Arterial Anatomy of the Posterior Tibial Nerve in the Tarsal Tunnel

Abstract

Background: Both vascular and compression etiologies have been proposed as the source of neurologic symptoms in tarsal tunnel syndrome. Advancing the understanding of the arterial anatomy supplying the posterior tibial nerve (PTN) and its branches may provide insight into the cause of tarsal tunnel symptoms. The purpose of this study was to describe the arterial anatomy of the PTN and its branches. Methods: Sixty adult cadaveric lower extremities (thirty previously frozen and thirty fresh specimens) were amputated distal to the knee. The vascular supply to the PTN and its branches was identified, measured, and described macroscopically (the thirty previously frozen specimens, prepared using a formerly described debridement technique) and microscopically (the thirty fresh specimens, processed using the Spälteholz technique). Results: On both macroscopic and microscopic evaluation, the PTN and the medial and lateral plantar nerves were observed to have multiple entering vessels within the tarsal tunnel. On microscopic evaluation, a vessel was observed to enter the nerve at the bifurcation of the PTN into the medial and lateral plantar nerves in twenty-two (73%) of the thirty specimens. There was a significant difference (p < 0.05) in vascular density between the PTN and each of its branches. Conclusions: The abundant blood supply to the PTN and its branches identified in this study is consistent with observations of other peripheral nerves. This rich vascular network may render the PTN and its branches susceptible to nerve compression related to vascular congestion. The combination of vascular and structural compression may also elicit neurologic symptoms. Clinical Relevance: Advancing the understanding of the arterial anatomy supplying the PTN and its branches may provide insight into the cause and treatment of tarsal tunnel syndrome.

The long-lasting post-stimulation inhibitory effects of bladder activity induced by posterior tibial nerve stimulation in unanesthetized rats

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Value of motor nerve conduction studies in the diagnosis of idiopathic tarsal tunnel syndrome: A single-center prospective observational study from India

“…[ 5 7 8 ] It is noteworthy that PTN and its branches (MPN and LPN) are supplied by multiple blood vessels, often abnormally tortuous,[ 2 ] within the TT as they pass through different tight fibroosseous canals. [ 39 ] Fullerton and Gilliatt have shown that the plantar nerves are susceptible to repeated minor trauma. [ 40 ] In their elegant experimental study, they found that animals kept in confinement with the wire-mesh floor, developed demyelinating plantar neuropathy characterized by prolongation of the terminal latency and dispersion of CMAP, confirmed to be segmental demyelination in the nerve samples of those animals.…”

MRI Study on Tibial Nerve of the Ankle Canal and Its Branches: A method of multiplanar reconstruction with 3D-FIESTA-C sequences

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