Anat Cell Biol.  2015 Jun;48(2):130-137. 10.5115/acb.2015.48.2.130.

Topography of human ankle joint: focused on posterior tibial artery and tibial nerve

• Kim DI
• Kim YS
• Han SH

• KMID: 1845281
• DOI: http://doi.org/10.5115/acb.2015.48.2.130

Abstract

Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain.

Keyword

Tibial nerve; Posterior tibial artery; Medial calcaneal branch; Foot pain; Coordinate

MeSH Terms

Ankle
Ankle Joint*
Arteries
Cadaver
Classification
Diagnosis
Foot
Humans
Tibial Arteries*
Tibial Nerve*

Figure

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  Fig. 1 Schematic diagram showing the bony landmarks and a reference line. M, inferior tip of medial malleolus of the tibia; C, posterior superior tip of calcaneal tuberosity; DLBA, Perpendicular distance from Line A to bifurcation of posterior tibial artery; DLBN, Perpendicular distance from Line A to bifurcation of tibial nerve; DMA, distance between inferior tip of medial malleolus of tibia and posterior tibial artery; DMBA, distance from inferior tip of medial malleolus of tibia to location of bifurcation of posterior tibial artery; DMBN, distance from inferior tip of medial malleolus of tibia to location of bifurcation of tibial nerve; DMC, distance between inferior tip of medial malleolus of tibia and superior tip of calcaneus; DMN, distance between inferior tip of medial malleolus of tibia and tibial nerve; P, medial process of calcaneal tuberosity; Line A, reference line from M to C.

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  Fig. 2 Classification of relationship between posterior tibial artery and tibial nerve in triangle in medial view. Type I, posterior tibial artery is located medial to the tibial nerve; type II, posterior tibial artery is situated anterior to the tibial nerve; type III, artery is located lateral to the nerve; type IV, artery is located between medial and lateral plantar nerves; M, tip of medial malleolus of the tibia; C, posterior superior tip of calcaneal tuberosity; P, medial process of calcaneal tuberosity.

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  Fig. 3 Comparison among studies of the most common bifurcated location of the tibial nerve.

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  Fig. 4 Territories of neurovascular structures' bifurcations according to the sexes. (A) Territories of posterior tibial artery's bifurcations. (B) Territories of tibial nerve's bifurcations.

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  Fig. 5 Schematic drawing of the tibial nerve of an average Korean. A, Average location of the tibial nerve on a reference line (Line A); B, X- and Y-coordinates of the bifucation of the tibial nerve on average; dark grey square, territory 75% of location of the tibial nerve on the reference line (39% to 53%); pale grey irregular shape, territory 75% of the bifurcation of the tibial nerve (32% to 65% in X-coordinate and 13 to -39% in Y-coordinate).

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