Persistent Symptoms of Ganglion Cysts in the Dorsal Foot

Background: A ganglion is a common benign cystic lesion, containing gelatinous material. Ganglia are most commonly asymptomatic, except for a lump, but symptoms depend on the location. A dorsal foot ganglion is typically painful. On the dorsal foot, the dorsalis pedis artery and the medial branch of the deep peroneal nerve are located under the fascia. Objective: Five female patients of average age 45.8 ± 20 years (range, 12 to 60 years) with a painful ganglion in the dorsal foot were analyzed. Results: Average lesion size was 2.94 ± 1.1 cm (range, 1.5 to 4.0 cm) and patients had experienced pain for a median of 2-3 years (range, 6 months to 3 years). Four patients had a single cystic lesion and 1 patient had developed multiple cystic lesions over the time that were associated with hypoesthesia. In 3 cases, symptomatic lesions were located deep beneath the fascia and were resected. In 2 cases, the depth of the non-resected lesions was shallow. Conclusion: The cause of a painful dorsal foot ganglion can be attributed to its location in the thin subcutaneous tissue over the foot bone, in addition to its proximity to a nearby artery and nerve. Mild symptoms caused by a dorsal foot ganglion seem to be persistent, and the deeper the location, the more likely is the need for resection. To avoid nerve injury, anatomical knowledge is prerequisite to any puncturing procedure or operation performed.

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The Clinical Importance of the Relationship between the Deep Peroneal Nerve and the Dorsalis Pedis Artery on the Dorsum of the Foot

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000270310.39084.2d ◽

2007 ◽

Vol 120 (3) ◽

pp. 690-696 ◽

Cited By ~ 7

Author(s):

Zuhre Asl Aktan ??kiz ◽

H??lya ????erler ◽

M??jde Uygur

Keyword(s):

Peroneal Nerve ◽

Clinical Importance ◽

Deep Peroneal Nerve ◽

Dorsalis Pedis Artery ◽

The Relationship

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

Clinical Anatomy ◽

10.1002/ca.20690 ◽

2008 ◽

Vol 21 (7) ◽

pp. 705-712 ◽

Cited By ~ 10

Author(s):

A.V. Ranade ◽

V. Rajanigandha ◽

R. Rai ◽

David A. Ebenezer

Keyword(s):

Peroneal Nerve ◽

Cadaveric Study ◽

Deep Peroneal Nerve ◽

Dorsalis Pedis Artery

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00446 ◽

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.

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A Part of the Medial Branch of the Deep Peroneal Nerve Distributes the Dorsal Pedis Artery and Its Distribution Area is Close to the Acupuncture Point LR3 (Taichong)

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/6760958 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Kanae Umemoto ◽

Munekazu Naito ◽

Naoyuki Hatayama ◽

Shuichi Hirai ◽

Kou Sakabe

Keyword(s):

Peroneal Nerve ◽

Acupuncture Point ◽

Specific Area ◽

Distribution Area ◽

Medial Branch ◽

Deep Peroneal Nerve ◽

Metatarsal Bones ◽

Second Metatarsal ◽

The Mean ◽

Arterial Constriction

Cutaneous nerves have vascular branches (VBs) that reach the arteries and are thought to be involved in arterial constriction. We aimed to examine the anatomical and histological relationship between the VBs of a cutaneous nerve in the foot and the acupuncture point LR3 (Taichong), which is a depression between the base of the first and second metatarsal bones on the dorsum of the foot and is a source point of the foot. We examined 40 cadaver feet to assess the distribution areas of the VBs of the medial branch of the deep peroneal nerve (MBDPN). MBDPNs were distally followed to identify the point where the VBs reached the arteries. The distance between the point and LR3 was measured. Sympathetic fibers in the VBs were histologically observed using tyrosine hydroxylase (TH) immunostaining. The VBs of the MBDPNs reaching the dorsal pedis arteries were observed in all specimens (100%). The mean distance between LR3 and the point where the VBs of the MBDPN reached the arteries was 3.2 ± 2.6 mm. Among the VBs, 70% were distributed proximal to LR3. Moreover, TH-positive fibers were present in the VBs. These findings revealed that a part of the MBDPN distributed the dorsal pedis artery and contained sympathetic fibers. We also found that the distribution area of the VBs was close to LR3. Our study provides anatomical evidence that LR3 is a specific area and its stimulation would be useful for treating peripheral circulatory failure.

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Deep Peroneal Nerve Palsy Caused by an Extraneural Ganglion Cyst: A Rare Case

Case Reports in Orthopedics ◽

10.1155/2015/861697 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Dimitrios Nikolopoulos ◽

George Safos ◽

Neoptolemos Sergides ◽

Petros Safos

Keyword(s):

Peroneal Nerve ◽

Ganglion Cyst ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Peripheral Neuropathies ◽

Tibiofibular Syndesmosis ◽

Deep Peroneal Nerve ◽

Intraneural Ganglion ◽

Ganglion Cysts ◽

The Common

Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve.

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Anterocentral Portal in Ankle Arthroscopy

Foot & Ankle International ◽

10.1177/1071100720931095 ◽

2020 ◽

Vol 41 (9) ◽

pp. 1133-1142

Author(s):

Christoph Stotter ◽

Thomas Klestil ◽

Andreas Chemelli ◽

Vahid Naderi ◽

Stefan Nehrer ◽

...

Keyword(s):

Peroneal Nerve ◽

Ankle Arthroscopy ◽

Anterior Tibial Artery ◽

Medial Branch ◽

Superficial Peroneal Nerve ◽

Deep Peroneal Nerve ◽

Tibial Artery ◽

Anterior Tibial ◽

Anterolateral Portal

Background: The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal. Methods: We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months. Results: Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm. Conclusion: Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve. Level of Evidence: Level III, retrospective cohort study.

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