Medial plantar nerve

study of its anatomical variations

Abstract

Objective: To measure and evaluate the distance from the medial plantar nerve (MPN) to six predetermined anatomical landmarks, identifying 12 distances, and establish a correlation with the trajectory of the flexor hallucis longus (FHL) tendon, especially the knot of Henry, and the location of the bifurcation of the posterior tibial nerve (PTN) relative to the tarsal tunnel. Methods: A descriptive and quantitative study was conducted in which 15 adult feet (six right and nine left) from cadavers were dissected, and the anatomical relationship between the MPN and predetermined structures was evaluated. The distance from the medial border of the medial malleolus to the inferior calcaneal tuberosity [defined as a fixed reference (FR)] was measured to compensate for variability in foot size. Results: The results indicated that the bifurcation of the PTN was proximal to the tarsal tunnel in 11 feet (73.3%), within the tunnel in three feet (20%), and distal to the tunnel in one foot (6.66%). A statistically significant (p=0.035) association was found between the FR and the distance from the superior calcaneal tuberosity to the MPN, a strong correlation (p=0.004) was found between the FR and the distance from the inferior calcaneal tuberosity to the MPN, and a significant association (p=0.013) was found between the FR and the distance from the medial calcaneal tuberosity to the knot of Henry. Conclusion: Some anatomical structures, especially the knot of Henry, have a strong correlation with the MPN and should be considered by surgeons who intend to approach the FHL in the plantar region. Bifurcation of the PTN proximal to the tarsal tunnel was the most common presentation.
Level of Evidence V; Expert opinion.