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IJAR.2020.106

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Type of Article:  Original Research

Volume 8; Issue 1.3 (March 2020)

Page No.: 7371-7377

DOI: https://dx.doi.org/10.16965/ijar.2020.106

TOPOGRAPHIC ANATOMY OF TIBIAL NERVE AND ITS TERMINAL BRANCHES IN RELATION WITH THE POSTERIOR TARSAL TUNNEL WITH CLINICAL CORRELATIONS

Preeti  Awari *1, P Vatsalaswamy 2.

*1Assistant professor, Department of Anatomy, Dr. .Y. Patil Medical College, Hospital and Research centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India.

2 Director Academics,  Dr. DY. Patil Medical College, Hospital and Research centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India.

Corresponding author: Dr. Preeti Awari, Assistant professor, Department of Anatomy, Dr. .Y. Patil Medical College, Hospital and Research centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India.Mobile no : 9075001993  E-Mail: preeti.awari@dpu.edu.in

ABSTRACT

Background: Variations in the level of terminal branching of tibial nerve into medial and lateral plantar nerve in the posterior tarsal tunnel and its relations with posterior tibial artery has tremendous clinical importance. Tibial nerve and its terminal branches are at risk of entrapment in the posterior tarsal tunnel which is called as tarsal tunnel syndrome. The results of surgeries for tarsal tunnel syndrome are variable or suboptimal. The reason could be poor understanding of detailed anatomy of the tarsal tunnel and potential sites of nerve compression. Information regarding the same can help in endoscopic decompression surgeries for tarsal tunnel syndrome with minimal exposure of the region to be operated. Knowledge regarding these variations can also help the anesthetists to give ultrasonography guided ankle block without puncturing the blood vessels.

Materials and Methods: The authors have studied topographic anatomy of tibial nerve and its terminal branches in relation with posterior tarsal tunnel in 50 formalinized cadaveric feet. Authors divided the location of division of tibial nerve in posterior tarsal tunnel (PTT) into seven levels and also categorized the distance between the point of terminal division of tibial nerve (TN) and point of terminal division of posterior tibial artery (PTA) in four categories.

Results and conclusion: Tibial nerve divides relatively higher than the posterior tibial artery in the PTT. Both lie in the same compartment in the tarsal tunnel. The tibial nerve is situated deep to posterior tibial blood vessels .The neurovascular bundle is covered by an unyielding fibrous tissue which could be the reason for the entrapment. Commonest division level of tibial nerve in PTT is level 4 which means the division lies in the range of 6mm to 10mm above the distal border of flexor retinaculum. In 52% of feet the distance between point of division of TN and point of division of PTA is in a range between 0-5mm above the distal border of flexor retinaculum falling under category 1.

KEY WORDS: Posterior tarsal tunnel syndrome, Ankle block, Tibial nerve, Medial plantar nerve, lateral plantar nerve.

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Cite this article: Preeti Awari, P Vatsalaswamy. TOPOGRAPHIC ANATOMY OF TIBIAL NERVE AND ITS TERMINAL BRANCHES IN RELATION WITH THE POSTERIOR TARSAL TUNNEL WITH CLINICAL CORRELATIONS. Int J Anat Res 2020;8(1.3):7371-7377. DOI: 10.16965/ijar.2020.106