Anatomical variations in the cutaneous innervation on the dorsum of the foot

Nayak, Vanishri S.; Bhat, Nandini; Nayak, Sunil S; Sumalatha, Suhani

doi:10.5115/acb.2019.52.1.34

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…The deep peroneal nerve accompanies the dorsalis pedis artery on the dorsum of the foot, traveling in the first web space. 9 It is intimately associated with open exposures of the Lisfranc complex and is commonly visualized during surgery. 5 Despite nerve injury being a documented risk of this procedure, the rate of injury to the deep peroneal nerve has not been previously published in the literature.…”

Section: Discussionmentioning

confidence: 99%

Deep Peroneal Nerve Injury Following Hardware Removal for Lisfranc Joint Injury

et al. 2019

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Background: Surgical exposure of the Lisfranc joint complex is within close proximity to the deep peroneal nerve, which can be injured in this approach. Common clinical practice is to remove Lisfranc hardware at 3 to 4 months postoperatively. However, it is unknown if this provides a clinical benefit or risks injury to the deep peroneal nerve. The rate of nerve injury is currently unknown from the published literature. This study clarifies rates of neurological injury to the deep peroneal nerve during primary surgery and hardware removal. Methods: This retrospective study was performed on all patients of a single surgeon from 2012 to 2018. Fixation was performed with locking plates or screws depending on the injury pattern. All patients who required open reduction and internal fixation routinely underwent hardware removal during this time. Neurological injury was assessed in a binary fashion (normal or abnormal) at 2, 6, and 12 weeks after the primary surgery and 2 and 12 weeks after hardware removal. McNemar’s test was performed to compare the rates of injury. Patients were contacted at a minimum follow-up of 15 months (range, 15-87 months) to assess persistent nerve injury and satisfaction. Fifty-seven patients with an average age of 29.8 years were included in the final analysis; all had documentation at 3 months postsurgery. Results: All patients had normal neurology before surgery. The rate of nerve injury for the primary surgery (11%) was significantly lower than the rate for patients with nerve injury following hardware removal (23%). However, the rate of spontaneous neurological recovery was low, with symptoms persisting in 5 of 6 patients between the primary operation and subsequent hardware removal. When these patients were excluded from the analysis, the rate of new nerve injury following hardware removal (15%) was not significantly different from the primary surgery rate. Seventy-one percent of nerve injuries persisted at the minimum 15-month final follow-up, with all patients with nerve injury being very or partially satisfied. Conclusion: The rate of deep peroneal nerve injury from primary Lisfranc fixation was 11%, and when routine hardware removal was planned the overall rate of nerve injury rose to 23%. This may be useful information during the patient consent process. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 99%

Deep Peroneal Nerve Injury Following Hardware Removal for Lisfranc Joint Injury

et al. 2019

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“… 14 With the limitation of visualization compared to open excision, understanding anatomic variations of the ankle could reduce the risk of iatrogenic injuries during ankle surgical procedures. 15 From a surgical point of view, it is very important to know the precise anatomic information and the variations, which are beneficial for experienced and inexperienced surgeons. In the present study we aimed to establish the specific anatomic description of the attachment area or footprint of each bundle of PTFL, especially in the talar attachment site, and to apply to the operation of bony excision for treating PAIS and to improve the knowledge of the exact anatomic information of PTFL to decrease the complications of over-detachment of PTFL, which may cause chronic ankle instability.…”

Section: Discussionmentioning

confidence: 99%

Effect of Bone Resection on Posterior Talofibular Ligament Integrity for Posterior Ankle Impingement Syndrome: A Cadaveric Study

Inchai

Vaseenon

Tanaka

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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The purpose of this study was to evaluate the attachment areas of the posterior talofibular ligament (PTFL) on the posterolateral tubercle of the talus and the remaining PTFL attachment areas after consequential bony excision. Methods: Thirty fresh cadaveric ankles were dissected to study the proximal and distal attachment of the PTFL and separated the PTFL into anterior and posterior bundles. The description of the PTFL footprint and the anatomic landmarks from the surrounding structures were analyzed during consequential posterolateral bony excision. Results: The average PTFL dimension was 26.11 mm (length), 7.65 mm (width), and 1.82 mm (thickness). The footprint area of the PTFL on the talar site consists of the posterior bundle (76.82%) and the anterior bundle (23.18%). If posterolateral tubercle excision was stayed up to a line of a bottom of the flexor hallucis longus (FHL) groove, at least 89% of the PTFL can be preserved. Conclusion:The posterior bundle of the PTFL is the main bundle on the talar footprint area. To maintain the majority of the attachment of the PTFL, the resection of the posterolateral process could be performed to the bottom of the FHL tendon groove. If resection reaches to the posterior articular cartilage, less than 50% of the PTFL will be preserved. Understanding the footprint of the PTFL plays a key role in posterior ankle impingement surgery. Clinical Relevance: This study provides guidance for resection of the posterolateral tubercle of the talus and a portion of the PTFL attachment for posterior ankle impingement syndrome. Too much resection of the tubercle may cause instability symptoms.

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“…Type 2 was reported as the most frequent type in their study (38.50%). Nayak and colleagues [18] in 2019 investigated and classified the different patterns of nerve distribution on the dorsum of the foot. The distribution pattern of the cutaneous nerve of the dorsum of foot was categorized into four groups.…”

Section: Discussionmentioning

confidence: 99%

The distribution pattern of the dorsal cutaneous nerves of the foot and its clinical implications

et al. 2020

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Iatrogenic injury to subcutaneous nerves on the dorsum of the foot is an established risk factor during the surgical procedures resulting in postoperative pain, sensation loss and painful neuroma. Previous studies have reported on the distribution pattern of the superficial peroneal, deep peroneal and sural nerves (SNs) and their branches with various classifications about specific populations. The purpose of the present study was to evaluate the distribution pattern and classification of the nerves on the dorsum of the foot and analyze the location of these nerves into five zones with clinical implications. Fifty-four lower limbs of fresh frozen cadavers were used in the present study. The anatomical patterns of the superficial peroneal, deep peroneal, SN and their branches were classified into eight, two and five patterns respectively. Type VI pattern, a classic distribution pattern of the superficial peroneal nerve was the most frequent type with a prevalence of 13 limbs (25.00%). In Zone 5, where the arthroscopic portal placements for the first metatarsophalangeal joint arthrodesis, 29 limbs (55.77%) showed three nerve branches located in this zone. The results of the present study provide anatomical knowledge that may help the surgeon to choose the appropriate treatment for their patients and reducing the rate of complications in surgery.

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Anatomical variations in the cutaneous innervation on the dorsum of the foot

Cited by 12 publications

References 10 publications

Deep Peroneal Nerve Injury Following Hardware Removal for Lisfranc Joint Injury

Deep Peroneal Nerve Injury Following Hardware Removal for Lisfranc Joint Injury

Effect of Bone Resection on Posterior Talofibular Ligament Integrity for Posterior Ankle Impingement Syndrome: A Cadaveric Study

The distribution pattern of the dorsal cutaneous nerves of the foot and its clinical implications

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