Anat Cell Biol.  2020 Dec;53(4):422-434. 10.5115/acb.20.087.

Anatomical study and branching point of neurovascular structures at the medial side of the ankle

• Inthasan C
• Vaseenon T
• Mahakkanukrauh P

• KMID: 2509688
• DOI: http://doi.org/10.5115/acb.20.087

Abstract

Nerve entrapment and blood circulation impairment associated with the medial side of the ankle are not uncommon. The purpose of this study was to describe the anatomical basis of neurovascular structures of the medial ankle which comprised the number, origin, branching pattern, and branching point. Forty feet of fresh cadavers were examined by using 2 reference lines: the malleolar-calcaneal (MC) and navicular-calcaneal (NC) axes. We recorded number, origin, length of the 2 axes, the locations and widths of neurovascular structures on MC and NC axes, the branching point of neurovascular structures, and the branching pattern of neurovascular structures was recorded and was separated into 5 types. The posterior tibial nerve (PTN) bifurcated to plantar and calcaneal nerves and branched proximally to the tarsal tunnel (TT). The posterior tibial artery bifurcated to plantar and calcaneal arteries and branched inferiorly to PTN and within the TT. The calcaneal nerves and arteries had more variation of number and origin. The most common branching point of calcaneal nerves and arteries is within the TT, except the medial calcaneal nerve. It branched proximally to the TT. The anatomical knowledge from this study is important for the diagnosis and treatment of clinicians.

Keyword

Tibial nerve; Tibial arteries; Ankle

Figure

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  Fig. 1 The reference lines: the MC axis and the NC axis. The MC axis started from the medial M to the C. The NC axis that starts from the N to the C. C, medial process of calcaneal tubercle; M, medial malleolus; MC, malleolar-calcaneal; N, tubercle of navicular bone; NC, navicular-calcaneal.

• 

  Fig. 2 The boundary of the TT expanded ±2 cm from the MC axis. The solid line (—) presented the MC axis. The dotted line (…) presented the MC axis with ±1 cm width. The dashed line (–––) presented the MC axis with ±2 cm width. C, medial process of calcaneal tubercle; M, medial malleolus; MC, malleolar-calcaneal; N, tubercle of navicular bone; TT, tarsal tunnel.

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  Fig. 3 Location and width of the neurovascular structures on the MC axis and the NC axis. LMC, locations of neurovascular structures on malleolar-calcaneal axis from medial process of calcaneal tubercle; LMM, locations of neurovascular structures on malleolar-calcaneal axis from medial malleolus; LNC, locations of neurovascular structures on navicular-calcaneal axis from medial process of calcaneal tubercle; LNM, locations of neurovascular structures on navicular-calcaneal axis from tubercle of navicular bone; M, medial malleolus; MC, malleolar-calcaneal; NC, navicular-calcaneal; WM, widths of neurovascular structures on MC axis; WN, widths of neurovascular structures on NC axis.

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  Fig. 4 The distance of the branching point of the neurovascular structures on the MC axis and NC axis (X-coordinate) and the perpendicular distance from the branching point of the neurovascular structures to MC axis and NC axis (Y-coordinate). The solid line (—) presented the distance of the branching point of the neurovascular structures from the medial malleolus on the MC axis. The dotted line (…) presented the perpendicular distance from the branching point of the neurovascular structures to MC axis. The dashed line (–––) presented the distance of the branching point of the neurovascular structures from the medial malleolus on the NC axis. The long-dashed line (–––) presented the perpendicular distance from the branching point of the neurovascular structures to NC axis. C, medial process of calcaneal tubercle; M, medial malleolus; MC, malleolar-calcaneal; N, tubercle of navicular bone; NC, navicular-calcaneal.

Reference

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