Innervation of the sinus tarsi and implications for treating anterolateral ankle pain.

Anterolateral ankle pain can persist despite the best care of sprains or fractures. It is possible that this pain is related to stretch or traction injuries to the nerves that innervate the subtalar joint. If this were true, identification of these nerve branches by local anesthetic block would provide an indication that surgical interruption of the function of these nerves may provide pain relief. In 28 feet of 14 cadavers (7 male/7 female), investigation of the deep peroneal nerve demonstrated a consistent pattern whereby a series of 2 to 4 (mean, 2.9 +/- 0.6) branches innervated the anterolateral part of the subtalar joint. All these nerve branches originated from the lateral terminal branch of the deep peroneal nerve on the dorsum of the foot. The mean distance between the exit of the first articular branch and the exit of the terminal motor branch both originating from the lateral terminal branch was 3.8 +/- 1.1 cm. The motor branch passed under the extensor digitorum brevis muscle at a mean distance of 5.3 +/- 0.6 cm from the tip of the lateral malleolus. The presented anatomy provides a basis for the diagnosis and treatment of persistent anterolateral ankle pain of neural origin.

Cutaneous innervation of the medial ankle: an anatomic study of the saphenous, sural, and tibial nerves and their clinical significance.

The distribution and variability of the nerves innervating the skin overlying the medial ankle were determined in 22 human anatomic specimens using x3.5 loupe magnification for dissection. Five different types could be identified: (1) Type A received contributions from the saphenous (SP), sural (SR), and the tibial (TB) nerves (54%); (2) Type B received contributions from the SR and SP nerves (14%); (3) Type C received contributions from the TB and SP nerves (9%); (4) Type D was singularly innervated by the SP (14%); and (5) Type E received contributions only from the TB nerve (9%). In two specimens, an unusual connection between the SP and the medial plantar nerves was found. Based on these findings, an incision line for tarsal tunnel release is suggested to avoid injury to the small cutaneous branches of the SP, SR, and TB nerves.

The anatomic basis for the innervated mylohyoid/digastric flap in facial reanimation.

This paper describes the anatomy of the neurovascular supply to the mylohyoid and digastric muscle and its potential use for a regional transposition to rehabilitate the paralyzed face and soft-tissue coverage in the head and neck area. The anatomy and the arc of rotation of this flap were determined in ten embalmed cadavers. To further demonstrate the vascular supply, the common carotid was injected with silicone in four additional fresh cadavers. In all specimens, the submental artery and the mylohyoid nerve were the sole contributors to the neurovascular supply of the mylohyoid and digastric muscle. The arc of rotation was an average of 5 cm (range 4 to 6.5 cm), which allowed the flap to be positioned appropriately between the zygomatic arch and the modiolus. From this anatomic study, the mylohyoid/digastric flap has a long enough neurovascular pedicle to be useful in facial reanimation and soft-tissue coverage in the head and neck area.