Anatomic Delineation of Tarsal Tunnel Innervation via Ultrasonography

Iborra, Álvaro; Villanueva, Manuel; Barrett, Stephen L.; Rodriguez-Collazo, Edgardo; Sanz, Pablo

doi:10.1002/jum.14499

Cited by 18 publications

(27 citation statements)

References 23 publications

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“…It is necessary that the operators are familiar with the anatomy and know the possible anatomic variants of this region. We have recently shown that with proper training and the use of high‐resolution equipment, it is possible to correctly identify branches of the TN as small as 1 mm in diameter . Although this has not been our practice, surgeons may consider forming a team with a radiologist or seeking assistance from a sonographer to accelerate his or her learning curve, at least during the initial stages of training.…”

Section: Discussionmentioning

confidence: 99%

“…The MPN is released by using the protocols with the instruments and US control as described for TN release. The bifurcation of the TN into the MPN and LPN should be mapped and its route drawn on the skin . A safe entry point is located by using US to avoid vascular damage to the deeper layers immediately proximal to the AHM.…”

Section: Methodsmentioning

confidence: 99%

“…The entry point is located with the US transducer in the axial view, 2 to 3 cm proximal to the malleolarcalcaneal axis. 19 At the selected level, a point is marked between the flexor digitorum longus tendon and the closest vein to the tendon, and then the needle is inserted at this point ( Figure 3). A 1-to 2-mm incision is made for insertion of the instruments used to release the flexor retinaculum.…”

Section: Tibial Nerve Release Methodsmentioning

confidence: 99%

“…The bifurcation of the TN into the MPN and LPN should be mapped and its route drawn on the skin. 19 A safe entry point is located by using US to avoid vascular damage to the deeper layers immediately proximal to the AHM. This point converges with the end of the released retinaculum flexor section, allowing a continuous release of the flexor retinaculum with the release of the deep fascia of the AHM.…”

Section: Medial Plantar Nerve Release Methodsmentioning

confidence: 99%

“…It has recently been reported that the main structures of the proximal and distal tarsal tunnels can be delineated with high-resolution US equipment, even in branches with a 1-mm diameter. 19,20 Therefore, US-guided tarsal tunnel release is feasible, as the surgeon can visualize the main structures involved. The goal of this study was to investigate the efficacy and safety of US-guided tarsal tunnel release.…”

mentioning

confidence: 99%

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Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Iborra¹,

Villanueva‐Martínez²,

Barrett³

et al. 2018

J of Ultrasound Medicine

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Objectives The purpose of the study was to determine whether ultrasound (US)‐guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome. Methods Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US‐guided tarsal tunnel release/decompression was performed through 2 small 1‐ to 2‐mm portals. After US‐guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure. Results In 12 fresh cadaveric specimens, US‐guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures. Conclusions Ultrasound‐guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Tibial Nerve Release Methodsmentioning

confidence: 99%

Section: Medial Plantar Nerve Release Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Iborra¹,

Villanueva‐Martínez²,

Barrett³

et al. 2018

J of Ultrasound Medicine

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Compressive Neuropathies and Plantar Fascia

Nikodinovska

Ivanoski²

2023

Medical Radiology

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Clinical-anatomic mapping of the tarsal tunnel with regard to Baxter’s neuropathy in recalcitrant heel pain syndrome: part I

et al. 2018

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Purpose Neuropathy of the Baxter nerve (BN) seems to be the first cause of the heel pain syndrome (HPS) of neurological origin. Methods 41 alcohol–glycerol embalmed feet were dissected. We documented the pattern of the branches of the tibial nerve (TN) and describe all relevant osteofibrous structures. Measurements for the TN branches were related to the Dellon–McKinnon malleolar-calcaneal line also called DM line (DML) for the proximal TT and the Heimkes Triangle for the distal TT. Additionally, we performed an ultrasound-guided injection procedure of the BN and provide an algorithm for clinical usage. Results The division of the TN was 16.4 mm proximal to the DML. The BN branches off 20 mm above the DML center or 30 mm distally to it. In most of the cases, the medial calcaneal branch (MCB) originated from the TN proximal to the bifurcation. Possible entrapment spots for the medial and lateral plantar nerve (MPN, LPN), the BN and the MCB are found within a circle of 5 mm radius with a probability of 80%, 83%, and 84%, respectively. In ten out of ten feet, the US-guided injection was precisely allocated around the BN. Conclusions Our detailed mapping of the TN branches and their osteofibrous tubes at the TT might be of importance for foot and ankle surgeons during minimally invasive procedures in HPS such as ultrasound-guided ankle and foot decompression surgery (UGAFDS).

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Anatomic Delineation of Tarsal Tunnel Innervation via Ultrasonography

Cited by 18 publications

References 23 publications

Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Compressive Neuropathies and Plantar Fascia

Clinical-anatomic mapping of the tarsal tunnel with regard to Baxter’s neuropathy in recalcitrant heel pain syndrome: part I

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