An anatomical approach to the tarsal tunnel syndrome: what can ankle's medial side anatomy reveal to us?

Autor: Lopes JG; Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. j.andre.lp@gmail.com., Rodrigues-Pinho A; Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Neves MA; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Pinto FF; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Relvas-Silva M; Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Vital L; Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Serdoura F; Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Nogueira-Sousa A; Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Madeira MD; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.; NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal.; CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal., Pereira PA; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.; NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal.; CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Jazyk: angličtina
Zdroj: Journal of foot and ankle research [J Foot Ankle Res] 2023 Nov 14; Vol. 16 (1), pp. 80. Date of Electronic Publication: 2023 Nov 14.
DOI: 10.1186/s13047-023-00682-4
Abstrakt: Background: The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle's medial side and if so, do they have a regular path after emerging from TN.
Methods: The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon-McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT).
Results: The TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter's nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p <  0.001).
Conclusions: In our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.
(© 2023. The Author(s).)
Databáze: MEDLINE
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