Anatomy of the tibial nerve in relation to the tarsal tunnel: a cadaveric study

H. Ubillus, I. Mattos, G. Campos, S. Soares, J.G. Kennedy

¹NYU Langone, Orthopedic Surgery, NYC, United States

²SAANA El Golf Clinic, Orthopedic Surgery, Lima, Peru 

³Roosevelt Hospital, Orthopedic Surgery, Guatemala, Guatemala

⁴Hospital Du Valais, Orthopedic Surgery, Sion, Switzerland

Introduction: Tibial nerve anatomy has not been studied profoundly in comparison to Tarsal Tunnel Syndrome (TTS). Assuming symptoms are caused by an anatomical variant or mechanical cause regarding the tibial nerve, it is essential to investigate the anatomy of this structure taking in consideration that surgical and conservative treatments have shown poor results.

Methods: 40 lower-leg specimens were obtained. Dissection started 20 centimeters proximal to the Dellon-McKinnon (DM) line towards the medial aspect of the naviculo-cuneiform joint distally. Anteriorly, dissection began at the tibio-talar medial gutter until the medial aspect of the Achilles tendon posteriorly. The plantar aspect extended from medial to lateral within the parameters previously described, ending at the level of the second metatarsal.

Results: The flexor retinaculum had a denser consistency in 22.5% of the cases and the average length was 51.9 mm. The flexor retinaculum as an independent structure was found absent and 77.2% of cases as undistinguished extension of the crural fascia. The lateral plantar nerver (LPN) and abductor digiti minimi (ADM) nerve shared same origin in 80% of cases, 34.5% bifurcated proximal to the DM line, 31.2% distally and 34.3% at the same level. The medial calcaneal nerve (MCN) emerged proximal to the DM line in 100% of specimens. The medial plantar nerve(MPN) has its origin proximal to the DM line in 95% of cases.

Conclusion: The flexor retinaculum is an extension of the crural fascia and not an independent structure. The LPN and ADM have the same origin in most cases and this presents as an important finding that must be studied in detail for clinical correlations between the motor and sensatory affections of the ADM and LPN respectively. Finally, the branches of the MCN and MPN are the most constant in their distribution and proximal origin in relation to the Dellon-McKinnon line.

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