The injection site in the tarsal tunnel to minimize neurovascular injury for heel pain: an anatomical study

• Published in: Surgical and radiologic anatomy (English ed.) Vol. 42; no. 6; pp. 681 - 684
• Main Authors: Sun, Mei-Yu, Jeon, Anna, Seo, Chang Min, Kim, Ye Gyung, Wu, Ya-Nan, Kim, Dong Woon, Lee, Je-Hun
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.06.2020; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anatomy; Cadaver; Cadavers; Calcaneus; Calcaneus - anatomy & histology; Calcaneus - diagnostic imaging; Dissection; Female; Glucocorticoids - administration & dosage; Heel - anatomy & histology; Heel - diagnostic imaging; Humans; Imaging; Injection; Injections, Intralesional - adverse effects; Injections, Intralesional - methods; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neuralgia - etiology; Neuralgia - therapy; Original Article; Orthopedics; Pain; Pain Management - adverse effects; Pain Management - methods; Radiology; Surgery; Tibia; Tibial Arteries - anatomy & histology; Tibial Arteries - diagnostic imaging; Tibial Arteries - injuries; Tibial Nerve - anatomy & histology; Tibial Nerve - diagnostic imaging; Tibial Nerve - injuries; Tibial Neuropathy - complications; Tibial Neuropathy - therapy; Young Adult; Tarsal tunnel; Neurovascular structure; Anatomical study; Heel pain
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-019-02411-8

Introduction The aim of this study was to investigate the location and distribution patterns of neurovascular structures and determine the effective injection point in the tarsal tunnel for heel pain. Methods Fifteen adult non-embalmed cadavers with a mean age of 71.5 years were studied. The most inferior point of the medial malleolus of the tibia (MM) and the tuberosity of the calcaneus (TC) were identified before dissection. A line connecting the MM and TC was used as a reference line. The reference point was expressed in absolute distance along the reference line using the MM as the starting point. For measurements using MRI, the depth from the skin was measured to inferior at an interval of 1 cm from the MM. Results The posterior tibial artery, lateral plantar nerve, and medial plantar nerve were located from 29.0 to 37.3% of the reference line from the MM. The distribution frequencies of the medial calcaneal nerve on the reference line from the MM were 0%, 8.60%, 37.15%, 37.15%, and 17.10%, respectively. The mean depth of the neurovascular structures was 0.3 cm. Discussion This study recommended an effective injection site from 45.0 to 80.0% of the reference line.