Type of Article: Original Research
Year: 2016 | Volume 4 | Issue 1 | Page No. 1901-1904
Date of Publication: 29-02-2016
A STUDY ON THE LEVEL OF TERMINATION OF TIBIAL NERVE: REVIEW OF LITERATURE AND ITS CLINICAL IMPLICATIONS
Sharma S *1, Wadhwa A 2, Bhardwaj S 3.
*1 Associate Professor, Department of Anatomy, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India.
2 Professor Department of Anatomy, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India.
3 Medical Officer, PHC Thariewal, Block Majitha, Amritsar, Punjab, India.
Address: Dr. Sherry Sharma, Associate Professor, Department of Anatomy, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India. Ph: 9872830406
Introduction: Variation of nerve is not only of anatomical and embryological interest, but also of clinical importance, as these can be etiological factors behind various pathological conditions. Likewise, their adequate knowledge will help in increasing surgical precision and decreasing morbidity. In present study level of division of tibial nerve into medial and lateral plantar nerve was studied.
Material and Methods: The material for the present study comprised of 60 lower extremities belonging to 30 adult human cadavers obtained from Dept of Anatomy, GMC, Amritsar. Tibial nerve was dissected and the level at which it divided into medial and lateral plantar nerve was studied.
Result: Tibial nerve bifurcated into medial and lateral plantar nerve deep to flexor retinaculum in 93.33% of cases and proximal to flexor retinaculum in 6.67% of cases.
Discussion: There are various clinical conditions associated with the involvement of tibial nerve. It is reported that an accessory flexor digitorum muscle is associated with high division of tibial nerve. Accessory flexor digitorum muscle can be one of causes of tarsal tunnel syndrome.
Anatomical studies of the tibial nerve in the distal third of the leg and at the level of the tarsal tunnel began to take more importance with the establishment and definition of compression pathology of this nerve, in its osteofibrous tunnel. In an analogy with the upper limb, this syndrome resembles carpal tunnel syndrome, also sharing decompression surgery as one of the therapeutic approaches.
Key words: Tibial Nerve, Medial Plantar Nerve, Lateral Plantar Nerve, Flexor Retinaculum, Accessory Flexor Digitorum Muscle.
- Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek LE et al. The Nervous System. Berry MM, Mstandring S, Bannister LH. In: Gray’s Anatomy. 38th Edition. Edinburgh, London: Churchill Livingstone; 1995;1282-1288
- Richard B, Khatri B, Knoll E, Lucas S, Turkof E. Leprosy affects the tibial nerve diffusely from the middle of thigh to the sole of the foot, including skip lesions. Plast Reconstr Surg 2001;107(7):1717-1724.
- Lau J, Daniels TR. Effects of tarsal tunnel release and stabilization procedures on tibial nerve tension in a surgically created pes planus foot. Foot Ankle Int 1998;19(11):770-777.
- Davis TJ, Schon LC. Branches of tibial nerve: anatomic variation. Foot Ankle Int1995;16(1):21-29
- Romans GJ. The popliteal fossa, back of thigh, leg and foot. In: Cuningham’s Manual of Practical Anatomy. 15th Edition. Edinburgh, London: Book Society and Oxygen University Press; 1986;(3):160-214.
- Louisia S, Masquelet AC. The medial and inferior calcaneal nerves; an anatomic study. Surg Radiol Anat 1999;21:169-173.
- Dellon AL, Mackinnon SE. Tibial nerve branching in tarsal tunnel. Arch Neurol 1984;41:645-646.
- Havel PE, Ebraheim NA, Clark SE, Jackson WT, Didio L. The tibial nerve branching in tarsal tunnel. Foot Ankle 1988;9:117-119.
- Davis TJ, Schon LC. Branches of tibial nerve and anatomic variation. Foot Ankle Int 1995;16:21-29.
- Bareither DJ, Genau JM, Massaro JC. Variation in the division of the tibial nerve: application to nerve blocks. The Journal of foot surgery 1990;29(6):581-3.
- Torres ALG, Ferreira MC. Study of the anatomy of the tibial nerve and its branches in the dital medial leg. Acta Ortop Bras 2012;20(3):157-164.
- Kurtoglu Z, Uluutku MH, Can MA, Onderoglu S. An accessory flexor digitorum longus muscle with high division of tibial nerve. Surg Radiol Anat 2001;23(1):61-63.
- Sammarco GT, Conti SF. Anomalous tibial nerve: a case report. Clin Orthop Relates Res 1994;305:239-241.
- Kopell HP, Thompson WA. Peripheral entrapment neuropathies of the lower extremity. N Engl J Med. 1960;262:56-60.
- Feve A, Decq P, Filipetti P, Verroust J, Harf A, N’ Guyen JP et al. Physiological effects of selective tibial neurotomy on lower limb spasticity. J Neurol Neurosurg Psychiatry 1997;63(5):575-8.
- Vloka JD, Hadzic A, April E, Thys DM. The division of sciatic nerve in the popliteal fossa: Anatomical implications for popliteal nerve blockade. Anesth Analg 2001;92: 215-217.
- Tobias JD, Mencio GA. Popliteal fossa block for postoperative analgesia after foot surgery in infants and children. J Pediatr Orthop 1999;19(4):511-514.
Sharma S, Wadhwa A, Bhardwaj S. A STUDY ON THE LEVEL OF TERMINATION OF TIBIAL NERVE: REVIEW OF LITERATURE AND ITS CLINICAL IMPLICATIONS. Int J Anat Res 2016;4(1):1901-1904. DOI: 10.16965/ijar.2016.109