Abstract
PurposeNeuropathy of the Baxter nerve (BN) seems to be the first cause of the heel pain syndrome (HPS) of neurological origin.Methods41 alcohol–glycerol embalmed feet were dissected. We documented the pattern of the branches of the tibial nerve (TN) and describe all relevant osteofibrous structures. Measurements for the TN branches were related to the Dellon–McKinnon malleolar-calcaneal line also called DM line (DML) for the proximal TT and the Heimkes Triangle for the distal TT. Additionally, we performed an ultrasound-guided injection procedure of the BN and provide an algorithm for clinical usage.ResultsThe division of the TN was 16.4 mm proximal to the DML. The BN branches off 20 mm above the DML center or 30 mm distally to it. In most of the cases, the medial calcaneal branch (MCB) originated from the TN proximal to the bifurcation. Possible entrapment spots for the medial and lateral plantar nerve (MPN, LPN), the BN and the MCB are found within a circle of 5 mm radius with a probability of 80%, 83%, and 84%, respectively. In ten out of ten feet, the US-guided injection was precisely allocated around the BN.ConclusionsOur detailed mapping of the TN branches and their osteofibrous tubes at the TT might be of importance for foot and ankle surgeons during minimally invasive procedures in HPS such as ultrasound-guided ankle and foot decompression surgery (UGAFDS).
Highlights
Chronic heel pain syndrome (HPS) affects a large number of podiatric patients
Three nerves are running through these osteofibrous tubes, the medial plantar nerve (MPN), the lateral plantar nerve (LPN) and the Baxter’s nerve (BN)
Between the LPN and the MPN we found the extension of the medial septum (MS), i.e. connective tissue partition of Heimkes et al in 40 out of 41 feet [16] (Table 1)
Summary
Chronic heel pain syndrome (HPS) affects a large number of podiatric patients. The overall incidence of this syndrome is stated between 11% and 15% of the population based on studies of various authors [1, 7, 15, 37, 43, 44]. One overlooked cause for HPS, first described in 1940 by Roegholt [35], might be the entrapment of the first branch of lateral plantar nerve, known as Baxter’s nerve (BN), the anterior branch of the calcaneal nerve or the inferior calcaneal nerve [3,4,5,6, 17, 38]. The topographical localization of this structure is essential for the description of nerve entrapment syndromes at the medial heel region. Heimkes et al described a connective tissue partition that originates from the medial side of the calcaneus and attaches at the MS forming a middle bridge for the two Surgical and Radiologic Anatomy (2019) 41:29–41 osteofibrous tubes in which the tibial nerve (TN) branches are running through [16]. Singh et al stated that this medial intermuscular septum is probably the most important compression site for HPS beside the laciniate ligament (the flexor retinaculum of the ankle) [41]
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