open access

Vol 82, No 2 (2023)
Review article
Submitted: 2022-03-01
Accepted: 2022-03-31
Published online: 2022-04-20
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Variations in the branching pattern of tibial nerve in foot: a review of literature and relevant clinical anatomy

A. Priya1, S. K. Ghosh1, J. A. Walocha2, R. S. Tubbs345678, J. Iwanaga93108
·
Pubmed: 35481703
·
Folia Morphol 2023;82(2):231-241.
Affiliations
  1. Department of Anatomy, All India Institute of Medical Sciences, Phulwarisharif, Patna, India
  2. Department of Anatomy, Jagiellonian University, Krakow, Poland
  3. Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
  4. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada, West Indies
  5. Department of Structural and Cellular Biology, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
  6. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, United States
  7. Department of Surgery, Tulane Centrefor Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
  8. Department of Neurology, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
  9. Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
  10. Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan

open access

Vol 82, No 2 (2023)
REVIEW ARTICLES
Submitted: 2022-03-01
Accepted: 2022-03-31
Published online: 2022-04-20

Abstract

Considerable variations have been reported regarding the branching pattern of tibial nerve (TN) close to its termination in foot. In order to comprehend the clinical anatomy of heel pain awareness of all the possible variations in relation to terminal branching pattern of TN (close to the tarsal tunnel) is essential. The present study was conducted to undertake a comprehensive review of the variations in TN branches in foot with particular emphasis on the implications for sensory distribution of these branches. Articles were searched in major online indexed databases using relevant key words. The pattern of termination of TN was noted as either trifurcation or bifurcation. Bifurcation pattern was more commonly observed and is associated with the medial calcaneal nerve (MCN) either arising high or low relative to the tarsal tunnel. The most commonly noted type of bifurcation was proximal to malleolar-calcaneal axis but within the tarsal tunnel. Across all five types of bifurcation reported in literature, the termination points of TN ranged from 3 cm proximal to 3 cm distal to malleolar-calcaneal axis and, therefore, the area beyond this region can be considered as safe zone for performing invasive procedures. MCN showed considerable variations in its origin both in trifurcation and bifurcation pattern pertaining to number of branches (one/two/three) at the point of origin. The origin of inferior calcaneal nerve was observed to be relativelyless variable as it mostly arose as a branch of lateral plantar nerve and sometimes as a direct branch from TN before termination. The frequent variation of MCN in the tarsal tunnel should be kept in mind while undertaking decompression measures in medial ankle region.

Abstract

Considerable variations have been reported regarding the branching pattern of tibial nerve (TN) close to its termination in foot. In order to comprehend the clinical anatomy of heel pain awareness of all the possible variations in relation to terminal branching pattern of TN (close to the tarsal tunnel) is essential. The present study was conducted to undertake a comprehensive review of the variations in TN branches in foot with particular emphasis on the implications for sensory distribution of these branches. Articles were searched in major online indexed databases using relevant key words. The pattern of termination of TN was noted as either trifurcation or bifurcation. Bifurcation pattern was more commonly observed and is associated with the medial calcaneal nerve (MCN) either arising high or low relative to the tarsal tunnel. The most commonly noted type of bifurcation was proximal to malleolar-calcaneal axis but within the tarsal tunnel. Across all five types of bifurcation reported in literature, the termination points of TN ranged from 3 cm proximal to 3 cm distal to malleolar-calcaneal axis and, therefore, the area beyond this region can be considered as safe zone for performing invasive procedures. MCN showed considerable variations in its origin both in trifurcation and bifurcation pattern pertaining to number of branches (one/two/three) at the point of origin. The origin of inferior calcaneal nerve was observed to be relativelyless variable as it mostly arose as a branch of lateral plantar nerve and sometimes as a direct branch from TN before termination. The frequent variation of MCN in the tarsal tunnel should be kept in mind while undertaking decompression measures in medial ankle region.

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Keywords

tibial nerve, tarsal tunnel, heel pain, plantar nerves, medial calcaneal nerve, inferior calcaneal nerve

About this article
Title

Variations in the branching pattern of tibial nerve in foot: a review of literature and relevant clinical anatomy

Journal

Folia Morphologica

Issue

Vol 82, No 2 (2023)

Article type

Review article

Pages

231-241

Published online

2022-04-20

Page views

2594

Article views/downloads

1219

DOI

10.5603/FM.a2022.0042

Pubmed

35481703

Bibliographic record

Folia Morphol 2023;82(2):231-241.

Keywords

tibial nerve
tarsal tunnel
heel pain
plantar nerves
medial calcaneal nerve
inferior calcaneal nerve

Authors

A. Priya
S. K. Ghosh
J. A. Walocha
R. S. Tubbs
J. Iwanaga

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