CLINICAL-ANATOMIC MAPPING OF THE TARSAL TUNNEL WITH REGARD TO BAXTER’S NEUROPATHY IN RECALCITRANT HEEL PAIN SYNDROME - PART I

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Aim. To describe the topographic anatomy of the tibial nerve (TN) and its branches in relation to their osteofibrose chambers in the proximal and distal postero-medial tarsal tunnels, with ultrasonographic injection procedures proof of the Baxter nerve (BN). Material and Methods. 41 alcohol-glycerin embalmed feet were dissected. We documented the pattern of the branches of the TN and describe all relevant osteofibrose structures. Measurements for the TN branches were related to the Dellon-McKinnon Malleolar-Calcaneal Axis (DML) for the proximal TT and the Heimkes Triangle for the distal TT. Additionally we performed an ultrasound guided injection procedure of the BN and provide an algorithm for clinical usage. Results and Discussion. The division of the TN was 16.4 mm proximal to the DML. The BN branches off 20 mm above the DML center or 30 mm distally to it. In most of the cases the medial calcaneal branch (MCB) originated from the TN proximal to the bifurcation. Possible entrapment spots for the medial and lateral plantar nerve (MPN, LPN), the BN and the MCB are found within a circle of 5 mm radius with a probability of 80, 83 and 84%, respectively. In 10 out of 10 feet the US guided injection was precisely allocated around the BN. Conclusions. Our detailed mapping of the TN branches and their osteofibrous tubes at TT might be of importance for foot and ankle surgeons during minimally invasive procedures in HPS such as ultrasound-guided ankle and foot decompression surgery.