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Tibialis posteriorMusculus tibialis posterior

The deepest muscle at the back of the leg; it turns the sole inwards, helps point the foot and is a major support for the inner arch.

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LatinMusculus tibialis posterior
Origin
  • Posterior surface of the interosseous membrane (except its lowest part)
  • Lateral part of the posterior surface of the tibia, from below the soleal line to the junction of the middle and lower thirds
  • Upper two-thirds of the medial surface of the fibula
Insertion
  • Tuberosity of the navicular bone (main attachment)
  • Expansions to the sustentaculum tali of the calcaneus, all three cuneiforms, the cuboid and the bases of the 2nd–4th metatarsals
Action
  • Inverts the foot (turns the sole inwards)
  • Assists plantarflexion of the ankle (pointing the foot)
  • Supports the inner (medial) longitudinal arch of the foot
  • Steadies the lower leg over the foot
NerveTibial nerve (L5–S1)
NameLatin tibia, 'shin bone', and posterior, 'behind'.

Palpation

  1. Client prone or side-lying on the side being worked, with the knee slightly bent.
  2. The belly lies too deep under the calf muscles to feel directly; instead find its tendon just behind and below the medial malleolus (inner ankle bone).
  3. Follow the tendon forward to the bump of the navicular on the inner side of the foot, in front of and below the ankle.
  4. Ask the client to point the foot and turn the sole inwards against light resistance; the tendon firms behind the inner ankle bone.

Landmarks: Medial malleolus · Calcaneus

Tibialis posterior is the deepest muscle in the back of the leg. It lies under Soleus and between Flexor digitorum longus and Flexor hallucis longus, so in massage you work it through the calf muscles or reach its tendon at the inner ankle. Unlike the calf muscles, it does not join the Achilles (calcaneal) tendon; its tendon passes behind the Medial malleolus instead and runs under the foot.

Its tendon spreads out under the arch like a sling, which is why it matters for the inner arch of the foot. Runners and people with flat feet commonly report tenderness along the inner shin or behind the inner ankle. Specific tendon work belongs to remedial training.

It works with Tibialis anterior to turn the sole inwards, even though the two work against each other for pointing and lifting the foot. It works against Fibularis longus and Fibularis brevis, which turn the sole outwards.

Source notes. Wikipedia’s text describes the origin only as the fibula and interosseous membrane; Gray’s Anatomy (1918) adds the back of the tibia, as does Wikipedia’s infobox. Wikipedia gives no nerve root levels, so L5–S1 comes from Gray only.

Techniques

  • Compression — Pressing straight down into a muscle with the palm, fist or forearm, holding briefly, then releasing and moving on.
  • Stripping — A slow, deep, narrow glide along the length of a single muscle with the thumb, knuckle or elbow, pausing over tight bands on the way.
  • Cross-fibre friction — Deep, specific friction applied back and forth across the direction of a tendon, ligament or muscle's fibres, with the fingers and skin moving together as one.
  • Trigger point pressure release — Sustained thumb or finger pressure on a tender spot within a taut band of muscle, held until the client reports the discomfort easing, then slowly released.

Works with

  • Tibialis anterior — Long muscle beside the shin bone that lifts the foot up (dorsiflexion) and turns the sole inwards (inversion).
  • Flexor digitorum longus — Deep muscle on the inner back of the leg that curls the four small toes and helps point the foot.
  • Flexor hallucis longus — Deep muscle on the outer back of the leg that bends the big toe and gives the push-off in walking, running and rising onto the toes.
  • Soleus — Broad, flat calf muscle lying under the gastrocnemius that points the foot and keeps the body from tipping forward when standing.

Opposes

  • Fibularis longus — Long muscle on the outer side of the lower leg whose tendon wraps behind the outer ankle and under the foot to turn the sole outwards and support the arches.
  • Fibularis brevis — Shorter fibular muscle lying under fibularis longus on the outer leg; it turns the sole outwards and helps point the foot.

Sources

  1. Wikipedia: Tibialis posterior muscle
  2. Wikipedia: Tibial nerve
  3. Gray's Anatomy of the Human Body (1918), Myology 8c: The Muscles and Fasciae of the Leg (archived Bartleby page) (Public domain. Used for attachments and nerve roots (L5–S1); the Wikipedia article gives no root levels.)