Variation of Nerve to Flexor Hallucis Brevis

2008 ◽  
Vol 29 (10) ◽  
pp. 1042-1044 ◽  
Author(s):  
Loretta B. Chou ◽  
Lisa E. Choi ◽  
Tara Ramachandra ◽  
Gene Ma
Keyword(s):  
Clinical Significance ◽  
Clinical Relevance ◽  
Anatomic Variation ◽  
Matched Pairs ◽  
Medial Plantar Nerve ◽  
Lateral Plantar Nerve ◽  
Fresh Frozen

Background: Hallopeau's nerve is a branch of the lateral plantar nerve that supplies the flexor hallucis brevis muscle while also forming an anastomosis with the medial plantar nerve. In this study, the presence of this neural anastomosis was determined through dissection of cadaveric specimens. Materials and Methods: Twenty-six fresh-frozen adult feet (13 matched pairs) were dissected to assess the presence or absence of Hallopeau's nerve. Results: Dissections revealed four out of 26 specimens had this anastomosis. Conclusion: This study confirms this anatomic variation. Clinical Relevance: The clinical significance of these anastomoses remains unknown. These anastomoses are analogous to some in the hand and forearm.

scholarly journals Small Bowel Review: Part I

1996 ◽  
Vol 10 (3) ◽  
pp. 179-189
Author(s):  
ABR Thomson ◽  
JA Thomson ◽  
MJ Ropeleski ◽  
GE Wild
Keyword(s):  
Small Bowel ◽  
Clinical Significance ◽  
Clinical Relevance ◽  
The Past ◽  
Scientific Advances

Major scientific advances have been made over the past few years in the areas of small bowel physiology, pathology, microbiology and clinical sciences. Over 1000 papers have been reviewed and a selective number are considered here. Wherever possible, the clinical relevance of these advances have been identified. There have been a number of important and/or interesting developments in the past year that have clinical significance.

Pseudoganglion on the connecting branch between the deep branch of the lateral plantar nerve and medial plantar nerve

2011 ◽  
Vol 24 (5) ◽  
pp. 646-651 ◽  
Author(s):  
Takamitsu Arakawa ◽  
Shin-Ichi Sekiya ◽  
Toshio Terashima ◽  
Akinori Miki
Keyword(s):  
Medial Plantar Nerve ◽  
Lateral Plantar Nerve ◽  
Deep Branch

scholarly journals MRI Study on Tibial Nerve of the Ankle Canal and Its Branches: A method of multiplanar reconstruction with 3D-FIESTA-C sequences

2020 ◽  
Author(s):  
Yan Zhang ◽  
Xucheng He ◽  
Juan Li ◽  
Ju Ye ◽  
Wenjuan Han ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Three Dimensional ◽  
The Body ◽  
Multiplanar Reconstruction ◽  
Medial Malleolus ◽  
Cross Sectional ◽  
Medial Plantar Nerve ◽  
Lateral Plantar Nerve ◽  
Good Imaging ◽  
Starting Point

Abstract Background The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning.The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reconstruction (MPR) display of tibial nerve and its branches of the ankle canal. Methods The subjects were 20 healthy volunteers (40 ankles), aged 22–50, with no history of ankle joint desease. 3D-FIESTA-C sequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia.The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reconstruction. Results Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°.The average cross-sectional diameter of the medial plantar nerve is about mm, and the lateral plantar nerve about mm. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations. Conclusion The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches and the bifurcation point’s projection position on the body surface can be marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.

An Anatomic Analysis of Endoscopic Plantar Fascia Release

1995 ◽  
Vol 16 (9) ◽  
pp. 552-558 ◽  
Author(s):  
Bryan J. Hawkins ◽  
Richard J. Langermen ◽  
Timothy Gibbons ◽  
Jason H. Calhoun
Keyword(s):  
Plantar Fascia ◽  
Heel Pain ◽  
Deep Fascia ◽  
Abductor Hallucis ◽  
Lateral Plantar Nerve ◽  
Local Structures ◽  
Abductor Hallucis Muscle ◽  
Fresh Frozen ◽  
Plantar Fascia Release ◽  
Partial Release

Eighteen fresh-frozen cadaver foot specimens underwent release of the plantar fascia via a newly described endoscopic technique. A 75% release was attempted on each specimen in order to represent a partial fascial release. Each specimen was then dissected to assess the success of the procedure. Five separate measurements were recorded evaluating the reproducibility of the procedure, adequacy of the release considering accepted etiologies for chronic heel pain, and the possibility of damage to local structures. Partial release was noted to be possible, but controlling the exact percentage of the incision was difficult. The release averaged 82% of the width of the fascia, with a range of 53% to 100%. There was no damage in any specimen to the first branch of the lateral plantar nerve, the structure considered most at risk during the procedure. Release of the deep fascia of the abductor hallucis muscle was not possible with this approach.

scholarly journals Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

2019 ◽  
Vol 40 (8) ◽  
pp. 978-986 ◽  
Author(s):  
Lena Hirtler ◽  
Katarina Schellander ◽  
Reinhard Schuh
Keyword(s):  
Minimally Invasive ◽  
Ankle Joint ◽  
Clinical Relevance ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Neutral Position ◽  
Matched Pairs ◽  
Talar Dome ◽  
Statistical Comparison ◽  
Posterior Ankle Arthroscopy

Background: Osteochondral lesions of the talus are frequent pathologies of the ankle joint. Especially through arthroscopy, the treatment is kept as minimally invasive as possible. However, there are some drawbacks as to the reachability because of the high congruency of the ankle joint. Here, either noninvasive distraction or maximal dorsiflexion may be an option for better access to the lesion. The purpose of this study was to evaluate maximal dorsiflexion compared to neutral position or noninvasive distraction of the ankle joint in the arthroscopic reachability of the talar dome. The hypothesis of this study was that maximal dorsiflexion would allow for greater accessibility of the talar dome compared to neutral position or noninvasive distraction of the joint. Methods: Twenty matched pairs (n=40) of anatomical ankle specimens were used. The effects of neutral position, maximal dorsiflexion, and noninvasive distraction of the ankle joint on arthroscopic accessibility of the ankle joint were tested. After disarticulation of the talus, reach was measured and compared between the 3 positions. Results: In neutral position, 13.7±1.2 mm of the talar dome was reached laterally and 14.0±1.0 mm medially. In maximal dorsiflexion, the distance was 19.0±1.1mm laterally and 19.8±1.4 mm medially, and in noninvasive distraction it was 16.1±1.5 mm laterally and 15.7±1.0 mm medially. The statistical comparison showed a significantly better reach in dorsiflexion laterally ( P = .003) and medially ( P = .026). Conclusion: Accessibility of the talar dome in maximal dorsiflexion was superior to that in neutral position or noninvasive distraction. Clinical Relevance: Results of this study may allow for better planning in arthroscopic treatment of osteochondral lesions of the talus.

scholarly journals Safe Zone for the Plantar Portal

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Shingo Maeda ◽  
Takaaki Hirano ◽  
Akiyama Yui ◽  
Hiroyuki Mitsui ◽  
Hisateru Niki
Keyword(s):  
Endoscopic Surgery ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Peroneus Longus Tendon ◽  
Medial Plantar Nerve ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Lateral Plantar Nerve ◽  
Medial Side ◽  
Flexor Digitorum

Category: Arthroscopy Introduction/Purpose: Open surgery of the sole of the foot requires an extensive amount of soft tissue to be dissected. In recent years, various types of endoscopic surgery for the sole of the foot have been reported, making it possible to dynamically evaluate and treat plantar lesions with a small skin incision and minimal dissection. However, there have also been reports of complications involving plantar nerve injury. A good knowledge of the plantar nerve anatomy is crucial for safe endoscopic surgery of the sole. We aimed to anatomically dissect the soles of cadaveric feet to investigate the safe zones for plantar portals. Methods: We studied 36 feet of 24 cadavers. The soft tissue of the sole was dissected, and the relationships between the plantar nerve and flexor digitorum longus tendon, flexor hallucis longus tendon and peroneus longus tendon were studied. The plantar nerve course was digitally imaged and uploaded into Image J software to determine the nerve position. The back of the calcaneus, the medial side of the base of M (Metatarsal) 1, the medial side of the head of M1, the lateral side of the head of M5, and the proximal tip of M5 were plotted and defined as A, B, C, D, and E respectively on Image J. The nerve courses were plotted on AB, BE, and CD, and the percentage at which they were positioned on the line segment was calculated. Next, the bifurcation positions of each nerve were plotted and measured to the defined line segments. Results: No major differences were noted in the course of the medial plantar nerve and lateral plantar nerve. The medial plantar nerve and lateral plantar nerve ran between B and E, at 32.4% ± 4% and 61.2%± 5.1% respectively from B. No plantar arteries were found to run between the medial plantar nerve and lateral plantar nerve on BE. Taking mean and standard deviation values into account, no neurovascular structure existed from 36.4% to 56.1% along a line between the medial aspect of the base of M1 to the proximal tip of M5. The flexor digitorum longus tendon and peroneus longus tendon passed through the deep layer of this region. Conclusion: We believe this region to be a safe zone for creating plantar endoscopic portal. The plantar central portal can be created at the center of the sole. An approach from the plantar central portal to the flexor digitorum longus tendon, flexor hallucis longus tendon, and peroneus longus tendon with the plantar lateral portal, posteromedial portal, and toe portal allows for a greater range of vision and treatment options and may further advance endoscopic surgery of the sole.

scholarly journals Prevalence of objectively measured movement asymmetry in yearling Standardbred trotters

2019 ◽  
Author(s):  
Anne Selven Kallerud ◽  
Cathrine T. Fjordbakk ◽  
Eli H. S. Hendrickson ◽  
Emma Persson-Sjodin ◽  
Marie Hammarberg ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Measurement System ◽  
Clinical Relevance ◽  
Hind Limb ◽  
Movement Analysis ◽  
Objective Measurement ◽  
Locomotor System ◽  
Movement Asymmetry ◽  
Objectively Measured ◽  
Over Time

Abstract Background Objective measurement of movement asymmetry is gaining in popularity, especially as an adjunct to traditional lameness evaluation. Earlier research has highlighted the need for more knowledge regarding the clinical significance of measured movement asymmetry, and the influence of biological variation. Evaluating the locomotor system of the Standardbred trotter can be challenging, and studies using objective technology on this breed are few. The aim of this study was to quantify the prevalence and magnitude of objectively measured movement asymmetry in young, presumed sound Standardbred trotters, by performing objective movement analysis during in-hand trot and while driven on a track. Our hypothesis was that asymmetry scores would be higher when evaluating horses in-hand versus while driving on a track.Results Of 103 horses included in the study, 77 were measured both in-hand and on the track, 24 were measured only in-hand, and two were measured only on the track. Previously set symmetry thresholds for the measurement system were used, during both in-hand and track trials. The majority of horses (91, 88.3%) did not have any trials below threshold. Front and/or hind limb parameters were above the symmetry thresholds during in-hand trials for 94 (93.1%) horses, and during track trials for 74 (93.7%) horses. For the total 180 in-hand and track trials, 166 (92.2%) trials were above threshold. Asymmetry magnitude ranged from mild to severe, with the majority of horses showing mild asymmetry. A minority of horses (19.7%) switched side of asymmetry for one or more parameters between in-hand and track trials. Trial standard deviations were overall high, mainly due to horse behavior, and this variability should be considered when interpreting the results. There was no significant effect on asymmetry of measuring horses in-hand versus driven.Conclusions A high proportion of presumed sound Standardbred yearlings showed movement asymmetries above previously determined thresholds. The biological and clinical relevance of the study findings may be aided by examining how this asymmetry evolves over time and with training. This is important in order to ensure the welfare of the Standardbred trotter.

scholarly journals MRI Study on Tibial Nerve of the Ankle Canal and Its Branches: A method of multiplanar reconstruction with three-dimensional dual-excitation balanced steady-state free precession sequence

2020 ◽  
Author(s):  
Yan Zhang ◽  
Xucheng He ◽  
Juan Li ◽  
Ju Ye ◽  
Wenjuan Han ◽  
...  
Keyword(s):  
Steady State ◽  
Steady State Free Precession ◽  
Tibial Nerve ◽  
Three Dimensional ◽  
Multiplanar Reconstruction ◽  
Medial Malleolus ◽  
Free Precession ◽  
Medial Plantar Nerve ◽  
Lateral Plantar Nerve ◽  
Starting Point

Abstract Background: The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning.The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reconstruction (MPR) display of tibial nerve and its branches of the ankle canal.The subjects were 20 healthy volunteers (40 ankles), aged 22-50, with no history of ankle joint desease. 3D-FIESTA-Csequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia so that the results of measurement are more accurate .The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reconstruction.Results: Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°.The average cross-sectional diameter of the medial plantar nerve is about mm, and the lateral plantar nerve about mm. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations.Conclusion: The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches. By measuring the distance between each bifurcation point, the tip of the medial malleolus and the angle between this line and the horizontal line that passes the tip of the medial malleolus, the bifurcation point’s projection position on the body surface can be accurately marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.

scholarly journals HbA1c: a review of non-glycaemic variables

2018 ◽  
Vol 72 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Leon Campbell ◽  
Tessa Pepper ◽  
Kate Shipman
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Practice ◽  
Clinical Significance ◽  
Diabetic Complications ◽  
Clinical Relevance ◽  
Literature Search ◽  
Clinical Implications ◽  
Search Terms ◽  
Clinical Scenarios ◽  
Clinically Significant

Identification of the correlation between HbA1c and diabetic complications has yielded one of the most clinically useful biomarkers. HbA1c has revolutionised the diagnosis and monitoring of diabetes mellitus. However, with widespread adoption of HbA1c has come increasing recognition that non-glycaemic variables can also affect HbA1c, with varying clinical significance. Furthermore, the identification of a discrepancy between predicted and measured HbA1c in some individuals, the so-called ‘glycation gap’, may be clinically significant. We aimed to review the current body of evidence relating to non-glycaemic variables to quantify any significance and provide subsequent suggestions. A PubMed-based literature search was performed, using a variety of search terms, to retrieve articles detailing the non-glycaemic variables suggested to affect HbA1c. Articles were reviewed to assess the relevance of any findings in clinical practice and where possible guidance is given. A range of non-glycaemic variables have statistically significant effects on HbA1c. While the clinical implications are generally irrelevant, a small number of non-glycaemic variables do have clinically significant effects and alternative biomarkers should be considered instead of, or in addition to, HbA1c. There are a small number of non-glycaemic variables which have a clinically significant effect on HbA1c, However, the vast majority of non-glycaemic variables have no clinical relevance. While clinicians should have an awareness of those non-glycaemic variables with clinical significance, in the vast majority of clinical scenarios HbA1c should continue to be used with confidence.

Endoscopic Flexor Hallucis Longus Decompression: A Cadaver Study

2007 ◽  
Vol 28 (7) ◽  
pp. 810-814 ◽  
Author(s):  
John J. Keeling ◽  
Gregory P. Guyton
Keyword(s):  
Sural Nerve ◽  
Significant Risk ◽  
Cadaver Study ◽  
Flexor Hallucis Longus ◽  
Lateral Plantar Nerve ◽  
Endoscopic Release ◽  
Incision Size ◽  
Large Joint ◽  
Fresh Frozen ◽  
Neurovascular Structures

Background New indications for arthroscopy are being considered because arthroscopy limits incision size and potentially decreases operative morbidity. This cadaver study investigated the utility of performing an all-endoscopic flexor hallucis longus (FHL) decompression. Methods Eight fresh-frozen cadaver legs were used. In the simulated prone position with large joint arthroscopic equipment, posterolateral and posteromedial portals were used to perform posterolateral talar process bony excision and FHL sheath debridement and release. We noted the integrity of the sural nerve, FHL tendon, and medial tibial neurovascular bundle. After open dissection, values for sural nerve distance to the posterolateral portal, the amount of FHL sheath released and the proximity of the arthroscopic instrumentation to the medial tibial neurovascular structures were recorded. Results Three of eight FHL tendons were injured during the attempted FHL release. Furthermore, no FHL sheath was completely released down to the level of the sustentaculum. Although posterolateral portal placement was on average 12.1 mm from the sural nerve, it was only 6.1 mm from the lateral calcaneal branch of the sural nerve. Moreover, in all cases the medial calcaneal nerve and first branch of the lateral plantar nerve were closely juxtaposed and in some cases adherent to the FHL fibro-osseous sheath. Conclusions Although os trigonum or posterolateral talar process excision was performed without difficulty, endoscopic release of the FHL tendon proved technically demanding with significant risk to the local neurovascular structures. Given the reliability and low morbidity of open techniques, this cadaver study calls into question the clinical use of complete endoscopic FHL release to the level of the sustentaculum. Moreover, hindfoot endoscopic surgery should be performed by surgeons familiar with open posterior ankle anatomy and experienced in hindfoot endoscopy.

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