Fine dissection of the tarsal tunnel in 60 cases

Yang, Yong; Du, Meiling; Fu, Yuanshan; Liu, W.; Xu, Qingyang; Chen, X.; Hao, Y. J.; Liu, Z.; Gao, Ming

doi:10.1038/srep46351

Cited by 24 publications

(62 citation statements)

References 20 publications

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“…The PTA is located posterior to the medial malleolus and bifurcates into the MPA and LPA. All bifurcation points of the PTA are located within the tarsal tunnel, 19 while the LPA passes laterally under the proximal abductor hallucis and exor digitorum brevis muscles, coursing along the lateral margin of the exor digitorum brevis, where it is located super cially below the plantar fascia. The anatomic relationship of the LPA renders it vulnerable to injury during calcaneal osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Tonogai¹,

Sairyo²,

Tsuruo³

2020

Preprint

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Background Calcaneal osteotomy is used to correct hindfoot deformity. Pseudoaneurysms of the lateral plantar artery (LPA) have been reported following calcaneal osteotomy and are at risk of rupture. The vascular structures in close proximity to the calcaneal osteotomy have variable courses and branching patterns. However, there is little information on the “safe zone” during calcaneal osteotomy. This study aimed to identify the safe zone that avoids LPA injury during calcaneal osteotomy.Methods Enhanced computed tomography scans of 25 fresh cadaveric feet (13 male and 12 female specimens; mean age 79.0 years at time of death) were assessed. The specimens were injected with barium via the external iliac artery. A landmark line (line A) connecting the posterosuperior aspect of the calcaneal tuberosity and the origin of the plantar fascia was drawn and the shortest perpendicular distance between the LPA and line A was measured on sagittal images.Results The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 feet (8.0%), the perpendicular distance between the LPA and line A at its closest point was very short (approximately 9 mm). In 18 of the 25 feet (72.0%), the point where the perpendicular distance from line A to the LPA was closest was the bifurcation of one of the medial calcaneal branches of the LPA, and in 7 feet (28.0%) the shortest perpendicular distance from line A to the LPA was the trifurcation of the LPA, medial plantar artery, and one of the medial calcaneal branches.Conclusion Calcaneal osteotomy performed more than 9 mm from line A could damage the LPA by overpenetration on the medial side. Calcaneal osteotomy on the medial side should be performed with caution to avoid iatrogenic injury to the LPA.Level of Evidence: IV, cadaveric study

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Section: Discussionmentioning

confidence: 99%

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Tonogai¹,

Sairyo²,

Tsuruo³

2020

Preprint

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“…and ). Since this nerve has been known to travel through a tight space between the abductor hallucis and QP, there is a high possibility that calcaneal pain is triggered by compression of the FBLPN (Presley et al, ; Yang et al, ; Del Toro and Nelson, ). Based on the present study, an approach to alleviate pain triggered by FBLPN entrapment should target the LPT.…”

Section: Discussionmentioning

confidence: 99%

Interfascicular septum of the calcaneal tunnel and its relationship with the plantar nerves: A cadaveric study

et al. 2019

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The relationship between the plantar nerves and internal fascial structure of the calcaneal tunnel is clinically important to alleviate pain of the sole. The study aimed to investigate the three-dimensional (3D) anatomy of the calcaneal tunnel and its internal fascial septal structure by using microcomputed tomography (mCT) with a phosphotungstic acid preparation, histologic examination, and ultrasound-guided simulation. Twenty-one fixed cadavers and three fresh-frozen cadavers (13 men and 11 women, mean age 82.1 years at death) were used in this study. The 3D images of the calcaneal tunnel harvested by mCT were analyzed in detail. Modified Masson trichrome staining and serial sectional dissection after ultrasound-guided injection were conducted to verify the 3D anatomy. Within the calcaneal tunnel, the interfascicular septum (IFS) commenced proximal to the malleolar-calcaneal line and distal to the bifurcation of the tibial nerve into the plantar nerves. The medial and lateral plantar nerves were separated by the IFS, which divided the calcaneal tunnel into two compartments. The plantar nerves were ramified into two or three branches within each compartment. The IFS terminated around the talocalcaneonavicular joint, and the plantar nerves traveled into the sole. Clinical manipulation of the plantar nerves should be performed in consideration of the fact that they are clearly separated by the IFS. Clin. Anat. 32:877-882, 2019.

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“…This not only leads to tibial nerve dysfunction and plantar pain, but also mainly causes heel pain and even abductor atrophy of the little toe [4].It is noteworthy that this body part is used as a pathway in minimally invasive and surgical operations [5], ankle canal decompression, ankle canal incisions, and external nail xation of fractures are likely to cause iatrogenic nerve injury [6][7][8]. At present, through the anatomic study of the tibial nerve and its branches at the ankle canal, the location and course of the nerve are determined, and the origin and quantity of the medial calcaneus nerve and the inferior calcaneus nerve at the ankle canal are classi ed [9][10][11], which provides a great help for the understanding of the nerve in the ankle canal. Using ultrasound to display the nerves in this area, and the injection of infracalcaneus nerve under the guidance of ultrasound can improve the injection accuracy [12,13], but ultrasound can not display the whole shape of the nerves in a stereoscopic and intuitive way, and largely depends on the technology and experience of the operator.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2020

Preprint

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Background The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning.The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reconstruction (MPR) display of tibial nerve and its branches of the ankle canal. Methods The subjects were 20 healthy volunteers (40 ankles), aged 22–50, with no history of ankle joint desease. 3D-FIESTA-C sequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia.The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reconstruction. Results Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°.The average cross-sectional diameter of the medial plantar nerve is about mm, and the lateral plantar nerve about mm. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations. Conclusion The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches and the bifurcation point’s projection position on the body surface can be marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.

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Fine dissection of the tarsal tunnel in 60 cases

Cited by 24 publications

References 20 publications

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Interfascicular septum of the calcaneal tunnel and its relationship with the plantar nerves: A cadaveric study

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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