Tibial Nerve Entrapment Anatomy

Tibial nerve entrapment was not recognized as a clinical entity until its description by both Keck and Lam in 1962.31 This pathologic process is termed tarsal tunnel syndrome. The nerve entrapment involves the tibial nerve or one or more of its distal branches. The hallmark symptoms include neurogenic, lancinating pain about the medial ankle with radiation into the plantar foot.

The tibial nerve, a mixed motor and sensory nerve, supplies motor function to the intrinsic foot muscles, as well as sensation of the medial heel and plantar foot. The tarsal tunnel consists of a fibro-osseous space, located plantar and inferior to the medial malleolus. The most superficial border is the flexor reti-naculum. Within this tunnel passes the tibial nerve and its terminal branches, the lateral and medial plantar and medial calcaneal nerves (Fig. 70-18). Impingement may occur anywhere from the proximal aspect of the tunnel to the plantar midfoot.

Figure 70-17 A clinical photograph of a biomechanical foot examination performed in a prone position. The "tripod" of the foot formed by the calcaneal tuberosity and head of the first and fifth metatarsals can be readily assessed.

Figure 70-18 Schematic of the anatomy of the tarsal tunnel. The four branches of the tibial nerve are demonstrated. The medial and lateral plantar nerves and the nerve to the abductor digiti minimi course deep to the abductor hallucis muscle. (From Beskin JL, Baxter DE: Tarsal tunnel and associated nerve entrapment. Op Tech Orthop 1992;2:162-166.)

Figure 70-18 Schematic of the anatomy of the tarsal tunnel. The four branches of the tibial nerve are demonstrated. The medial and lateral plantar nerves and the nerve to the abductor digiti minimi course deep to the abductor hallucis muscle. (From Beskin JL, Baxter DE: Tarsal tunnel and associated nerve entrapment. Op Tech Orthop 1992;2:162-166.)

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

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