Anatomy of the tibial nerve in relation to the tarsal tunnel: A cadaveric study

Abstract

BackgroundTarsal tunnel syndrome (TTS) is typically caused by an anatomical variant or mechanical compression of the tibial nerve (TN) with variable success after surgical treatment. Method40 lower-leg specimens were obtained. Dissections were appropriately conducted. Extremities were prepared under formaldehyde solution. The tibial nerve and branches were dissected for measurements and various characteristics. ResultsThe flexor retinaculum had a denser consistency in 22.5% of the cases and the average length was 51.9 mm. The flexor retinaculum as an independent structure was absent and 77.2% of cases as an undistinguished extension of the crural fascia. The lateral plantar nerve (LPN) and abductor digiti minimi (ADM) nerve shared same origin in 80% of cases, 34.5% bifurcated proximal to the DM (Dellon-McKinnon malleolar-calcaneal line) line 31.2% distally and 34.3% at the same level. ConclusionUnderstanding the tibial nerve anatomy will allow us to adapt our surgical technique to improve the treatment of this recurrent pathology.•Tarsal tunnel syndrome•Tibial nerve•Crural Fascia•Malleolar-calcaneal line