From the Guidelines
Tibial neuropathy is primarily caused by compression, trauma, or systemic diseases affecting the tibial nerve, with diabetes mellitus being a significant contributor, as highlighted in the 2023 standards of care in diabetes 1.
Causes of Tibial Neuropathy
The causes of tibial neuropathy can be categorized into several groups, including:
- Compression or entrapment, such as tarsal tunnel syndrome
- Trauma, including fractures or lacerations
- Systemic diseases, such as diabetes mellitus, vasculitis, and hypothyroidism
- Repetitive stress injuries from activities like running or prolonged squatting
- Anatomical variations, including accessory muscles, ganglion cysts, or varicose veins
- Space-occupying lesions, such as tumors or hematomas It is essential to note that diabetic neuropathy is a diagnosis of exclusion, and other causes of neuropathic pain should be carefully assessed and excluded, as recommended in the consensus guidelines for painful diabetic peripheral neuropathy 1.
Importance of Early Recognition and Management
Early recognition and management of tibial neuropathy are crucial to prevent further nerve damage and improve quality of life. The 2023 standards of care in diabetes emphasize the importance of assessing for diabetic peripheral neuropathy starting at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes, and at least annually thereafter 1.
Assessment and Diagnosis
A careful clinical history and peripheral neurological and vascular examination of the lower extremities are essential to diagnose tibial neuropathy and exclude other causes of neuropathic pain, as recommended in the consensus guidelines for painful diabetic peripheral neuropathy 1.
Treatment and Management
While specific treatment to reverse the underlying nerve damage is currently not available, addressing the underlying cause of tibial neuropathy is essential for effective management. Glycemic control can effectively prevent diabetic peripheral neuropathy and cardiac autonomic neuropathy in type 1 diabetes, and may modestly slow their progression in type 2 diabetes, as highlighted in the 2023 standards of care in diabetes 1.
From the Research
Causes of Tibial Neuropathy
- Compression of the posterior tibial nerve due to various factors such as trauma, vascular disorders, soft tissue inflammation, diabetes mellitus, compression lesions, bony lesions, masses, lower extremity edema, and postoperative injury 2
- Entrapment of the posterior tibial nerve within the tarsal tunnel, which can be caused by distinct movements of the foot, trauma, and other factors 3, 2
- Idiopathic causes, accounting for 20% of cases 3
- Ruptured Baker cyst, which can cause direct compression of the posterior tibial nerve at the lower calf area 4
- Other potential causes include plantar fasciitis, lumbosacral radiculopathy, rheumatologic diseases, metatarsal stress fractures, and Morton's neuroma, which should be considered in the differential diagnosis 3, 2