Topography of human ankle joint: focused on posterior tibial artery and tibial nerve

The use of standard anterolateral and anteromedial portals in ankle arthroscopy results in reduced risk of vascular complications. Anatomical variations of the arterial network of the foot and ankle might render the vessels more susceptible to injury during procedures involving the anterior ankle joint. The literature, to our knowledge, reports only one case of a pseudoaneurysm involving the peroneal artery after ankle arthroscopy. Here, we report the unusual case of a 48-year-old man in general good health with the absence of the anterior tibial artery and posterior tibial artery. The patient presented with a pseudoaneurysm of the perforating peroneal artery following ankle arthroscopy for traumatic osteoarthritis associated with nonunion of the medial malleolus. The perforating peroneal artery injury was repaired by performing end-to-end anastomosis. The perforating peroneal artery is at higher risk for iatrogenic injury during ankle arthroscopy in the presence of abnormal arterial variations of the foot and ankle, particularly the absence of the anterior tibial artery and posterior tibial artery. Before ankle arthroscopy, surgeons should therefore carefully observe the course of the perforating peroneal artery on enhanced 3-dimensional computed tomography, especially in patients with a history of trauma to the ankle joint.

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Tarsal Tunnel Surgery for Treatment of Tarsal Ganglion

Journal of the American Podiatric Medical Association ◽

10.7547/0950459 ◽

2005 ◽

Vol 95 (5) ◽

pp. 459-463 ◽

Cited By ~ 15

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)

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

10.14293/s2199-1006.1.sor-.ppuprts.v1 ◽

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.

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

ANZ Journal of Surgery ◽

10.1111/ans.13825 ◽

2016 ◽

Vol 88 (11) ◽

pp. 1206-1208 ◽

Cited By ~ 1

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

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Absence of the posterior tibial artery. A case report

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-84-7-363 ◽

1994 ◽

Vol 84 (7) ◽

pp. 363-364 ◽

Cited By ~ 1

Author(s):

D Poratt ◽

GE Tilley

Keyword(s):

Case Report ◽

Ankle Joint ◽

Medical Literature ◽

Posterior Tibial Artery ◽

Peroneal Artery ◽

Posterior Tibial ◽

Tibial Artery

In the case presented, the arteriograms showed that the peroneal artery had replaced the absent posterior tibial artery. The peroneal artery coursed medially below the ankle joint to become the plantar arteries of the foot. This has been previously described in the medical literature.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420917325 ◽

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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