(iii) Entrapment neuropathies of the foot and ankle

Williams, Timothy H.; Robinson, A. H. N.

doi:10.1016/j.mporth.2009.09.004

Cited by 15 publications

(10 citation statements)

References 23 publications

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“…Therefore, an understanding of the anatomical relationship between vascular and nerve components inside this limited space has important significance for clinical treatment. Excessive tension of the flexor retinaculum, deformity of the bones surrounding the tarsal tunnel, bleeding and adhesion caused by trauma, neuroma, space occupying lesions, even the placement of the foot in inversion and eversion positions, may cause neurovascular bundle compression 19 20 21 22 .…”

Section: Discussionmentioning

confidence: 99%

Fine dissection of the tarsal tunnel in 60 cases

Yang¹,

Du²,

Fu³

et al. 2017

Sci Rep

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The fine dissection of nerves and blood vessels in the tarsal tunnel is necessary for clinical operations to provide anatomical information. A total of 60 feet from 30 cadavers were dissected. Two imaginary reference lines that passed through the tip of the medial malleolus were applied. A detailed description of the branch pattern and the corresponding position of the posterior tibial nerve, posterior tibial artery, medial calcaneal nerve and medial calcaneal artery was provided, and the measured data were analyzed. Our results can be summarized as follows. I. A total of 81.67% of the bifurcation points of the posterior tibial nerve, which was divided into the medial and lateral plantar nerves, were located within the tarsal tunnel, not distal to the tarsal tunnel. II. The bifurcation points of the posterior tibial artery were all located in the tarsal tunnel. Almost all of the bifurcation points of the posterior tibial artery were lower than those of the posterior tibial nerve. The bifurcation point of the posterior tibial artery situated distal to the tarsal tunnel was not found. III. The number and the origin of the medial calcaneal nerves and arteries were highly variable.

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Section: Discussionmentioning

confidence: 99%

Fine dissection of the tarsal tunnel in 60 cases

Yang¹,

Du²,

Fu³

et al. 2017

Sci Rep

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“…The location, branching point, and branching pattern of the neurovascular structures were essential for the management of several clinical conditions. The clinical conditions related to the neurovascular structures at the medial side of the ankle such as TT syndrome [ 29 - 31 ], heel pain [ 15 , 16 ], the atrophy of ADM muscle [ 32 ], and avascular necrosis of the talus [ 33 - 35 ]. The treatment of each condition depended on the knowledge of the neurovascular structures for successful treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, the TT syndrome could be caused by the neurovascular entrapment in the TT. The compression of the neurovascular structures could be caused by the excessive tension of the flexor retinaculum, bone deformities surrounding the TT, bleeding, and adhesions caused by trauma, neuroma, space-occupying lesions, the placement of the foot in inversion and eversion positions [ 29 - 31 ]. The data of these structures, PTN, PTA, and their branches, might improve the anatomical knowledge of neurovascular structures.…”

Section: Discussionmentioning

confidence: 99%

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

2020

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Nerve entrapment and blood circulation impairment associated with the medial side of the ankle are not uncommon. The purpose of this study was to describe the anatomical basis of neurovascular structures of the medial ankle which comprised the number, origin, branching pattern, and branching point. Forty feet of fresh cadavers were examined by using 2 reference lines: the malleolar-calcaneal (MC) and navicular-calcaneal (NC) axes. We recorded number, origin, length of the 2 axes, the locations and widths of neurovascular structures on MC and NC axes, the branching point of neurovascular structures, and the branching pattern of neurovascular structures was recorded and was separated into 5 types. The posterior tibial nerve (PTN) bifurcated to plantar and calcaneal nerves and branched proximally to the tarsal tunnel (TT). The posterior tibial artery bifurcated to plantar and calcaneal arteries and branched inferiorly to PTN and within the TT. The calcaneal nerves and arteries had more variation of number and origin. The most common branching point of calcaneal nerves and arteries is within the TT, except the medial calcaneal nerve. It branched proximally to the TT. The anatomical knowledge from this study is important for the diagnosis and treatment of clinicians.

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“…Those participants with the skill set strongly recommended the use of this method, even those who did not have the skill themselves but work in multi-disciplinary team(s) also ranked this highly. Evidence indicates this technique is used to confirm suspicions, if imaging is negative, or for surgical planning [ 8 ]. It is appropriate to suggest that this method could potentially be of benefit to those working in teams who have the resources and training to ensure safe, competent practice is achieved.…”

Section: Discussionmentioning

confidence: 99%

“…The research team (CD, LC, LJ and CB) reviewed previous Delphi publications in healthcare to identify potential threshold values. The literature does not suggest a set agreement scale or rate to define consensus [ 8 ]. However there is general concurrence that the researchers should identify and define an agreement scale/rate for consensus to their participants and this is what is adopted for the Delphi study [ 4 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study

Dando

Cherry

Jones

et al. 2017

Journal of Foot and Ankle Research

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BackgroundThere is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma.MethodsA four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” Votes that were equal to or greater than 60% were accepted into the next round; participant’s votes equal to or less then 20% were excluded. The remaining participant’s votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” The recruitment and Delphi rounds were conducted through email.ResultsIn round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging.ConclusionFollowing the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma.Electronic supplementary materialThe online version of this article (10.1186/s13047-017-0241-2) contains supplementary material, which is available to authorized users.

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(iii) Entrapment neuropathies of the foot and ankle

Cited by 15 publications

References 23 publications

Fine dissection of the tarsal tunnel in 60 cases

Fine dissection of the tarsal tunnel in 60 cases

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

The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study

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