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Vol 80, No 2 (2021)
Original article
Submitted: 2020-04-04
Accepted: 2020-05-26
Published online: 2020-06-03
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Ultrasound-guided topographic anatomy of the medial calcaneal branches of the tibial nerve

Ł. Warchol1, J. A. Walocha1, E. Mizia1, M. Bonczar2, H. Liszka1, M. Koziej1
DOI: 10.5603/FM.a2020.0062
·
Pubmed: 32488855
·
Folia Morphol 2021;80(2):267-274.
Affiliations
  1. Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
  2. Intermed Medical Clinic, Zabierzow, Poland

open access

Vol 80, No 2 (2021)
ORIGINAL ARTICLES
Submitted: 2020-04-04
Accepted: 2020-05-26
Published online: 2020-06-03

Abstract

Background: The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment. Materials and methods: Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analysed in reference to the amount and their respective nerves of origin. Results: In 77% of cases, tibial nerve bifurcation occurred below the tip of the medial malleolus with the average distance of 5.9 mm and in 48% of cases above the posterior superior tip of the calcaneal tuberosity with the average distance of 2.7 mm. In 73% of cases medial calcaneal branches occurred as a single branch originating from the tibial nerve (60%). The average distance of the first, second and third medial calcaneal branch was accordingly 9.3 mm above, 9.5 mm below and 11.6 mm below the tip of the medial malleolus and 17.7 mm above, 1.6 mm below and 4 mm below the posterior superior tip of the calcaneal tuberosity. Conclusions: As the tibial nerve and its branches present a huge variability in the medial ankle area, in order to prevent the iatrogenic injuries, the preoperative or intraoperative ultrasound assessment (sonosurgery) of its localisation should be introduced into the clinic.

Abstract

Background: The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment. Materials and methods: Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analysed in reference to the amount and their respective nerves of origin. Results: In 77% of cases, tibial nerve bifurcation occurred below the tip of the medial malleolus with the average distance of 5.9 mm and in 48% of cases above the posterior superior tip of the calcaneal tuberosity with the average distance of 2.7 mm. In 73% of cases medial calcaneal branches occurred as a single branch originating from the tibial nerve (60%). The average distance of the first, second and third medial calcaneal branch was accordingly 9.3 mm above, 9.5 mm below and 11.6 mm below the tip of the medial malleolus and 17.7 mm above, 1.6 mm below and 4 mm below the posterior superior tip of the calcaneal tuberosity. Conclusions: As the tibial nerve and its branches present a huge variability in the medial ankle area, in order to prevent the iatrogenic injuries, the preoperative or intraoperative ultrasound assessment (sonosurgery) of its localisation should be introduced into the clinic.

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Keywords

medial calcaneal nerve, ultrasound-guided nerve examination, tarsal tunnel syndrome, medial plantar nerve, lateral plantar nerve, sonosurgery

About this article
Title

Ultrasound-guided topographic anatomy of the medial calcaneal branches of the tibial nerve

Journal

Folia Morphologica

Issue

Vol 80, No 2 (2021)

Article type

Original article

Pages

267-274

Published online

2020-06-03

Page views

1904

Article views/downloads

1807

DOI

10.5603/FM.a2020.0062

Pubmed

32488855

Bibliographic record

Folia Morphol 2021;80(2):267-274.

Keywords

medial calcaneal nerve
ultrasound-guided nerve examination
tarsal tunnel syndrome
medial plantar nerve
lateral plantar nerve
sonosurgery

Authors

Ł. Warchol
J. A. Walocha
E. Mizia
M. Bonczar
H. Liszka
M. Koziej

References (39)
  1. Ahmad M, Tsang K, Mackenney PJ, et al. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg. 2012; 18(3): 149–152.
    CrossRefPubMed
  2. Aldridge T. Diagnosing heel pain in adults. Am Fam Physician. 2004; 70(2): 332–338.
    PubMed
  3. Alshami AM, Souvlis T, Coppieters MW. A review of plantar heel pain of neural origin: differential diagnosis and management. Man Ther. 2008; 13(2): 103–111.
    CrossRefPubMed
  4. Andreasen Struijk LNS, Birn H, Teglbjaerg PS, et al. Size and separability of the calcaneal and the medial and lateral plantar nerves in the distal tibial nerve. Anat Sci Int. 2010; 85(1): 13–22.
    CrossRefPubMed
  5. Bailie DS, Kelikian AS. Tarsal tunnel syndrome: diagnosis, surgical technique, and functional outcome. Foot Ankle Int. 1998; 19(2): 65–72.
    CrossRefPubMed
  6. Bilge O, Ozer MA, Govsa F. Neurovascular branching in the tarsal tunnel. Neuroanatomy. 2003; 2: 39–41.
  7. Davis TJ, Schon LC. Branches of the tibial nerve: anatomic variations. Foot Ankle Int. 1995; 16(1): 21–29.
    CrossRefPubMed
  8. De Maeseneer M, Madani H, Lenchik L, et al. Normal anatomy and compression areas of nerves of the foot and ankle: US and MR imaging with anatomic correlation. Radiographics. 2015; 35(5): 1469–1482.
    CrossRefPubMed
  9. Dellon AL, Kim J, Spaulding CM. Variations in the origin of the medial calcaneal nerve. J Am Podiatr Med Assoc. 2002; 92(2): 97–101.
    CrossRefPubMed
  10. Dellon AL, Mackinnon SE. Tibial nerve branching in the tarsal tunnel. Arch Neurol. 1984; 41(6): 645–646.
    CrossRefPubMed
  11. Didia BC, Horsefall AU. Medial calcaneal nerve. An anatomical study. J Am Podiatr Med Assoc. 1990; 80(3): 115–119.
    CrossRefPubMed
  12. Doneddu PE, Coraci D, Loreti C, et al. Tarsal tunnel syndrome: still more opinions than evidence. Status of the art. Neurol Sci. 2017; 38(10): 1735–1739.
    CrossRefPubMed
  13. Flanigan RM, DiGiovanni BF. Peripheral nerve entrapments of the lower leg, ankle, and foot. Foot Ankle Clin. 2011; 16(2): 255–274.
    CrossRefPubMed
  14. Govsa F, Bilge O, Ozer MA. Variations in the origin of the medial and inferior calcaneal nerves. Arch Orthop Trauma Surg. 2006; 126(1): 6–14.
    CrossRefPubMed
  15. Havel PE, Ebraheim NA, Clark SE, et al. Tibial nerve branching in the tarsal tunnel. Foot Ankle. 1988; 9(3): 117–119.
    CrossRefPubMed
  16. Heimkes B, Posel P, Stotz S, et al. The proximal and distal tarsal tunnel syndromes. An anatomical study. Int Orthop. 1987; 11(3): 193–196.
    CrossRefPubMed
  17. Horwitz MT. Normal anatomy and variations of the peripheral nerves of the leg and foot application in operations for vascular diseases: study of one hundred specimens. Arch Surg. 1938; 36(4): 626–636.
    CrossRef
  18. Iborra A, Villanueva M, Sanz-Ruiz P. Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months. J Orthop Surg Res. 2020; 15(1): 30.
    CrossRefPubMed
  19. Iborra A, Villanueva M, Barrett SL, et al. Anatomic delineation of tarsal tunnel innervation via ultrasonography. J Ultrasound Med. 2018; 37(6): 1325–1334.
    CrossRefPubMed
  20. Iborra Á, Villanueva-Martínez M, Barrett SL, et al. Ultrasound-Guided release of the tibial nerve and its distal branches: a cadaveric study. J Ultrasound Med. 2019; 38(8): 2067–2079.
    CrossRefPubMed
  21. Joshi SS, Joshi SD, Athavale AS. Anatomy of tarsal tunnel and its applied Significeance. J Anat Soc india. 2006; 55(1): 52–56.
  22. Keck C. The tarsal-tunnel syndrome. J Bone Joint Surg. 1962; 44(1): 180–182.
    CrossRef
  23. Kim DI, Kim YS, Han SH. Topography of human ankle joint: focused on posterior tibial artery and tibial nerve. Anat Cell Biol. 2015; 48(2): 130–137.
    CrossRefPubMed
  24. Kopell HP, Thompson WA. [Peripheral entrapment neuropathies of the lower extremity]. N Engl J Med. 1960; 262: 56–60.
    CrossRefPubMed
  25. LAam SJ. A tarsal-tunnel syndrome. Lancet. 1962; 2(7270): 1354–1355.
    CrossRefPubMed
  26. Lijoi F, Lughi M, Baccarani G. Posterior arthroscopic approach to the ankle: an anatomic study. Arthroscopy. 2003; 19(1): 62–67.
    CrossRefPubMed
  27. Louisia S, Masquelet AC. The medial and inferior calcaneal nerves: an anatomic study. Surg Radiol Anat. 1999; 21(3): 169–173.
    CrossRefPubMed
  28. Moore KL. Clinically oriented anatomy. 8th Ed, LWW 2017.
  29. Mullick T, Dellon AL. Results of decompression of four medial ankle tunnels in the treatment of tarsal tunnels syndrome. J Reconstr Microsurg. 2008; 24(2): 119–126.
    CrossRefPubMed
  30. Ndiaye A, Dia A, Konate I, et al. [Topographic anatomy of the tibial nerve in the medial malleolus: application to the effect of nerve block anesthesia]. Morphologie. 2003; 87(277): 25–27.
    PubMed
  31. Netter FH. Atlas of human anatomy. 7th Ed, Elsevier 2018.
  32. Oztuna V, Ozge A, Eskandari MM, et al. Nerve entrapment in painful heel syndrome. Foot Ankle Int. 2002; 23(3): 208–211.
    CrossRefPubMed
  33. Paulsen F, Waschke J. Sobotta atlas of human anatomy. 15th Ed, Urban & Fischer 2012.
  34. Pilecki Z, Pilecki G, Bubnov R. Introduction to sonosurgery. EPMA J. 2014; 5(S1).
    CrossRef
  35. Rondhuis JJ, Huson A. The first branch of the lateral plantar nerve and heel pain. Acta Morphol Neerl Scand. 1986; 24(4): 269–279.
    PubMed
  36. Rowley WR, Bezold C, Arikan Y, et al. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag. 2017; 20(1): 6–12.
    CrossRefPubMed
  37. Torres ALG. Marcus Castro Ferreira MC. Study of the anatomy of the tibial nerve and its branches in the distal medial leg. Acta Ortop Bras. 2012; 20(3): 157–164.
  38. Warchoł Ł, Mróz I, Mizia E, et al. Vascular density of inferior tibiofibular joint - cadaveric experimental study. Folia Med Cracov. 2017; 57(1): 47–54.
    PubMed
  39. Yates B. Merriman's Assessment of the Lower Limb. 3rd Ed. Churchill Livingstone, New York 2008.

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