Tibialis Posterior Reflex

Tibialis Posterior Reflex isa deep tendon reflex used to evaluate the L5 Nerve Root function, or it can indicate pathology of the tibial and/or sciatic nerve.

How to perform the Tibialis Posterior Reflex?

Optimal patient positioning significantly influences the accuracy of reflex testing. The tibialis posterior reflex is evaluated in the seated patient and the ankle should be held in slight dorsiflexion to place the tibialis posterior tendon under mild stretch. This positioning enhances the sensitivity of the reflex response and improves the reliability of the assessment.

The examiner holds the patient’s foot in a small amount of eversion and dorsiflexion and strikes the posterior tibial tendon just below the medial malleolus. The examiner may also place a finger on the posterior tibial tendon and strike the finger instead of striking the tendon directly. When the reflex is elicited, a slight plantar flexion inversion response is noted.

See Also: Deep Tendon Reflex Testing

Normal reflex response manifests as immediate plantar flexion and inversion of the foot. The amplitude and speed of this response should be compared bilaterally to establish symmetry. Grading typically follows the standard 0-4+ scale, where 0 represents absent reflexes and 4+ indicates hyperactive reflexes with clonus. Medical professionals should note that slight variations in reflex intensity can occur naturally between individuals.

See Also: Tibialis Posterior Muscle

References & More

1. DeJong’s The Neurologic Examination – 8th Edition
2. Zimmerman B, Hubbard JB. Deep Tendon Reflexes. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: Pubmed