Abstract
The posterior tibial muscle (PTM) is a key muscle in diagnosing the level of the neurologic lesion that causes steppage gate that is a paralysis of nervous origin of the muscles ensuring the foot dorsiflexion.The aim of this manuscript is to illustrate the anatomical peculiarities of the PTM, the ultrasound (US) anatomy of the infero-posterior part of the leg, and the technique of US-guided electro-neuro-myography (ENMG) of the PTM, which is considered a key muscle in the diagnosis of the neurological lesion causing steppage gate.The US-guided ENMG of the PTM is technically easy and safe for young practitioners provided there is a good knowledge of US anatomy of the infero-posterior part of the leg.
Highlights
Nowadays, the needle electro-neuro-myography (ENMG) plays a major role in the site diagnosis of neurological lesions of the limbs, for example in steppage gate
The use of ultrasound (US) facilitates the implementation of the ENMG of these anatomical elements and makes it accessible to less-experienced clinicians [1]. The aim of this manuscript is to illustrate the anatomical peculiarities of the posterior tibial muscle (PTM), the US anatomy of the infero-posterior part of the leg, and the technique of US-guided ENMG of the PTM, which is considered a key muscle in the diagnosis of the neurological lesion causing steppage gate
Taking into account that PTM is innervated by the L5 root but does not depend on the peroneal nerve, its clinical, US, and electromyographic evaluation is of great help in the diagnosis of the level of neurological lesion causing the steppage gate [12]
Summary
The needle electro-neuro-myography (ENMG) plays a major role in the site diagnosis of neurological lesions of the limbs, for example in steppage gate The latter is known as drop foot that is a paralysis of nervous origin of the muscles ensuring the dorsiflexion of the foot. The use of ultrasound (US) facilitates the implementation of the ENMG of these anatomical elements and makes it accessible to less-experienced clinicians [1] The aim of this manuscript is to illustrate the anatomical peculiarities of the posterior tibial muscle (PTM), the US anatomy of the infero-posterior part of the leg, and the technique of US-guided ENMG of the PTM, which is considered a key muscle in the diagnosis of the neurological lesion causing steppage gate. ENMG: electro-neuro-myography; T: tibia; F: fibula; PTM: posterior tibial muscle; Sol: soleus muscle; FDLM: flexor digitorum longus muscle; FHLM: flexor hallucis longus muscle; A: posterior tibial artery; N: posterior tibial nerve
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