Ultrasound-guided topographic anatomy of the medial calcaneal branches of the tibial nerve.

BACKGROUND: The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment. MATERIALS AND METHODS: Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analysed in reference to the amount and their respective nerves of origin. RESULTS: In 77% of cases, tibial nerve bifurcation occurred below the tip of the medial malleolus with the average distance of 5.9 mm and in 48% of cases above the posterior superior tip of the calcaneal tuberosity with the average distance of 2.7 mm. In 73% of cases medial calcaneal branches occurred as a single branch originating from the tibial nerve (60%). The average distance of the first, second and third medial calcaneal branch was accordingly 9.3 mm above, 9.5 mm below and 11.6 mm below the tip of the medial malleolus and 17.7 mm above, 1.6 mm below and 4 mm below the posterior superior tip of the calcaneal tuberosity. CONCLUSIONS: As the tibial nerve and its branches present a huge variability in the medial ankle area, in order to prevent the iatrogenic injuries, the preoperative or intraoperative ultrasound assessment (sonosurgery) of its localisation should be introduced into the clinic.

Computer-assisted measurements of the histological structure of the tibial nerve and its terminal branches.

BACKGROUND: The aim of this study was to analyse the histological structure (cross-sectional area [CSA] and number of nerve bundles) of the distal part of the tibial nerve and its terminal branches (medial plantar nerve, lateral plantar nerve) using computer-assisted image analysis. MATERIALS AND METHODS: The tibial nerve and its distal branches (medial and lateral plantar nerves) were dissected from the fresh cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the tibial nerve bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 µm slices and stained with haematoxylin and eosin. Then photographed and analysed using Olympus cellSens software. RESULTS: The studied group comprised 28 female and 32 male feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve bundles were respectively 17.86 ± 4.57 mm2, 33.88 ± 6.31 for the tibial nerve, 9.58 ± 1.95 mm2, 23.41 ± 7.37 for the medial plantar nerve and 7.17 ± 2.36 mm2, 15.06 ± 5.81 for the lateral plantar nerve in males and 12.27 ± 2.45 mm2, 26.32 ± 8.87 for the tibial nerve, 7.81 ± 1.41 mm2, 17.71 ± 5.28 for the medial plantar nerve and 5.83 ± 1.25 mm2, 11.50 ± 3.72 for the lateral plantar nerve in females. Both CSA and number of nerve bundles of the tibial, medial plantar and lateral plantar nerves revealed no statistical differences when comparing foot side of the individual. The statistical difference was related to the gender, showing significantly bigger CSA and number of nerve bundles in males (CSA: p = 0.000, p = 0.000, p = 0.016; number of nerve bundles: p = 0.01, p = 0.003, p = 0.004, respectively). A positive correlation was found between the donor age and the tibial nerve CSA (r = 0.44, p = 0.000). A significant statistical difference was found between the medial and lateral plantar nerves both in CSA and number of nerve bundles (p < 0.001, p < 0.001, respectively). CONCLUSIONS: The CSA and the number of nerve bundles in the distal part of the tibial nerve and its branches are significantly larger in males with no differences between right and left foot of the individual. The tibial nerve shows increasing CSA with advanced age. The medial plantar nerve has larger CSA and more nerve bundles than the lateral plantar nerve.

Comparison of the histological structure of the tibial nerve and its terminal branches in the fresh and fresh-frozen cadavers.

BACKGROUND: The aim of this study was to compare the histological structure (cross-sectional area [CSA] and number of nerve fascicles) of the distal part of the tibial nerve (TN) and its terminal branches (medial plantar nerve [MPN], lateral plantar nerve [LPN]) in the fresh and fresh-frozen cadavers using computer assisted image analysis. MATERIALS AND METHODS: The TNs with terminal branches (MPN and LPN) were dissected from the fresh and fresh-frozen cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the TN bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 µm slices and stained with haematoxylin and eosin. Then the specimens were photographed and analysed using Olympus cellSens software. RESULTS: The fresh cadavers' group comprised 60 feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve fascicles were respectively 15.25 ± 4.6 mm2, 30.35 ± 8.45 for the TN, 8.76 ± 1.93 mm2, 20.75 ± 7.04 for the MPN and 6.54 ± 2.02 mm2, 13.40 ± 5.22 for the LPN. The fresh-frozen cadavers' group comprised 21 feet (mean age 75.1 ± 9.0 years). The mean CSA and the number of nerve fascicles were respectively 13.71 ± 5.66 mm2, 28.57 ± 8.00 for the TN, 7.55 ± 3.25 mm2, 18.00 ± 6.72 for the MPN and 4.29 ± 1.93 mm2, 11.33 ± 1.93 for the LPN. Only LPNs showed statistical differences in the CSA and the number of nerve fascicles between examined groups (p = 0.000, p = 0.037, respectively). A positive correlation was found between donors age and tibial nerve CSA in the fresh cadavers group (r = 0.44, p = 0.000). A statistical difference was found between the MPN and LPN both in the CSA and the number of nerve fascicles (p < 0.001, p < 0.001, respectively). CONCLUSIONS: The CSA and the number of nerve fascicles of the tibial and medial plantar nerves were similar in the fresh and fresh-frozen cadavers whilst different in the LPN. The TN showed increasing CSA with the advanced age in the fresh cadavers. The MPN had larger CSA and more nerve fascicles than the LPN.

Imaging of highly turbid media by the absorption method.

The results of a study on imaging that is based on the absorption method are presented. This method is based on attenuation measurements carried out in the presence of a sufficiently high absorption coefficient by the use of a continuous-wave source. The benefit of absorption on image quality comes from the strong attenuation of photons traveling along long trajectories. When the absorption coefficient is increased, the received energy decreases, but the mean path length of received photons decreases. The effect of increasing the absorption coefficient is similar to that of decreasing the gating time when the time-gating technique is used. Experimental results showed that the spatial resolution obtained with the absorption technique is similar to that obtained with the time-gating technique.