The posterior tibial cortex forms the posterior surface of the tibial diaphysis, providing origin for tibialis posterior, flexor digitorum longus, and flexor hallucis longus in the deep posterior compartment. The nutrient foramen of the tibia opens on this posterior cortex in the proximal third.
The posterior tibial cortex is the site of tibial stress fractures in the compression zone — the posteromedial cortex — in runners and military recruits. These are distinguished from the more serious anterior tension-zone fractures by their location and healing potential. CT demonstrates cortical thickening and stress reaction before frank fracture. Posterior tibial cortex screw purchase is important in locked intramedullary nailing for tibial shaft fractures.
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