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Variations in the origin of the medial and inferior calcaneal nerves

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Abstract

Introduction: Entrapment of the medial heel region nerves is often mentioned as a possible cause of heel pain. Some authors have suggested that the medial and inferior calcaneal nerves may be involved in such heel pain, including plantar fasciitis, heel pain syndrome and fat pad disorders. The aim of this study was to give a detailed description of the medial heel that would determine the variability and pattern of the medial and inferior calcaneal nerves, as well as to relate these findings to the currently used incision line for tarsal tunnel, fixations of fractures with external nailing, medial displacement osteotomy and nerve blocks in podiatric medicine. Materials and methods: The origin, relationship, distribution, variability and innervation of medial and inferior calcaneal nerves were studied with the use of a 3.5 power loupe magnification for dissection of 25 adult male feet of formalin-fixed cadavers. The medial heel was found to be innervated by just one medial calcaneal nerve in 38% of the feet, by two medial calcaneal nerves in 46%, by three medial calcaneal nerves in 12% and by four medial calcaneal nerves in 4%. An origin for a medial calcaneal nerve from the medial plantar nerve was found in 46% of the feet. This nerve most often innervates the skin of the posteromedial arch. Results: In our dissection, the rate of occurrence of the medial and inferior calcaneal nerves in medial heel region was 100%. When compared with the inferior calcaneal nerve, the medial calcaneal nerve was posterior, superior and thicker. The inferior calcaneal nerve supplies deeper structures. In the majority of the cases, inferior calcaneal nerve aroused from the lateral plantar nerve, but it may also arise from the tibial nerve, sometimes in a common origin with the medial calcaneal nerve. Conclusions: Knowledge of fine anatomy of the calcaneal nerves is necessary to ensure safe surgical intervention in the medial heel region.

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References

  1. Arenson DJ, Cosentino GL, Suran SM (1990) The inferior calcaneal nerve: an anatomic study. J Am Podiatry Assoc 70:552–560

    Google Scholar 

  2. Aszmann OC, Ebmer JM, Dellon AL (1998) Cutaneous innervation of the medial ankle: an anatomic study of the saphenous, sural and tibial nerve and their clinical significance. Foot Ankle 19:753–756

    PubMed  CAS  Google Scholar 

  3. Bareither DJ, Genau JM, Massaro JC (1990) Variation in the division of the tibial nerve: application to nerve blocks. J Foot Surg 29:581–583

    PubMed  CAS  Google Scholar 

  4. Baxter DE, Thingpen M (1984) Heel pain: operative results. Foot Ankle 5:16–25

    PubMed  CAS  Google Scholar 

  5. Baxter DE, Pfeffer GB Thingpen M (1989) Chronic heel pain. Orthop Clin North Am 20:564–569

    Google Scholar 

  6. Baxter DE, Pfeffer GB (1992) Treatment of chronic heel pain by surgical release of the first branch of the lateral plantar nerve. Clin Orthop 279:229–236

    PubMed  Google Scholar 

  7. Bilge O, Ozer MA, Govsa F (2002) Neurovascular branching in the tarsal tunnel. Neuroanatomy 2:39–41

    Google Scholar 

  8. Bordelon RL (1983) Subcalcaneal pain. Clin Orthop Relat Res 177:49–53

    PubMed  Google Scholar 

  9. Casey D, Mc Connell T, Parekh S, Tornetta P (2002) Percutaneus pin placement in the medial calcaneus; is anywhere. J Orthrop Trauma 16:26–29

    Article  Google Scholar 

  10. Davis TJ, Schon LC (1995) Branches of the tibial nerve: anatomic variations. Foot Ankle Int 16:21–29

    PubMed  CAS  Google Scholar 

  11. Dellon AL, Mackinnon SE (1984) Tibial nerve branching in the tarsal tunnel. Arch Neurol 41:645–646

    PubMed  CAS  Google Scholar 

  12. Dellon AL, Kim J, Spaulding CM (2002) Variations in the origin of the medial calcaneal nerve. J Am Podiatry Assoc 92:97–101

    Google Scholar 

  13. Del Sol M, Olave E, Gabrielli C, Mandiola E, Prates JC (2002) Innervation of the abductor digiti minimi muscle of the human foot: anatomical basis of the entrapment of the abductor digiti minimi nerve. Surg Radiol Anat 24:18–22

    Article  PubMed  Google Scholar 

  14. Didia BC, Horsefall AU (1990) Medial calcaneal nerve: an anatomic study. J Am Podiatry Assoc 80:115–119

    CAS  Google Scholar 

  15. Donald JA, Gerald LC, Steven MS (1980) The inferior calcaneal nerve. JAPA 70:552

    Google Scholar 

  16. Furey G, Ohio C (1975) Plantar fasciitis, the painful heel syndrome. J Bone Joint Surg 57:672–673

    PubMed  CAS  Google Scholar 

  17. Greene DL, Thompson MC, Gesink DS, Graves SC (2001) Anatomic study of the medial neurovascular structures in relation to calcaneal osteotomy. Foot Ankle Int 22:569–571

    PubMed  CAS  Google Scholar 

  18. Havel PE, Ebraheim NA, Clark SE, Jackson WT, Didio L (1988) Tibial nerve branching in the tarsal tunnel. Foot Ankle 9:117–119

    PubMed  CAS  Google Scholar 

  19. Henricson AS, Westlin NE (1984) Chronic calcaneal pain in athletes: entrapment of the calcaneal nerve? Am J Sports Med 12:152–154

    Article  PubMed  CAS  Google Scholar 

  20. Horwitz MT (1938) Normal anatomy and variation of the peripheral nerves of the leg and foot. Arch Surg 36:626–636

    Google Scholar 

  21. Kenzora JE (1987) The painful heel syndrome: an entrapment neuropathy. Bull Hosp Jt Dis Orthop Inst 47:178–189

    PubMed  CAS  Google Scholar 

  22. Louisia S, Masquelet AC (1999) The medial and inferior calcaneal nerves: an anatomic study. Surg Radiol Anat 21:169–173

    Article  PubMed  CAS  Google Scholar 

  23. Martin Ch, Seiler JG III, Lesesne JS (1996) The cutaneous innervation of the palm: an anatomic study of the ulnar and median nerves. J Hand Surg 21A:634–638

    Google Scholar 

  24. Mekhail AO, Ebraheim NA, Heck BE, Yeasting RA (1996) Anatomic considerations for safe placements of calcaneal pins. Clin Orthop 332:254–259

    Article  PubMed  Google Scholar 

  25. Oh SJ, Kwon KH, Hah JS, Kim DE, Demirci M (1999) Lateral plantar neuropathy. Muscle Nerve 22:1234–1238

    Article  PubMed  CAS  Google Scholar 

  26. Park TA, Del Toro DR (1995) The medial calcaneal nerve: anatomy and nerve conduction technique. Muscle Nerve 18:32–38

    Article  PubMed  CAS  Google Scholar 

  27. Park TA, Del Toro DR (1996) Isolated inferior calcaneal neuropathy. Muscle Nerve 19:106–108

    Article  PubMed  CAS  Google Scholar 

  28. Roegholt MN (1940) Een nervus calcaneus inferior als overbrenger van de pijn bij calcaneodynie of calcaneusspor en de daaruit volgende therapie. Ned Tijdschr v Geneskd 84:1898–1902

    Google Scholar 

  29. Rondhuis JJ, Huson A (1986) The first branch of the lateral plantar nerve and heel pain. Acta Morphol Neerl Scand 24:269–279

    PubMed  CAS  Google Scholar 

  30. Przylucki H, Jones CL (1981) Entrapment neuropathy of muscle branch of lateral plantar nerve. J Am Podiatry Assoc 71:119–124

    PubMed  CAS  Google Scholar 

  31. Santi MD, Botte MJ (1996) External fixation of the calcaneus and talus: an anatomic study for safe pin insertion. J Orthop Trauma 10:487–491

    Article  PubMed  CAS  Google Scholar 

  32. Schon LC, Baxter DE (1990) Neuropathies of the foot and ankle in athletes. Clin Sports Med 9:489–509

    PubMed  CAS  Google Scholar 

  33. Schon LC, Baxter DE (1994) Heel pain syndrome and entrapment neuropathies about the foot and ankle. In: Gould JS (ed) Operative foot surgery. WB Saunders, Philadelphia, pp 192–208

    Google Scholar 

  34. Schon LC, Glennon TC, Baxter DE (1993) Heel pain syndrome: electrodiagnostic support for nerve entrapment. Foot Ankle 14:129–135

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anatomy, Faculty of Medicine, Ege University, 35100, Bornova, Izmir-Turkey

    Figen Govsa, Okan Bilge & M. Asim Ozer

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  1. Figen Govsa
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  2. Okan Bilge
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  3. M. Asim Ozer
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Correspondence to Figen Govsa.

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Govsa, F., Bilge, O. & Ozer, M.A. Variations in the origin of the medial and inferior calcaneal nerves. Arch Orthop Trauma Surg 126, 6–14 (2006). https://doi.org/10.1007/s00402-005-0088-z

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  • DOI: https://doi.org/10.1007/s00402-005-0088-z

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