Anatomical study and branching point of neurovascular structures at the medial side of the ankle

Inthasan, Chanatporn; Vaseenon, Tanawat; Mahakkanukrauh, Pasuk

doi:10.5115/acb.20.087

Cited by 13 publications

(42 citation statements)

References 45 publications

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“…Care should be taken to prevent excessive penetration of the medial structures to prevent neurovascular injury. 6,8 Multiple drill holes are connected using a small osteotome to complete the dome-shaped osteotomy. The thalamic portion of the calcaneus, including the posterior articular facet and the calcaneal tuberosity, is detached from the anterior part of the calcaneus.…”

Section: Operative Techniquementioning

confidence: 99%

Rotational Osteotomy and Subtalar Arthrodesis for Subtalar Arthritis With Calcaneal Malunion: A Technical Note

et al. 2021

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Symptomatic subtalar arthritis that is unresponsive to conservative treatment can be treated using subtalar arthrodesis. 23 However, when the collapsed posterior articular facet is not reduced, causing a significant loss in height of the calcaneus, in situ subtalar arthrodesis alone may not be sufficient. 2 Subtalar distraction arthrodesis is recommended to restore the height of the calcaneus and arch of the foot and reinstitute the functional length of the gastrocnemius-soleus complex. 5 However, for cases with significant proximal migration of the entire calcaneal tuberosity, creating a rocker-bottomshaped calcaneus, subtalar joint distraction has certain limitations in repositioning the tuberosity to restore the height (Figure 1). 13,14,21 In a tongue-type Sanders 2C fracture, 15 in which the posterior articular facet is in continuity with the calcaneal tuberosity, severe depression of the posterior articular facet will rotate and elevate the calcaneal tuberosity proximally, creating a rocker-bottom-shaped calcaneus. When this deformity is not corrected in the initial treatment and results in malunion, it is extremely difficult to reposition the calcaneal tuberosity to the anatomical position using subtalar joint distraction. Furthermore, even if the calcaneus tuberosity could be repositioned downward, the rocker-bottom deformity with plantar exostosis that can cause plantar pain during weightbearing cannot be corrected using subtalar distraction arthrodesis. 20 We developed a technique combined with subtalar arthrodesis to restore the height of the calcaneus and arch of the foot. In addition, the functional length of the gastrocnemius-soleus complex could be reinstituted using dome-shaped osteotomy on the posterior articular facet followed by rotation of the thalamic portion of the calcaneus (the posterior part of the calcaneus that supports the posterior articular facet). 17 To the best of our knowledge, this report is the first to apply dome-shaped osteotomy on the posterior articular facet for the rotational correction of calcaneal malunion with significant height loss.

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Section: Operative Techniquementioning

confidence: 99%

Rotational Osteotomy and Subtalar Arthrodesis for Subtalar Arthritis With Calcaneal Malunion: A Technical Note

et al. 2021

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“…1 ). It is here that both the PTA & PTVs are located superficially and anteriorly to the TN [ 9 , 21 , 35 ]. Within the TT, proximal to its termination, the PTA gives rise to the medial calcaneal artery which acts as the blood supply for the heel and its associated fat pad [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is here that both the PTA & PTVs are located superficially and anteriorly to the TN [ 9 , 21 , 35 ]. Within the TT, proximal to its termination, the PTA gives rise to the medial calcaneal artery which acts as the blood supply for the heel and its associated fat pad [ 9 ]. The PTA will then terminate within the TT into the medial and lateral plantar arteries, generally distal to that of the bifurcation of the TN [ 6 , 7 , 9 , 17 , 21 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

The bifurcation and topography of the posterior tibial artery within the tarsal tunnel

2023

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Purpose The tarsal tunnel (TT) is a fibro-osseous anatomical space coursing from the medial ankle to the medial midfoot. This tunnel acts as a passage for both tendinous and neurovascular structures, including the neurovascular bundle containing the posterior tibial artery (PTA), posterior tibial veins (PTVs) and tibial nerve (TN). Tarsal tunnel syndrome (TTS) is the entrapment neuropathy that describes the compression and irritation of the TN within this space. Iatrogenic injury to the PTA plays a significant role in both the onset and exacerbation of TTS symptoms. The current study aims to produce a method to allow clinicians and surgeons to easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury during treatment of TTS. Methods Fifteen embalmed cadaveric lower limbs were dissected at the medial ankle region to expose the TT. Various measurements regarding the location of the PTA within the TT were recorded and multiple linear regression analysis performed using RStudio. Results Analysis provided a clear correlation (p < 0.05) between the length of the foot (MH), length of hind-foot (MC) and location of bifurcation of the PTA (MB). Using these measurements, this study developed an equation (MB = 0.3*MH + 0.37*MC – 28.24 mm) to predict the location of bifurcation of the PTA within a 23° arc inferior to the medial malleolus. Conclusions This study successfully developed a method whereby clinicians and surgeons can easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury that would previously lead to an exacerbation of TTS symptoms.

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“…MP SNAP is also useful in the diagnosis of a focal tibial or medial plantar neuropathy due to local causes e.g., tarsal tunnel syndrome, trauma or leprosy[ 18 19 ] The tibial nerve divides into its terminal branches, medial and lateral plantar nerves in the tarsal tunnel or just proximal to it, below the flexor retinaculum, at the medial malleolus-calcaneal axis. [ 20 21 22 23 ] The medial plantar nerve runs in the foot deep to the abductor hallucis brevis, supplies motor innervation to it and divides into one proper digital nerve to great toe and three common digital nerves [ Figure 1 ]. The SNAP recorded in our study is from stimulation of the first common digital nerve.…”

Section: Introductionmentioning

confidence: 99%

Medial Plantar Sensory Nerve Action Potential

Sharma

Chavan

Mansukhani

2022

Annals of Indian Academy of Neurology

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Context: The medial plantar nerve (MP) sensory nerve action potential (SNAP) has been shown to be a sensitive indicator for detecting a length-dependent axonal peripheral neuropathy. However, literature survey shows paucity of age stratified data. This study was undertaken to obtain age stratified reference data for MP SNAP amplitude and latency. Aim: To establish age-stratified reference data in Indian subjects for the MP SNAP. Study Setting and Design: The study was conducted in the electrodiagnostic laboratory of a tertiary city hospital and is retrospective study. Materials and Methods: A retrospective study was conducted using the nerve conduction study reports of 173 patients with only upper limb symptoms and findings. Patients were between the ages of 18 and 86 years, stratified into six groups, a = 18-30 years, b = 31- 40 years, c = 41-50 years, d = 51- 60 years, e = 61-70 years, f ≥70 years. Statistical Methods: Stata 12.1 statistical program was used. Lower limit of the SNAP amplitude was obtained using mean-2SD of transformed data. Analysis of variance defined the intergroup variability, linear regression and Pearson's correlation assessed the statistical significance. Results: The lower limit of normal MP SNAP amplitude for each age group is as follows: a: 8.7uv b: 7.5uv c: 3.7 uv d: 2.9uv e: 2.0 uv f: 1.4uv. The amplitude difference between the groups b & c, c & d and e and f using analysis of variance with Bonferroni correction and Tukey post-hoc test was not significant, but the other groups showed statistically significant variance. The equation of regression for the predicted amplitude value with age was defined as Y^ = {3.5 + age (-.0233) – 2 (0.389)} 3 . Conclusion: This study provides age stratified reference data for MP SNAP. There is evidence to suggest that MP SNAP amplitude varies with age hence age stratified data should be used to define abnormality.

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Anatomical study and branching point of neurovascular structures at the medial side of the ankle

Cited by 13 publications

References 45 publications

Rotational Osteotomy and Subtalar Arthrodesis for Subtalar Arthritis With Calcaneal Malunion: A Technical Note

Rotational Osteotomy and Subtalar Arthrodesis for Subtalar Arthritis With Calcaneal Malunion: A Technical Note

The bifurcation and topography of the posterior tibial artery within the tarsal tunnel

Medial Plantar Sensory Nerve Action Potential

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