scholarly journals Cadaveric Study of the Neurovascular Bundle in Tarsal Tunnel Region among Sudanese - 2020

2021 ◽  
Author(s):  
yasser seddeg ◽  
Elfarazdag Ismail
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Neurovascular Bundle ◽  
Medial Malleolus ◽  
Tarsal Tunnel ◽  
Nerve Blocks ◽  
Bifurcation Points ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Displacement Osteotomy

Abstract Background: Tarsal tunnel is situated medial to the ankle lying deep to the flexor retinaculum. Within which lies the neurovascular bundle in separate compartments. This study examines the level of bifurcation points of tibial nerve and posterior tibial artery, and the location of medial and lateral plantar nerves in the tarsal tunnel. As well as the origin of the medial calcaneal nerves. Methods: This study was a descriptive observational cross sectional study. Step by step dissections of the tarsal tunnel were performed on 30 Sudanese cadavers, the contents of the tarsal tunnel were explored. Results: The tibial nerve was found to bifurcate before the the medial malleolus calcaneal axis (MMCA) in (n=4/30, 13.3%) specimens , and inside the tunnel (n=26/30, 86.7%). The branching point of the posterior tibialartery was found before the MMCA in (n=10/28, 35.7%) of specimens, at the MMCA in (n=16/28, 57.1%), and after the MMCA in (n= 2/28, 7.1%). Medial calcaneal nerves were found to be derived from the LPN plus the TN in (n=13/30, 43.3%), while in (n=6/30, 20%) were derived from LPN plus MPN plus TN. only (n=5/30, 16.7 %) were derived from LPN alone. Conclusion: anatomical knowledge of the bifurcation points of tibial nerve and posterior tibial artery is of great importance in many medical procedures like external fixation of medial malleolus fractures, medial displacement osteotomy and nerve blocks in podiatric medicine.

scholarly journals Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

2016 ◽  
Vol 18 (1) ◽  
pp. 64 ◽  
Author(s):  
Miao Zheng ◽  
Chuang Chen ◽  
Qianyi Qiu ◽  
Changjun Wu
Keyword(s):  
Anatomical Variation ◽  
Posterior Tibial Artery ◽  
Peroneal Artery ◽  
Medial Malleolus ◽  
Anterior Tibial Artery ◽  
Tarsal Tunnel ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Tibial Arteries ◽  
Anterior Tibial

Aims: Knowledge about branching pattern of the popliteal artery is very important in any clinical settings involving the anterior and posterior tibial arteries. This study aims to elucidate the anatomical variation patterns and common types of anterior tibial artery (ATA) and posterior tibial arteries (PTA) in the general population in China. Material and methods: Anatomical variations of ATA, PTA, and peroneal artery were evaluated with ultrasound in a total of 942 lower extremity arteries in 471 patients. Results: Three patterns of course in the PTA were ultrasonographically identified:  1) PTA1: normal anatomy with posterior tibial artery entering tarsal tunnel to perfuse the foot (91.5%),  2) PTA2: tibial artery agenetic, and replaced by communicating branches of peroneal artery entering tarsal tunnel above the medial malleolus to perfuse the foot (5.9%), and 3) PTA3: hypoplastic or aplastic posterior tibial artery communicating above the medial malleolus with thick branches of peroneal artery to form a common trunk entering into the tarsal tunnel (2.4%). In cases where ATA  was hypoplastic or aplastic, thick branches of the peroneal artery replaced the anterior tibial artery to give rise to dorsalis pedis artery, with a total incidence of 3.2 % in patients, and were observed more commonly in females than in males. Hypoplastic or aplastic termini of ATA and PTA, with perfusion of the foot solely by the peroneal artery, was identified in 1 case. In another case, both communicating branches of the peroneal artery and PTA entered the tarsal tunnel to form lateral and medial plantar arteries.Conclusions: Anatomical variation of ATA and PTA is relatively common in the normal population. Caution should be exercised with these variations when preparing a peroneal artery vascular pedicle flap grafting. Ultrasound evaluation provides accurate and reliable information on the variations.

Tarsal Tunnel Surgery for Treatment of Tarsal Ganglion

2005 ◽  
Vol 95 (5) ◽  
pp. 459-463 ◽  
Author(s):  
Gedge D. Rosson ◽  
Robert J. Spinner ◽  
A. Lee Dellon
Keyword(s):  
Nerve Injury ◽  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Tarsal Tunnel ◽  
Posterior Tibial Nerve ◽  
Intraneural Ganglion ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Guiding Principles

Three patients who originally presented with a mass in the tarsal tunnel are described to develop an algorithm for management of the tarsal ganglion. All three patients had complications from ganglion excision, including complete division of the posterior tibial nerve, injury to the posterior tibial artery, and ganglion recurrence. The guiding principles relating to the presence of an extraneural versus an intraneural ganglion are developed. An example of a posterior tibial intraneural ganglion is presented. (J Am Podiatr Med Assoc 95(5): 459–463, 2005)

An Extraordinary Reconstruction of a Postoperative Defect after Metatarsophalangeal Joint Arthrodesis of the Big Toe Using the “Chinese Forearm Flap”

2021 ◽  
Author(s):  
Andrej Ring
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Posterior Tibial Artery ◽  
Hallux Rigidus ◽  
Soft Tissue Defect ◽  
Medial Malleolus ◽  
Soft Tissue Reconstruction ◽  
Tissue Defect ◽  
Posterior Tibial ◽  
Tibial Artery

Abstract Background We present an unusual technique for reconstruction of a postoperative tissue defect following hallux rigidus surgery. Methods A complicated course after left big toe arthrodesis resulted in a soft tissue defect with bone exposure of the first ray. Amputation of the big toe was categorically rejected by the patient. There was advanced arteriosclerosis with single-vessel supply to the foot via the posterior tibial artery. Outcome To preserve the big toe, the defect was covered by a fasciocutaneous radial free flap with a 15 cm long vascular pedicle which was microanastomosed to the posterior tibial artery and its accompanying vein at the level of the medial malleolus. Conclusion In certain extreme situations, the free “Chinese” radial flap can be quite effective in covering forefoot defects and allowing satisfactory and aesthetically pleasing soft tissue reconstruction.

Tibial Nerve Palsy by a Crossing Posterior Tibial Artery Branch After Lateral Sliding Calcaneal Osteotomy

2017 ◽  
Vol 38 (5) ◽  
pp. 580-583 ◽  
Author(s):  
Philipp Scacchi ◽  
Lampros Gousopoulos ◽  
Bettina Juon ◽  
Sufian Ahmed ◽  
Fabian G. Krause
Keyword(s):  
Nerve Palsy ◽  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Calcaneal Osteotomy ◽  
Artery Branch

scholarly journals Landmark Technique vs Ultrasound Guided Approach for Posterior Tibial Nerve Block in Cadaver Models

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Sara Elizabeth Morris ◽  
Haley McKissack ◽  
Leonardo V. M. Moraes ◽  
Gean C. Viner ◽  
James R. Jones ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Medial Malleolus ◽  
Anatomical Landmarks ◽  
Posterior Tibial Nerve ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Posterior Tibial ◽  
Linear Probe ◽  
Landmark Technique ◽  
Regional Anesthetic

Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Until recently, many regional anesthetic blocks were performed without the assistance of ultrasound, relying on methods such as anatomical landmarks and nerve stimulation. The use of ultrasound for peripheral nerve blocks has proven extremely useful for improving the efficacy of many regional anesthetic techniques. There remain a few nerve blocks which have lagged in employing the assistance of ultrasound consistently, one of which is the ankle block. This block is commonly utilized for either surgical anesthesia or post-operative analgesia for a variety of foot and ankle procedures. In this study, we compared the accuracy of traditional landmark technique with an ultrasound guided approach for ankle block by assessing the spread of injectate (dye) along the posterior tibial nerve (PTN) in cadaver models. Methods: Ten below-knee cadaver specimens were used for this study. Five were randomly chosen to undergo landmark guided PTN blocks, and five were selected for ultrasound-guided PTN blocks. The landmark technique was performed by identifying the medial malleolus and Achilles tendon and inserting the needle (4 cm long, 21G Braun® Stimuplex) at the midpoint of the two structures, aiming toward the medial malleolus and advancing until bone was contacted. 2 cc of blue acrylic dye was injected at this location. The ultrasound technique was performed with a linear probe identifying the medial malleolus and the PTN. The needle was advanced in-plane with a posterior to anterior trajectory until the tip of the needle was adjacent to the nerve. 2 cc of blue acrylic dye was injected surrounding the nerve. The extremities were then dissected to determine which nerves had been coated with dye. Results: 100% of the ultrasound guided blocks resulted in completely stained PTN with dye. In the landmark group, only 40% of the landmark technique blocks resulted in completely stained PTN with dye. Of the nerves not stained with dye, 2 were noted to have had dye injected posterior to the nerve and 1 was noted to have had dye injected into the flexor digitorum longus tendon. Conclusion: The base of evidence has dramatically increased in recent years in support of the use of ultrasound in regional anesthesia. This study substantiates the superiority of ultrasound guidance for ankle block by demonstrating a 100% success rate amongst the ultrasound guided group.

Tibial nerve palsy as the presenting feature of posterior tibial artery pseudoaneurysm

2016 ◽  
Vol 88 (11) ◽  
pp. 1206-1208 ◽  
Author(s):  
Adrian D. Murphy ◽  
Marion Chan ◽  
Sian M. Fairbank
Keyword(s):  
Nerve Palsy ◽  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Artery Pseudoaneurysm ◽  
Posterior Tibial ◽  
Tibial Artery

scholarly journals Position of the Posteromedial Ankle Structures in Patients Indicated for Total Ankle Replacement

2020 ◽  
Vol 5 (2) ◽  
pp. 247301142091732
Author(s):  
Matthew S. Conti ◽  
Jonathan H. Garfinkel ◽  
Harry G. Greditzer ◽  
Carolyn M. Sofka ◽  
Kristin C. Caolo ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Total Ankle Replacement ◽  
Posterior Cortex ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Tibial Plafond ◽  
Ankle Replacement ◽  
End Stage ◽  
Tibial Cortex

Background: The posteromedial ankle structures are at risk during total ankle replacement (TAR). The purpose of our study was to investigate the distance of these structures from the posterior cortex of the tibia and talus in order to determine their anatomy at different levels of bone resection during a TAR and whether plantarflexion of the ankle reliably moved these structures posteriorly. Methods: Ten feet in 10 patients with end-stage tibiotalar arthritis indicated for a TAR were included. Preoperative magnetic resonance images were obtained with the foot in a neutral position as well as in maximum plantarflexion to measure the distance of posteromedial ankle structures to the closest part of the posterior cortex of the tibia or talus. Wilcoxon signed-rank rests were used to investigate differences in these distances. Results: The mean distance from the posterior tibial cortex to the tibial nerve at 14 and 7 mm above the tibial plafond was 8.7 mm (range 5.0-11.8 mm) and 6.7 mm (range 2.7-10.6 mm), respectively, which represented a statistically significant movement anteriorly ( P = .021). The posterior tibial artery was, on average, 8.0 mm (range 3.6-13.9 mm) and 7.2 mm (range 3.1-9.4 mm) from the posterior tibial cortex at 14 and 7 mm above the tibial plafond, respectively. Distal to the tibial plafond, the posterior tibial artery and flexor digitorum longus tendons moved posteriorly by less than 1 mm in plantarflexion (all P < .05); otherwise, plantarflexion of the ankle did not affect the position of the tibial nerve, posterior tibial tendon, or flexor hallucis longus. Conclusion: In patients with end-stage ankle arthritis, the tibial nerve and posterior tibial artery lie, on average, between 6.5 and 10 mm from the posterior tibial and talar cortices. Plantarflexion of the ankle did not reliably move the posteromedial ankle structures posteriorly. Level of Evidence: Level IV, case series, therapeutic

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