Approach for needle insertion into the tibialis posterior: An ultrasonography study

Abstract

Among the 4 points used for needle insertion into the tibialis posterior, the midpoint by the posterior approach may be the most favorable insertion point. The upper third may be better for the anterior approach.

Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study

“…Three methods are used for placing the needle into the TP muscle: the anterior, medial and posterior approaches [ 13 , 29 ]. According to previous studies based on ultrasonography evaluation of healthy volunteers, access to the TP muscle for needle insertion is safer at the tibia midpoint (midpoint of the length from the tibial tubercle to the bimalleolar line) for the posterior approach, and at the upper third of the tibia (junction between the proximal and middle thirds from the tibial tubercle to the bimalleolar line) for the anterior approach, because of the larger safety windows for needle insertion [ 13 , 18 , 19 ]. This is further confirmed by studies on cadavers, which report that the anterior approach to TP muscle is safer than the posterior one for needle insertion into the upper third of the leg [ 20 , 21 ].…”

“…A small limb volume is associated with a small safety zone [ 20 ]. Spasticity may affect limb anatomy, causing disruption of the normal muscle architecture, which can lead to a reduction of muscle thickness and an increase in muscle echo intensity [ 18 , 24 , 25 ]. Thus, in the case of a patient with spasticity, the safety window for needle insertion may be smaller than in healthy subjects or cadavers.…”

“…As to the TP muscle, although it is deep-seated within the lower leg and not easily accessible for needle placement, the needle insertion into it is usually performed with the guidance of anatomical landmarks [ 13 , 14 ]. Previous research into TP muscle injection in adults has suggested safety windows for needle placement based on the evaluation of healthy volunteers and cadavers [ 13 , 18 , 19 , 20 , 21 ]. On these bases, and considering that MNP is actually the most commonly used BoNT-A injection technique for the treatment of spasticity in adults [ 22 ], there is a lack of information about the BoNT-A injection site for spastic TP muscle in adult patients.…”

Accuracy of Palpation-Guided Catheter Placement for Muscle Pressure Measurements in Suspected Deep Posterior Chronic Exertional Compartment Syndrome of the Lower Leg

“…This posteromedial approach is preferred as the TP is most voluminous and the ''safety window'' is large. 30 Moreover, this method theoretically allows for obtaining FDL pressures. However, the claimed safety of this posteromedial approach may be questioned as the present MRI study demonstrated a 38% hematoma rate, although these were clinically asymptomatic.…”

Relative index of ankle muscle activations on agonistic phase between subjects with and without flat foot

“…bialis muscle pl phy [34] . The RA rch of the foot n of the TA mu muscles could b level of specifi the relative act relative activa n synergistic a activation of th excessive prona ess torque [35] .…”