A Part of the Medial Branch of the Deep Peroneal Nerve Distributes the Dorsal Pedis Artery and Its Distribution Area is Close to the Acupuncture Point LR3 (Taichong)

Abstract

Cutaneous nerves have vascular branches (VBs) that reach the arteries and are thought to be involved in arterial constriction. We aimed to examine the anatomical and histological relationship between the VBs of a cutaneous nerve in the foot and the acupuncture point LR3 (Taichong), which is a depression between the base of the first and second metatarsal bones on the dorsum of the foot and is a source point of the foot. We examined 40 cadaver feet to assess the distribution areas of the VBs of the medial branch of the deep peroneal nerve (MBDPN). MBDPNs were distally followed to identify the point where the VBs reached the arteries. The distance between the point and LR3 was measured. Sympathetic fibers in the VBs were histologically observed using tyrosine hydroxylase (TH) immunostaining. The VBs of the MBDPNs reaching the dorsal pedis arteries were observed in all specimens (100%). The mean distance between LR3 and the point where the VBs of the MBDPN reached the arteries was 3.2 ± 2.6 mm. Among the VBs, 70% were distributed proximal to LR3. Moreover, TH-positive fibers were present in the VBs. These findings revealed that a part of the MBDPN distributed the dorsal pedis artery and contained sympathetic fibers. We also found that the distribution area of the VBs was close to LR3. Our study provides anatomical evidence that LR3 is a specific area and its stimulation would be useful for treating peripheral circulatory failure.

Nerve branches to the anterior tibial artery: Clinical application

“…However, only one type of branching pattern was seen, that is, one VB ramified from one nerve (Umemoto et al, 2020). These findings indicate that the branching patterns of VBs differ among body parts.…”

“…CRPS is considered to be mainly driven by sympathetic dysfunction, sympathetically maintained pain being its major pathogenetic mechanism. The DFN has VBs reaching the dorsalis pedis artery as well as the ATA, and those VBs contain sympathetic nerves (Umemoto et al, 2020). Therefore, VBs reaching the ATA also contain sympathetic nerves, and injuring them could lead to sympathetic dysfunction.…”

“…A more recent study has revealed that VBs reached the dorsalis pedis artery in the foot in 40 of 40 specimens (100%; Umemoto et al, 2020). However, only one type of branching pattern was seen, that is, one VB ramified from one nerve (Umemoto et al, 2020). These findings indicate that the branching patterns of VBs differ among body parts.…”

“…For example, two VBs ramifying from one nerve inserted independently; two VBs ramifying from one nerve were connected; VBs ramifying from different cutaneous nerves were connected (Umemoto et al, 2018). A more recent study has revealed that VBs reached the dorsalis pedis artery in the foot in 40 of 40 specimens (100%; Umemoto et al, 2020).…”

“…Few studies have examined cadavers histologically to assess the sympathetic fibers in VBs. The sympathetic fibers in the VBs of the palmar cutaneous branch of the ulnar nerve in the forearm and the medial branch of the deep fibular nerve in the foot were detected using tyrosine hydroxylase immunostaining (Balogh et al, 1999; Umemoto et al, 2020). There is thought to be a complex interplay between the sympathetic nervous system and atherosclerosis (Al‐Sharea et al, 2019; Chen et al, 2020; Chistiakov et al, 2015), characterized by the accumulation of lipids and inflammation in the circulating blood and the arterial vessel walls (Lichtor et al, 1987; Manuck et al, 1988).…”