scholarly journals Minimally Invasive Surgery for Correction of Adult Acquired Flat Foot Deformity: An Anatomic Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0044
Author(s):  
Ademola I. Shofoluwe ◽  
Erroll J. Bailey ◽  
Gary W. Stewart
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Sural Nerve ◽  
Peroneal Nerve ◽  
Osteotomy Site ◽  
Superficial Peroneal Nerve ◽  
Deep Peroneal Nerve ◽  
Dorsalis Pedis Artery ◽  
Extensor Hallucis Longus ◽  
Neurovascular Structures

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a complex and chronic debilitating condition characterized by a decrease in the medial arch height and, in advanced stages, a decrease in the talonavicular coverage angle as the forefoot drifts into pronation and abduction. Operative treatment of stage II deformity has changed significantly over the past few decades. Joint sparing procedures which aim to realign the hindfoot and augment the diseased tibialis posterior tendon with the flexor digitorum longus transfer are commonly performed. The introduction of minimally invasive surgery (MIS) has been associated with smaller incisions, less blood loss, and quicker recovery times. The purpose of this study was to qualitatively and quantitatively observe the tendinous and neurovascular structures at risk with MIS AAFD osteotomy procedures in cadaveric feet. Methods: MIS technique was used to perform medial displacement calcaneal, Evans, and Cotton osteotomies on nine cadaveric feet under fluoroscopic guidance. The sural nerve, superficial peroneal nerve and its branches, deep peroneal nerve, dorsalis pedis artery, saphenous vein, and peroneal and extensor hallucis longus tendons were carefully dissected from each cadaveric foot and evaluated for injuries following the MIS osteotomy cuts. The distance from the osteotomy cuts and these anatomic structures were measured and recorded. Results: On average, the sural nerve was 8.4 mm and 9 mm from the calcaneal and Evans osteotomy sites, respectively. The intermediate dorsal cutaneous nerve was on average 68.3 mm and 41.1 mm from the calcaneal and Evans osteotomy sites, respectively. The peroneal tendons were on average 16.7 mm and 0 mm from the calcaneal and Evans osteotomy sites, respectively. The extensor hallucis was an average of 1 mm from the Cotton osteotomy site. There was a partial tear injury to the peroneus brevis in four of the cadaveric specimens at the Evans osteotomy site without complete laceration. There was no injury to the sural nerve, superficial peroneal nerve and its branches, saphenous vein, deep peroneal nerve, dorsalis pedis artery, or extensor hallucis longus tendon. Conclusion: Tendinous and neurovascular structures are at risk with MIS AAFD osteotomy procedures. Care should be taken with soft tissue handling and blunt dissection to decrease iatrogenic injuries to these structures. Specifically, extra care and recognition of the peroneal tendons during the Evans osteotomy may prevent damage, as this structure was at greatest risk among the three osteotomy cuts. Future research studies evaluating this technique and the functional outcomes in patients in a clinical setting is warranted. Surgical technique studies are underway to implement smaller, yet appropriate bone grafts through mini incisions.

Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: A cadaveric study

2008 ◽  
Vol 21 (7) ◽  
pp. 705-712 ◽  
Author(s):  
A.V. Ranade ◽  
V. Rajanigandha ◽  
R. Rai ◽  
David A. Ebenezer
Keyword(s):  
Peroneal Nerve ◽  
Cadaveric Study ◽  
Deep Peroneal Nerve ◽  
Dorsalis Pedis Artery

The Deep Peroneal Nerve in the Foot and Ankle: An Anatomic Study

1995 ◽  
Vol 16 (11) ◽  
pp. 724-728 ◽  
Author(s):  
Steven J. Lawrence ◽  
Michael J. Botte
Keyword(s):  
Peroneal Nerve ◽  
Average Distance ◽  
Extensor Digitorum ◽  
Anterior Tibial Artery ◽  
Terminal Branch ◽  
Foot And Ankle ◽  
Deep Peroneal Nerve ◽  
Extensor Hallucis Longus ◽  
Anterior Tibial ◽  
Extensor Digitorum Brevis

Injury to the deep peroneal nerve in the foot and ankle may result from trauma, repetitive mechanical irritation, or iatrogenic harm. The nerve is most susceptible to injury along its more distal anatomic course. Dissection of 17 cadaver specimens was undertaken to describe the course of the deep peroneal nerve and quantify its branch patterns. In the distal one third of the leg, the nerve was located superficial to the anterior tibial artery between the tibialis anterior and extensor hallucis longus muscles. Typically, the nerve crossed deep to the extensor hallucis longus tendon to enter the interval between the extensor hallucis longus and extensor digitorum longus at an average distance of 12.5 mm proximal to the ankle. A proximal bifurcation was usually present at an average distance of 12.4 mm distal to the mortise. The lateral terminal branch penetrated the deep surface of the extensor digitorum brevis to provide motor innervation. The medial terminal branch passed over the talonavicular joint capsule, and coursed an average of 2.9 mm lateral to the first tarsometatarsal joint. Within the forefoot, it passed deep to the extensor hallucis brevis tendon, bifurcated in the midmetatarsal region, and then arborized, supplying sensibility to the first toe interspace and the adjacent sides of the first and second toes.

scholarly journals Hallux Valgus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035
Author(s):  
Alex Mierke ◽  
Stephen Morris ◽  
Scott Epperly ◽  
Deon Kidd ◽  
Daniel Patton
Keyword(s):  
Hallux Valgus ◽  
Saphenous Vein ◽  
Tibialis Anterior ◽  
Peroneal Nerve ◽  
Neurovascular Bundle ◽  
Screw Placement ◽  
Superficial Peroneal Nerve ◽  
Extensor Hallucis Longus ◽  
Severe Hallux Valgus ◽  
Anatomic Alignment

Category: Bunion Introduction/Purpose: Abnormal motion of the first tarsometatarsal (TMT) joint disrupts the anatomic alignment of the metatarsal head, sesamoid complex and proximal first phalanx. This anatomic disruption combined with the deforming forces of the extensor hallucis longus, adductor tendons, and extensor hallucis brevis result in a hallux valgus deformity. First TMT arthrodesis or the Lapidus procedure has been described as treatment for moderate to severe hallux valgus deformities by correcting hypermobility and restoring anatomic alignment of the first ray. The aim of this study was to evaluate the safety of a percutaneous approach to the Lapidus procedure and its relation to anatomic structures. Methods: A percutaneous, modified Lapidus procedure was performed on 19 embalmed cadaveric feet under fluoroscopic guidance. The specimens were then dissected to identify the extensor hallucis longus (EHL), extensor hallucis brevis (EHB), tibialis anterior (TA), median branch of the superficial peroneal nerve (MBSPN), intermediate branch of the superficial peroneal nerve (IBSPN), deep peroneal neurovascular bundle (DPNVB) and saphenous vein (SV). The structures were localized with reference to percutaneous burr and screw placement during the procedure. Results: The tibialis anterior and intermediate branch of the superficial peroneal nerve were a mean of 3.75 millimeters (mm) and 5.08 mm from the closest burr or screw placement. The extensor hallucis longus and extensor hallucis brevis were at greatest risk under the new approach with mean distances of .92 to 4.08 mm to nearby instrumentation. The extensor hallucis longus or extensor hallucis brevis were either directly pierced or <2 mm from instrumentation on 26 occasions. A terminal branch of the saphenous vein was also either pierced or within 2 mm of instrumentation on 4 occasions. The deep peroneal neurovascular bundle and median branch of superficial peroneal nerve were relatively safe, coming within 2 mm of percutaneous burr or screw placement on only 2 occasions each. Conclusion: The minimally invasive percutaneous Lapidus arthrodesis provides a safe alternative to the traditional, open approach for patients with moderate to severe hallux valgus deformities. This may be a beneficial alternative to conventional open Lapidus procedures by minimizing soft tissue dissection. Further clinical studies must be performed to compare deformity correction, fusion rate, and complications with the modified percutaneous Lapidus procedure.

scholarly journals The possibility of deep peroneal nerve neurotisation by the superficial peroneal nerve: an anatomical approach

1999 ◽  
Vol 194 (2) ◽  
pp. 309-312 ◽  
Author(s):  
M. BUYUKMUMCU ◽  
M. E. USTUN ◽  
M. SEKER ◽  
Y. KOCAOGULLARI ◽  
A. SAGMANLIGIL
Keyword(s):  
Peroneal Nerve ◽  
Superficial Peroneal Nerve ◽  
Deep Peroneal Nerve

scholarly journals Anomalous superficial peroneal nerve and variant cutaneous innervation of the sural nerve on the dorsum of the foot: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
pp. 197 ◽  
Author(s):  
Somayaji Nagabhooshana ◽  
Venkata Vollala ◽  
Vincent Rodrigues ◽  
Mohandas Rao
Keyword(s):  
Case Report ◽  
Sural Nerve ◽  
Peroneal Nerve ◽  
Superficial Peroneal Nerve ◽  
Cutaneous Innervation

scholarly journals Transient Common Peroneal and Tibial Nerve Palsy Following Knee Arthroscopy for the Treatment of Discoid Lateral Meniscus

Joints ◽  
2017 ◽  
Vol 05 (02) ◽  
pp. 118-120
Author(s):  
Gabriele Bernardi ◽  
Cosimo Tudisco
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Peroneal Nerve ◽  
Nerve Palsy ◽  
Knee Arthroscopy ◽  
Tibial Nerve ◽  
Lateral Meniscus ◽  
Common Peroneal Nerve ◽  
Orthopedic Procedures ◽  
Discoid Lateral Meniscus

AbstractThe number of knee arthroscopies has increased rapidly since the 1980s and are among the most common orthopedic procedures today. It is generally considered a minimally invasive surgery with relatively low morbidity, but it is not without risk of complications. We report the case of a 14-year-old boy who developed a lesion of common peroneal nerve and tibial nerve after knee arthroscopy for a torn discoid lateral meniscus, which was confirmed by electromyogram study.

scholarly journals Peroneal nerve decompression

2018 ◽  
Vol 44 (videosuppl1) ◽  
pp. V6 ◽  
Author(s):  
Mark Corriveau ◽  
Jacob D. Lescher ◽  
Amgad S. Hanna
Keyword(s):  
Peroneal Nerve ◽  
Foot Drop ◽  
Superficial Peroneal Nerve ◽  
Fibular Head ◽  
Deep Peroneal Nerve ◽  
Operative Techniques ◽  
Key Steps ◽  
Adequate Decompression ◽  
Nerve Release ◽  
Fibular Nerve

Peroneal neuropathy is a common pathology encountered by neurosurgeons. Symptoms include pain, numbness, and foot drop. When secondary to compression of the nerve at the fibular head, peroneal (fibular) nerve release is a low-risk procedure that can provide excellent results with pain relief and return of function. In this video, the authors highlight key operative techniques to ensure adequate decompression of the nerve while protecting the 3 major branches, including the superficial peroneal nerve, deep peroneal nerve, and recurrent genicular (articular) branches. Key steps include positioning, circumferential nerve dissection, fascial opening, isolation of the major branches, and closure.The video can be found here: https://youtu.be/0y9oE8w1FIU.

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