Morphological Study of the Posterior Tibial Nerve in Tarsal Tunnel of the Human Foot

Khalid Musa Fadlelmula Awadelseid,Yi Zhang

doi:10.14302/issn.2577-2279.ijha-20-3445

Abstract

The passage of the posterior tibial nerve in the tarsal tunnel has a great clinical significance, thus detailed anatomical knowledge is mandatory for safe clinical intervention. This study was to identify the morphological appearance of the tibial nerve and its bifurcation. Sixty lower limbs of formalin embalmed cadavers were randomly selected. Data were collected through the application of standard dissection method of the tarsal tunnel of lower limbs (30 rights and 30 left) of formalin embalmed cadavers. The posterior tibial nerve and its branches were exposed from the distal end of the leg toward plantar surface beyond its bifurcation by resecting the skin and flexor retinaculum. The study triggered several findings: The posterior tibial nerve is flattened shaped in 21 specimens 70% and has a rounded shape in 9 specimens 30%in the right foot. In the left foot it is flattened in 17 specimens 56.7% and rounded shape in 13 specimens 43.3%. Posterior tibial nerve bifurcates into medial and lateral planter nerves inside tarsal tunnel in 20 specimens 66.7% in the right foot and in 21 specimens 70% in the left foot. This study concludes that posterior tibial nerve commonly has flattened shape and divided into medial and lateral planter nerves inside tarsal tunnel.

Highlights

Anatomy represents the inlet for understanding clinical medicine and surgery [9].The tarsal tunnel has great clinical significance; it is the portal of the foot many structures pass from the leg to the foot
As well it is used as medial portal for arthroscopy, studding anatomy of the posterior tibial nerve (PTN) in this area may give important information which can help in explanation of many clinical conditions such as tarsal tunnel syndrome and may help clinicians to identify safe zone on medial side of the ankle joint during surgical procedures
In the left foot it is flattened in 17 specimens 56.7% and rounded shape in 13 specimens 43.3% these results nearly in agreement with Joshi et al described a flattened shape of the TN in 57.14% in the right foot and Lt 58.92% in the left foot [10]

Summary

Introduction

Tarsal tunnel is the term used to describe the area at medial side of the ankle joint where the tendons of the flexor muscles pass from the leg to the sole of the foot with the tibial nerve and posterior tibial vessels between them, fixed in their position by flexor retinaculum [1]. Tibial nerve is the larger terminal branch of sciatic nerve and is derived from the ventral rami of fourth lumbar (L4), fifth lumbar (L5), first sacral (S1), second sacral (S2), third sacral (S3) roots. It arises at the apex of popliteal fossa and descends in the popliteal fossa to the distal border of popliteus. Tibial nerve ends by dividing into medial and lateral plantar nerves beneath the flexor retinaculum [1,2]

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Conclusion