Ultrasound-guided topographic anatomy of the medial calcaneal branches of the tibial nerve.
BACKGROUND
The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment.


MATERIALS AND METHODS
Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analysed in reference to the amount and their respective nerves of origin.


RESULTS
In 77% of cases, tibial nerve bifurcation occurred below the tip of the medial malleolus with the average distance of 5.9 mm and in 48% of cases above the posterior superior tip of the calcaneal tuberosity with the average distance of 2.7 mm. In 73% of cases medial calcaneal branches occurred as a single branch originating from the tibial nerve (60%). The average distance of the first, second and third medial calcaneal branch was accordingly 9.3 mm above, 9.5 mm below and 11.6 mm below the tip of the medial malleolus and 17.7 mm above, 1.6 mm below and 4 mm below the posterior superior tip of the calcaneal tuberosity.


CONCLUSIONS
As the tibial nerve and its branches present a huge variability in the medial ankle area, in order to prevent the iatrogenic injuries, the preoperative or intraoperative ultrasound assessment (sonosurgery) of its localisation should be introduced into the clinic.
['Warchol|Ł|Ł|', 'Walocha|J A|JA|', 'Mizia|E|E|', 'Bonczar|M|M|', 'Liszka|H|H|', 'Koziej|M|M|']
D002102:Cadaver D002111:Calcaneus D006801:Humans D013979:Tibial Nerve D014463:Ultrasonography D018084:Ultrasonography, Interventional
sonosurgery lateral plantar nerve medial calcaneal nerve medial plantar nerve tarsal tunnel syndrome ultrasound-guided nerve examination