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Posterior Tibial Cortex

cortex tibiae posterior

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.

Anatomical Data

Structure & Landmarks

Articulations	No joint; posterior surface of the tibial shaft
Landmarks	Soleal line (superior boundary) Tibial nutrient foramen (proximal third) Origin ridges for deep posterior compartment muscles Posterior tibial periosteum
Ossification	Part of the primary tibial diaphyseal ossification centre present from the 7th fetal week.

Clinical Relevance

Clinical Notes

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.

Pathology

Common Injuries & Conditions

Compression-side Tibial Stress Fracture

Stress fractures on the posteromedial cortex are the common low-risk type and usually heal with rest.

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