open access

Ahead of Print
Original article
Published online: 2020-06-09
Submitted: 2020-04-21
Accepted: 2020-06-07
Get Citation

Computer-assisted measurements of the histological structure of the tibial nerve and its terminal branches

Ł. Warchol, J. A. Walocha, E. Mizia, H. Liszka, M. Bonczar, I. Zamojska
DOI: 10.5603/FM.a2020.0068
·
Pubmed: 32639574

open access

Ahead of Print
ORIGINAL ARTICLES
Published online: 2020-06-09
Submitted: 2020-04-21
Accepted: 2020-06-07

Abstract

Background: The aim of this study was to analyze the histological structure (cross-sectional area (CSA) and number of nerve bundles) of the distal part of the tibial nerve and its terminal branches (medial plantar nerve, lateral plantar nerve) using computer assisted image analysis.

Materials and methods: The tibial nerve with distal branches (medial and lateral plantar nerves) were dissected from the fresh cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the tibial nerve bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 µm slices and stained with haematoxylin and eosin. Then photographed and analyzed using Olympus cellSens software.

Results: The studied group comprised 28 female and 32 male feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve bundles were respectively 17.86 ± 4.57 mm2, 33.88 ± 6.31 for the tibial nerve, 9.58 ± 1.95 mm2, 23.41 ± 7.37 for the medial plantar nerve and 7.17 ± 2.36 mm2, 15.06 ± 5.81 for the lateral plantar nerve in males and 12.27 ± 2.45 mm2, 26.32 ± 8.87 for the tibial nerve, 7.81 ± 1.41 mm2, 17.71 ± 5.28 for the medial plantar nerve and 5.83 ± 1.25 mm2, 11.50 ± 3.72 for the lateral plantar nerve in females. Both CSA and number of nerve bundles of the tibial, medial plantar and lateral plantar nerves revealed no statistical differences when comparing foot side of the individual. The statistical difference was related to the gender showing significant bigger CSA and number of nerve bundles in males (CSA: p = 0.000, p = 0.000, p = 0.016; number of nerve bundles p = 0.01, p = 0.003, p = 0.004 respectively). A positive correlation was found between the donors age and the tibial nerve CSA (r = 0.44, p = 0.000). A significant statistical difference was found between the medial and lateral plantar nerves both in CSA and number of nerve bundles ( p < 0.001, p < 0.001 respectively).

Conclusions: The CSA and the number of nerve bundles in the distal part of the tibial nerve and its branches are significantly bigger in males with no differences between right and left foot of the individual. The tibial nerve shows increasing CSA with advanced age. The medial plantar nerve has larger CSA and more nerve bundles than the lateral plantar nerve.

Abstract

Background: The aim of this study was to analyze the histological structure (cross-sectional area (CSA) and number of nerve bundles) of the distal part of the tibial nerve and its terminal branches (medial plantar nerve, lateral plantar nerve) using computer assisted image analysis.

Materials and methods: The tibial nerve with distal branches (medial and lateral plantar nerves) were dissected from the fresh cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the tibial nerve bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 µm slices and stained with haematoxylin and eosin. Then photographed and analyzed using Olympus cellSens software.

Results: The studied group comprised 28 female and 32 male feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve bundles were respectively 17.86 ± 4.57 mm2, 33.88 ± 6.31 for the tibial nerve, 9.58 ± 1.95 mm2, 23.41 ± 7.37 for the medial plantar nerve and 7.17 ± 2.36 mm2, 15.06 ± 5.81 for the lateral plantar nerve in males and 12.27 ± 2.45 mm2, 26.32 ± 8.87 for the tibial nerve, 7.81 ± 1.41 mm2, 17.71 ± 5.28 for the medial plantar nerve and 5.83 ± 1.25 mm2, 11.50 ± 3.72 for the lateral plantar nerve in females. Both CSA and number of nerve bundles of the tibial, medial plantar and lateral plantar nerves revealed no statistical differences when comparing foot side of the individual. The statistical difference was related to the gender showing significant bigger CSA and number of nerve bundles in males (CSA: p = 0.000, p = 0.000, p = 0.016; number of nerve bundles p = 0.01, p = 0.003, p = 0.004 respectively). A positive correlation was found between the donors age and the tibial nerve CSA (r = 0.44, p = 0.000). A significant statistical difference was found between the medial and lateral plantar nerves both in CSA and number of nerve bundles ( p < 0.001, p < 0.001 respectively).

Conclusions: The CSA and the number of nerve bundles in the distal part of the tibial nerve and its branches are significantly bigger in males with no differences between right and left foot of the individual. The tibial nerve shows increasing CSA with advanced age. The medial plantar nerve has larger CSA and more nerve bundles than the lateral plantar nerve.

Get Citation

Keywords

tibial nerve, cross-sectional area, nerve bundles, medial and lateral plantar nerves, computer-assisted image analysis, histology

About this article
Title

Computer-assisted measurements of the histological structure of the tibial nerve and its terminal branches

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Original article

Published online

2020-06-09

DOI

10.5603/FM.a2020.0068

Pubmed

32639574

Keywords

tibial nerve
cross-sectional area
nerve bundles
medial and lateral plantar nerves
computer-assisted image analysis
histology

Authors

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

References (35)
  1. 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.
  2. Bailie DS, Kelikian AS. Tarsal tunnel syndrome: diagnosis, surgical technique, and functional outcome. Foot Ankle Int. 1998; 19(2): 65–72.
  3. Bedewi MA, Abodonya A, Kotb M, et al. Estimation of ultrasound reference values for the lower limb peripheral nerves in adults: A cross-sectional study. Medicine (Baltimore). 2018; 97(12): e0179.
  4. Bilge O, Ozer MA, Govsa F. Neurovascular branching in the tarsal tunnel. Neuroanatomy. 2003; 2: 39–41.
  5. Boehm J, Scheidl E, Bereczki D, et al. High-resolution ultrasonography of peripheral nerves: measurements on 14 nerve segments in 56 healthy subjects and reliability assessments. Ultraschall Med. 2014; 35(5): 459–467.
  6. Cartwright MS, Mayans DR, Gillson NA, et al. Nerve cross-sectional area in extremes of age. Muscle Nerve. 2013; 47(6): 890–893.
  7. Cartwright MS, Passmore LV, Yoon JS, et al. Cross-sectional area reference values for nerve ultrasonography. Muscle Nerve. 2008; 37(5): 566–571.
  8. Ceballos D, Cuadras J, Verdú E, et al. Morphometric and ultrastructural changes with ageing in mouse peripheral nerve. J Anat. 1999; 195 ( Pt 4): 563–576.
  9. Davis TJ, Schon LC. Branches of the tibial nerve: anatomic variations. Foot Ankle Int. 1995; 16(1): 21–29.
  10. 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.
  11. Delgado-Martínez I, Badia J, Pascual-Font A, et al. Fascicular topography of the human median nerve for neuroprosthetic surgery. Front Neurosci. 2016; 10: 286.
  12. Grimm A, Axer H, Heiling B, et al. Nerve ultrasound normal values - Readjustment of the ultrasound pattern sum score UPSS. Clin Neurophysiol. 2018; 129(7): 1403–1409.
  13. He Y, Xiang Xi, Zhu BH, et al. Shear wave elastography evaluation of the median and tibial nerve in diabetic peripheral neuropathy. Quant Imaging Med Surg. 2019; 9(2): 273–282.
  14. 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.
  15. Horwitz M . 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.
  16. Ito T, Kijima M, Watanabe T, et al. Ultrasonography of the tibial nerve in vasculitic neuropathy. Muscle Nerve. 2007; 35(3): 379–382.
  17. Joshi SS, Joshi SD, Athavale AS. Anatomy of tarsal tunnel and its applied Significeance. J Anat Soc India. 2006; 55(1): 52–56.
  18. Kang S, Kim SeH, Yang SN, et al. Sonographic features of peripheral nerves at multiple sites in patients with diabetic polyneuropathy. J Diabetes Complications. 2016; 30(3): 518–523.
  19. Kerasnoudis A, Pitarokoili K, Behrendt V, et al. Cross sectional area reference values for sonography of peripheral nerves and brachial plexus. Clin Neurophysiol. 2013; 124(9): 1881–1888.
  20. Koo GB, Lee JH, Jang JH, et al. Superficial course of the medial plantar nerve: case report. Anat Cell Biol. 2019; 52(1): 87–89.
  21. Kronlage M, Schwehr V, Schwarz D, et al. Magnetic resonance neurography: normal values and demographic determinants of nerve caliber and T2 relaxometry in 60 healthy individuals. Clin Neuroradiol. 2019; 29(1): 19–26.
  22. Lee D, Dauphinée D. Morphological and functional changes in the diabetic peripheral nerve. J Am Podiatr Med Assoc. 2005; 95(5): 433–437.
  23. Lijoi F, Lughi M, Baccarani G. Posterior arthroscopic approach to the ankle: an anatomic study. Arthroscopy. 2003; 19(1): 62–67.
  24. Lothet EH, Bishop TJ, Walker FO, et al. Ultrasound-Derived nerve cross-sectional area in extremes of height and weight. J Neuroimaging. 2019; 29(3): 406–409.
  25. Mizia E, Tomaszewski KA, Rutowicz B, et al. Computer-assisted assessment of the histological structure of the human sural nerve. Folia Morphol. 2014; 73(3): 292–297.
  26. Moore KL. Clinically Oriented Anatomy. 8th Ed, LWW 2017.
  27. Riazi S, Bril V, Perkins BA, et al. Can ultrasound of the tibial nerve detect diabetic peripheral neuropathy? A cross-sectional study. Diabetes Care. 2012; 35(12): 2575–2579.
  28. Seok HY, Jang JH, Won SJ, et al. Cross-sectional area reference values of nerves in the lower extremities using ultrasonography. Muscle Nerve. 2014; 50(4): 564–570.
  29. Singh K, Gupta K, Kaur S. High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy. J Ultrason. 2017; 17(71): 246–252.
  30. Singh Y, Dixit R, Singh S, et al. High resolution ultrasonography of peripheral nerves in diabetic peripheral neuropathy. Neurol India. 2019; 67(Suppl): S71–S76.
  31. Tagliafico A, Cadoni A, Fisci E, et al. Reliability of side-to-side ultrasound cross-sectional area measurements of lower extremity nerves in healthy subjects. Muscle Nerve. 2012; 46(5): 717–722.
  32. Tomaszewski KA, Graves MJ, Henry BM, et al. Surgical anatomy of the sciatic nerve: A meta-analysis. J Orthop Res. 2016; 34(10): 1820–1827.
  33. Warchol Ł, Walocha JA, Mizia E, et al. Ultrasound guided topographic anatomy of the medial calcaneal branches of the tibial nerve. Folia Morphol. 2020 [Epub ahead of print].
  34. 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.
  35. Yiu EM, Brockley CR, Lee KJ, et al. Peripheral nerve ultrasound in pediatric Charcot-Marie-Tooth disease type 1A. Neurology. 2015; 84(6): 569–574.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl