Neurovascular branching in the tarsal tunnel

The diagnosis and therapy of the tarsal tunnel syndrome, various surgical procedures at tarsal region and especially tibial nerve blocks requires a well understanded relationship and anatomy of the tibial nerve. For this purpose medial tarsal regions of 50 feet of embalmed human cadavers were investigated. The bifurcation level of the tibial nerve, the distance of the medial and lateral plantar nerves to the tip of the medial malleolus and the medial tubercle of calcaneus and the diameters of the nerves at the branching point were measured. The bifurcation point of the posterior tibial artery was also noted. We classified the bifurcations of the tibial nerve and posterior tibial artery as type I, II and III respect to the reference line between medial malleolus and calcaneus. While type I was the common type for tibial nerve (n=42, 84%), type III was common for posterior tibial artery (n=23, 46%). Knowledge of the variations in locations of bifurcation level of the tibial nerve and the posterior tibial artery may prevent to damage any neurovascular structure during some procedures like pin insertion and nerve blocks. © neuroanatomy.org