Zone 2 Flexor Hallucis Longus Tendoscopy: A Cadaveric Study

2009 ◽  
Vol 30 (5) ◽  
pp. 447-451 ◽  
Author(s):  
Tun Hing Lui ◽  
Kwok Bill Chan ◽  
Lap Ki Chan
Keyword(s):  
Tibial Nerve ◽  
Average Distance ◽  
Cadaveric Study ◽  
Flexor Hallucis Longus ◽  
Posterior Tibial Nerve ◽  
Medial Plantar Nerve ◽  
Endoscopic Findings ◽  
Posterior Tibial ◽  
Anatomic Dissection ◽  
The Relationship

Background: The purpose of this study was to verify the safety and efficacy of zone 2 flexor hallucis longus tendoscopy with the patient in the prone position. Materials and Methods: The technique was performed in 12 cadaver feet (6 pairs). The endoscopic findings were compared to an anatomic dissection. The locations of the posteromedial and plantar portals were studied. The relationship between the medial plantar nerve and the tract of FHL tendoscopy was also studied. Result: The average distance of the posteromedial portal above the medial malleolar tip was 10.3 mm. The average distance between the posteromedial portal and the posterior tibial nerve was 9.9 mm. The average distance between the plantar portal and the intermalleolar line was 41.5 mm. The average distance between the rod simulating the tenoscope and the nerve was 4.8 mm. The nerve was medial to the rod in 4 specimens and lateral to the rod in 8 specimens. Conclusion: Zone 2 flexor hallucis longus tendoscopy was a feasible approach to the deep portion of the flexor hallucis longus tendon in this cadaveric study. There is potential risk of damage to the medial plantar nerve. Clinical Relevance: These findings can help guide a surgeon who is considering trying this clinically.

The Intraneural Ganglion of the Posterior Tibial Nerve and Medial Plantar Nerve

2008 ◽  
Vol 43 (1) ◽  
pp. 127
Author(s):  
Seong-Ho Yoo ◽  
Seong-Jun Ahn ◽  
Bu-Hwan Kim ◽  
Moo-Ho Song ◽  
Seoung-Ho Shin
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Intraneural Ganglion ◽  
Medial Plantar Nerve ◽  
Posterior Tibial

Risk of Neurovascular Injuries in Flexor Hallucis Longus Tendon Transfers: An Anatomic Cadaver Study

2007 ◽  
Vol 28 (8) ◽  
pp. 910-915 ◽  
Author(s):  
Tom Mulier ◽  
Elise Rummens ◽  
Greta Dereymaeker
Keyword(s):  
Tibial Nerve ◽  
Cadaver Study ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Nerve ◽  
Nerve Lesions ◽  
Posterior Tibial ◽  
Incision Technique ◽  
Flexor Digitorum

Background: Flexor hallucis longus (FHL) tendon transfer is a frequently used treatment for both posterior tibial tendon insufficiency and chronic Achilles tendinopathy. We observed difficulties in harvesting the FHL tendon that may arise from cross-attachments with the flexor digitorum longus (FDL) tendon near the knot of Henry. The posterior tibial nerve is located nearby the decussation of these tendons. This study examined whether the difficult harvesting may be the cause of nerve injury. Methods: A cadaver study was performed on 24 foot specimens. In all feet, we used a double-incision technique. The FHL tendon was transected in the distal medial midfoot incision and retracted through the posteromedial hindfoot incision. After harvesting the FHL tendon, we exposed the posterior tibial nerve and its lateral and medial plantar branches to identify if any lesion had occurred. Results: The retraction failed at the first attempt in all specimens because of the presence of cross-attachments between the FHL and FDL tendons. A more extensive dissection of the FHL and FDL tendons was therefore required. We found lesions in 33% of all foot specimens, including two complete ruptures of the medial plantar nerve. Conclusions: Harvesting of the FHL tendon when transection is made distal to the knot of Henry may cause injuries to the medial and lateral plantar nerves. Experience in this procedure may reduce the risk of nerve injuries but even then nerve lesions remain possible. The clinical significance of these nerve lesions is not described in literature and remains to be determined.

scholarly journals Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 879
Author(s):  
Aida Agost-González ◽  
Isabel Escobio-Prieto ◽  
Azahara M. Pareja-Leal ◽  
María Jesús Casuso-Holgado ◽  
María Blanco-Diaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Incontinence ◽  
Electrical Stimulation ◽  
Overactive Bladder ◽  
Tibial Nerve ◽  
Scientific Evidence ◽  
Transcutaneous Electrical Stimulation ◽  
Posterior Tibial Nerve ◽  
Posterior Tibial

Background: Percutaneous electrical stimulation and transcutaneous electrical stimulation (PTNS and TTNS) of the posterior tibial nerve are internationally recognized treatment methods that offer advantages in terms of treating patients with overactive bladder (OAB) who present with urinary incontinence (UI). This article aims to analyze the scientific evidence for the treatment of OAB with UI in adults using PTNS versus TTNS procedures in the posterior tibial nerve. Methods: A systematic review was conducted, between February and May 2021 in the Web of Science and Scopus databases, in accordance with the PRISMA recommendations. Results: The research identified 259 studies, 130 of which were selected and analyzed, with only 19 used according to the inclusion requirements established. The greatest effectiveness, in reducing UI and in other parameters of daily voiding and quality of life, was obtained by combining both techniques with other treatments, pharmacological treatments, or exercise. Conclusions: TTNS has advantages over PTNS as it is more comfortable for the patient even though there is equality of both therapies in the outcome variables. More research studies are necessary in order to obtain clear scientific evidence.

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