness after tarsal tunnel decompression and for those patients with plantar numbness who also have weakness of toe flexion.