Medial Dorsal Cutaneous Nerve Research Articles

Surgical anatomy of the sural and superficial fibular nerves with an emphasis on the approach to the lateral malleolus.

The aim of this study was to investigate the risk and to analyse the significance of laceration of the sural and superficial fibular nerves during the surgical approach to the lateral malleolus. The sural and the superficial fibular nerves, and their branches were dissected under x 3 magnifying lenses in 68 embalmed leg-ankle-foot specimens. The specimens were measured, drawn and photographed. In 35% of specimens the superficial fibular nerve branched before piercing the crural fascia, and in all these specimens the medial dorsal cutaneous nerve of the foot was located in the anterior compartment while the intermediate dorsal cutaneous nerve of the foot was located in the lateral compartment. In 35% of specimens the intermediate dorsal cutaneous nerve of the foot was absent or did not innervate any toe. The deep part of the superficial fibular nerve was in contact with the intermuscular septum. Its superficial part was parallel with the lateral malleolus when the nerve pierced the fascia more proximally and oblique to the lateral malleolus when the nerve pierced the fascia distally. In one case the intermediate dorsal cutaneous nerve of the foot was in danger of laceration during a subcutaneous incision to the lateral malleolus. In 7 cases (10%) the sural nerve overlapped or was tangent to the tip of the malleolus. Malleolar nerve branches were identified in 76% of the cases (in 28% from both sources). The sural nerve supplies the lateral 5 dorsal digital nerves in 40% of cases. Our study indicates that during the approach to the lateral malleolus there is a high risk of laceration of malleolar branches from both the sural and the superficial fibular nerves. There is less risk of damage to the main trunk of these nerves, but the 10% chance of laceration of sural nerve at the tip of the malleolus is significant. As the sural nerve supplies the superficial innervation to the lateral half of the foot and toes in 40% of cases, the risk of its laceration is even more important than indicated by the common anatomical teaching.

Nerve Entrapment in the Foot and Ankle of an Athlete

Summary: Nerve entrapments in athletes can manifest as pain or dysfunction in the foot and ankle. Any lower extremity nerves—tibial, peroneal (superficial or deep), saphenous, and sural—can be involved. Some syndromes are more common, based on local factors that predispose the nerve to injury. Specific entities include the tarsal tunnel syndrome (with involvement of the tibial nerve at the ankle), jogger's foot (with involvement of the medial plantar nerve), first branch lateral plantar nerve entrapment, medial dorsal cutaneous nerve entrapment, and interdigital neuralgia. Typical symptoms include neuralgia (burning, shooting, lancinating, or radiating pain), tingling, or numbness along the distribution of the nerve's territory. Management includes activity modification, equipment adjustment, transcutaneous electrical nerve stimulation unit, braces, rest, and medications (topical, oral, or via injection). When these are unsuccessful in resolving the symptoms, surgical release of the nerve may be considered. With proper management, return to athletic function is possible.

The course of the superficial peroneal nerve: an anatomical cadaver study

The superficial peroneal nerve's branch patterns and the relationships of the nerve to fixed anatomical landmarks about the ankle were studied in 30 cadaver lower limbs. Two different branching patterns, in addition to the one considered as ‘normal anatomy’, were observed. In type A (73%) the nerve pierced the crural fascia proximal to the ankle joint and then divided into two major branches; the medial and intermediate dorsal cutaneous nerves. However, in type B (13%) and type C (10%) the branches arose independently from the superficial peroneal nerve. The main difference among the three types was the course of the intermediate dorsal cutaneous nerve. In conclusion, foot and ankle surgeons should be familiar with the variations in the course of the superficial peroneal nerve and its branches and especially of the ones that are ‘at risk’ during the surgical exposures of the ankle.

Cutaneous innervation of the medial dorsal aspect of the first toe: an anatomic study

The cutaneous innervation of the medial dorsal aspect of the first toe has been reported to originate from different nerve branches. Twenty cadaver feet were dissected to determine the origin of this nerve. In all 20 feet the medial dorsal cutaneous nerve arose from the medial dorsal cutaneous branch of the superficial peroneal nerve. This cutaneous innervation of the first toe is encountered during bunionectomy, first metatarsal osteotomy, excision of the metatarsal head and/or proximal part of the proximal phalanx, arthroplasty, and arthrodesis of the first MTP joint. The information concerning the course and origin of this nerve should assist protection during operative procedures, as well as enable quick localization and identification.

Origin and course of the dorsomedial cutaneous nerve to the great toe.

The purpose of this study was to describe the course of the dorsomedial cutaneous nerve (DMCN) to the great toe. The DMCN is a branch of the medial dorsal cutaneous nerve, which originates from the superficial peroneal nerve. Injury to the DMCN may result in a painful neuroma. Identifying and protecting the DMCN to the great toe during surgical procedures near these areas may decrease the rate of painful neuroma formation.

Surgical Anatomy of the Superficial Peroneal Nerve in the Ankle and Foot

The subcutaneous (sensory) portion of the superficial peroneal nerve was dissected in 25 cadaver lower limbs under loupe magnification. Three distinct branching pattern types were noted. Type A (72%) consisted of a pattern where the nerve penetrated the crural fascia to become subcutaneous at an average distance of 12.3 cm proximal to the ankle joint, then divided at a mean distance of 4.4 cm proximal to the ankle into two major branches: a large medial dorsal cutaneous nerve and a smaller more laterally located intermediate dorsal cutaneous nerve. Type B (16%) consisted of a pattern where both the medial and intermediate dorsal cutaneous nerve arose independently from the superficial peroneal nerve, with the medial dorsal cutaneous nerve having a similar course to that found in Type A, while the intermediate dorsal cutaneous nerve penetrated the crural fascia posterior to the fibula 5.5 cm proximal to the ankle joint and coursed medially to cross the lateral aspect of the fibula at mean distance 4.5 cm above the ankle joint. Type C (12%) consisted of a pattern where the medial dorsal cutaneous nerve and the intermediate dorsal cutaneous nerve arose independently and the medial dorsal cutaneous nerve coursed similar to that in Type A; however, the intermediate dorsal cutaneous nerve penetrated the crural fascia anterior to the fibula an average of 4.9 cm above the ankle joint and continued in close proximity to the anterior fibular border. In all patterns the mean diameters of the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve at the ankle were 2.9 mm and 2 mm, respectively. At the level of the malleoli, the medial dorsal cutaneous nerve was located approximately one half the distance from the lateral malleolus to medial malleolus while the intermediate dorsal cutaneous nerve was approximately one third the distance. Appreciation of these branch patterns and the quantified relationships should assist nerve protection during surgical procedures as well as aid rapid nerve isolation for exploration or decompression. Branches especially at risk for iatrogenic injury include: (1) the intermediate dorsal cutaneous nerve of Type B where the nerve crosses the lateral surface of the distal fibula; (2) the intermediate dorsal cutaneous nerve of Type C where the nerve travels adjacent to the anterior border of the fibula; and (3) the intermediate dorsal cutaneous nerve and the medial dorsal cutaneous nerve at the level of the ankle, where they are at risk during anterior ankle arthrotomy or arthroscopy.

Standardized nerve conduction studies in the lower limb of the healthy elderly.

Nerve conduction studies are commonly performed in elderly individuals. No complete set of reference data for the distal lower limb nerves exists for this population, making it difficult to accurately interpret electrodiagnostic findings. The purpose of this study was to provide reliable reference data by comprehensively examining conduction characteristics in routinely tested peripheral nerves of the lower limb in a healthy elderly population. Conduction studies of the tibial, deep peroneal, sural and medial dorsal cutaneous nerves were performed in one lower limb of 122 healthy elderly individuals between the ages of 60 and 89 years. Peak amplitudes of the sural sensory action potential and the tibial compound muscle action potential correlated significantly with both age and leg length. All other parameters did not show significant correlation with age. Conduction velocities and distal latencies slowed significantly with increasing leg length except for tibial distal latency.

The innervation of the joints of the foot.

AbstractThe nerve supply of the ankle joint and of the joints of the foot was studied in dissections of fetal and adult feet and in serial sections of fetal feet stained with silver.The ankle joint was supplied by the tibial, sural, deep peroneal, and saphenous nerves, and by the accessory deep peroneal nerve when present.The tarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves, and on their dorsal aspects chiefly by the deep peroneal nerve. The joint between the lateral and intermediate cuneiform received branches from the intermediate dorsal cutaneous nerve also. The lateral dorsal cutaneous nerve and the accessory deep peroneal nerve when present provided additional branches to the subtalar and calcaneocuboid joints.The tarsometatarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves. Most of them were supplied on their dorsal aspects by the deep peroneal nerve, but the cuboid‐metatarsal joints received their supply from the intermediate dorsal cutaneous nerve. The intermetatarsal joints had a similar but sparser supply. The joint between the fourth and fifth metatarsal received branches from the intermediate dorsal cutaneous nerve.The plantar digital nerves provided the main supply to the metatarsophalangeal joints. The dorsal aspect of the first metatarsophalangeal joint was supplied by the deep peroneal and the medial dorsal cutaneous nerves, of the second metatarsophalangeal joint by the deep peroneal nerve, and of the fourth and fifth metatarsophalangeal joints by the lateral dorsal cutaneous nerve. The interphalangeal joints did not receive articular branches from the dorsal digital nerves, except in the case of the interphalangeal joint of the big toe, which was supplied by the deep peroneal and the medial dorsal cutaneous nerves.