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

Abstract

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.

Complex regional pain syndrome type II caused by iatrogenic lateral dorsal cutaneous nerve injury

“…LDCN injury is a rare injury that may result from a lateral ankle sprain or damage during surgeries or procedures performed for the Achilles tendon and lateral side of the ankle [7,8] . The LDCN branches out as the SN passes under the lateral malleolus, and it is responsible for the sensory innervation of the dorsolateral aspect of the foot [5–7] . SN conduction is important for diagnosing nerve damage or entrapment and is the most useful test for detecting electrophysiological abnormalities in neuropathy cases [7] .…”

“…It is responsible for the cutaneous sensations in the posterior and lateral aspects of the legs, lateral calcaneal area of the distal third of the legs, and lateral aspect of the feet and fifth toes. [ 5 , 6 ] The SN originates from medial and lateral cutaneous nerves branching from each of the tibial and common peroneal nerves, joining just distal of the popliteal fossa. It then descends between the two heads of the gastrocnemius muscle and passes through the lateral margin of the calcaneal tendon and between the lateral malleolus and calcaneus.…”

“…It then descends between the two heads of the gastrocnemius muscle and passes through the lateral margin of the calcaneal tendon and between the lateral malleolus and calcaneus. After passing under the lateral malleolus, it leads toward the lateral dorsal cutaneous nerve (LDCN), which is responsible for the sensation of the dorsolateral aspects of the foot and terminates in the lateral aspects of the fifth toes of the feet [5–7] …”

An Anatomic Study of the Lateral Dorsal Cutaneous Nerve Using 3-Tesla MRI: A Comparison to Cadaveric Data With Surgical Applications

“…1,10,26 The branching pattern and location of the distal is variable and may also give off an anastomotic branch (AB) to the intermediate dorsal cutaneous nerve, which travels distally along the dorsal aspect of the foot to provide sensory innervation to the third, fourth, and fifth digits. 16,24 Previous cadaveric studies have observed a frequency of AB ranging from 24% to 63%. 1,9,10,17,30…”

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

“…It can be of great help to anesthetics while giving local anesthetic block (8)(9)(10)(11)(12)(13)(14). There are studies done by authors Cheredath et al [15], Inchai, Vaseenon, et al [16], V Nayak, et al [17] which describe the innervation pattern on dorsum of the foot according to the areas supplied by sural nerve, superficial perineal nerve and deep perineal nerve. Carla Gabrielli et al [18] have studied the topographic anatomy of superficial perineal nerve on dorsum of the foot.…”