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Anatomical study on compression of tibial nerve and it's branches in ankle and foot

YU Guang1,LIU Zhi-gang1,LIN Quan2(1.Department of Hand Surgery,First Hospital,Jilin University,Changchun 130021,China;2.Department of Plastic Surgry,,First Hospital,Jilin University,Changchun 130021,China)  
Objective To observe the branches and distribution of the tibial nerve and analyze the compressed position of it.Methods Twenty sides of adult cadavers were anatomized and the tibial nerve branches in ankle,foot,the internal and external plantar tunnel were observed.Correlated data was measured and recorded.Results ① The tendinous part of abductor hallucis muscle that was located under the muscle and consisted the surface of the internal and external plantar tunnel was(8.62±0.79)cm in length,(3.01±0.30)cm in width,and the thickness of it was about(0.24±0.02)cm.The internal and external nerves were located in the internal and external tunnel.The length of the internal tunnel was about(4.58±0.41)cm,and the diameter was(1.11±0.10)cm.The length of the external tunnel was about(2.58±0.23)cm,the diameter was about(0.96±0.08)cm.② Internal hell nerve was in an isolated tunnel interior the hell,which was the hell tunnel.The length of the hell tunnel was about(3.03±0.21)cm,the diameter was(1.07±0.09)cm.Conclusion The tibial nerve branches can be compressed at internal,external plantar tunnel or the heel tunnel.When making neurolysis of the tibial nerve for tarsal tunnel syndrome patients,except for the flexor retinaculum,the internal and external plantar tunnel and the hell tunnel should also be decompressed especially for the patients with the symptom of compressed single branch.
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