• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.216-219
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• 2008

Tarsal tunnel syndrome is a complex of symptoms resulting from the compression of the posterior tibial nerve or its branches. Many studies have done on etiologic agents. We reported two cases of tarsal tunnel syndrome secondary to the varicosis of posterior tibial vein. Symptoms were relieved after excision of the varicosis, neurolysis and reposition of posterior tibial nerve.

• Anatomy and Cell Biology
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• v.57 no.2
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• pp.320-323
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• 2024

Sciatic nerve (SN) is the thickest and longest nerve of the body. Deviations from the normal anatomical origin and level of bifurcation of SN have been frequently reported. In the present case, we are presenting a unique scenario of origin of terminal branches of the SN-tibial nerve (TN) and common peroneal nerve (CPN) in the pelvic region itself from divisions arising directly from the lumbosacral plexus. This variation was associated with origin of posterior femoral cutaneous nerve from the superior division of CPN with anomalous communicating branches between pudendal nerve and TN. The unique characteristics of the present case are the presence of 'pseudoganglion' found on the inferior division of TN. The present case stands out as the first of its kind to mention such pseudoganglion. Knowledge of some unusual findings like presence of pseudoganglion and intercommunications between nerves have clinical implications in anesthesiology, neurology, sports medicine, and surgery.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.648-651
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• 2006

Purpose: Tarsal tunnel syndrome is characterized by pain and paresthesia of the entire posterior tibial nerve and its branches of the lower extremity. The cause of the tarsal tunnel syndrome is usually unknown but, rare case of space occupying benign tumors such as a ganglion may be one of the causes. We report our experiences of surgical treatment of the tarsal tunnel syndrome caused by ganglion we have encountered recently. Methods: A 54-year-old male patient presented with paresthesia, burning pain, positive Tinnel's sign without preceeding trauma, infection or any other causes of event. With surgical intervention, we completely removed the space occupying ganglion and with performed surgical release of the posterior tibial nerve and its branches. Results: At a 14-month follow up examination, the symptoms of paresthesia, burning pain, sensory disturbance was much improved compared to the preoperative conditions. Takakura's rating scale was elevated from 4(Poor) to 8(Good). Conclusion: We report our surgical experience of a rare case of tarsal tunnel syndrome caused by a ganglion, with a review of literature.

• Annals of Clinical Neurophysiology
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• v.6 no.1
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• pp.20-25
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• 2004

Background and Objectives: The proximal and distal nerve segments are preferentially involved in acquired demyelinating polyneuropathies (ADP). This study was undertaken in order to assess the usefulness of motor evoked potential (MEP) and somatosensory evoked potential (SSEP) in the detection of the proximal nerve lesion in ADP. Methods: MEP, SSEP and conventional NCS were performed in 6 consecutive patients with ADP (3 AIDP, 3 CIDP). MEP was recorded from abductor pollicis brevis and abductor hallucis using magnetic stimulation of the cortex and the cervical/lumbar spinal roots. SSEP were elicited by stimulating the median and posterior tibial nerves. Latency from cortex and cervical/lumbar roots, central motor conduction time (CMCT), EN1-CN2 interpeak latency were measured for comparison. Results: MEP was recorded in 24 limbs (12 upper and 12 lower limbs) and SSEP in 24 limbs (12 median nerve, 12 posterior tibial nerve). F-wave latency was prolonged in 25 motor nerves (25/34, 73.5%). Prolonged CML and PML were found in 41.7% (10/24) and 45.8% (11/24), respectively. Interside difference (ISD) of CMCT was abnormally increased in the upper extremity, 66.7% (4/6 pairs) in case of CML-PML. EN1-CN2 interpeak latency was abnormally prolonged in one median nerve (1/10) and LN1-P1 interpeak latency was normal in all posterior tibial nerves. Conclusions: MEP and SSEP may provide useful information for the proximal nerve and root lesion in ADP. MEP and SSEP is supplemental examination as well as complementary to conventional NCS.

• Journal of Korean Foot and Ankle Society
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• v.18 no.1
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• pp.36-39
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• 2014

Tarsal tunnel syndrome is defined as a compressive neuropathy of the posterior tibial nerve in the tarsal canal. Schwannoma is a benign tumor that arises from the peripheral nerve sheath. It presents as a discrete, often tender, and palpable nodule associated with neurogenic pain or paresthesia when compressed or traumatized. The growth rate is usually slow, and these lesions seldom exceed 2 cm in diameter. In addition, local recurrence occurs less than 5%. We report on a case of tarsal tunnel syndrome caused by a large recurred space-occupying lesion measuring $4.3{\times}2.7{\times}2.7cm^3$.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.2
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• pp.102-105
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• 2012

Schwannoma is a common peripheral nerve tumor that mainly occur at head and neck, flexor muscle of upper, and lower extrimity. In posterior tibial nerve schwannoma, diagnosis is difficult, since physicians often consider achilles tendinitis, posterior impingement syndrome, retrocalcaneal bursitis, or injury of the flexor tendons, as the primary cause in patients with posterior ankle pain. Ultrasonogram may be a simple tool to differentiate such various diseases. The authors report a case of posterior tibial nerve schwannoma diagnosed with ultrasonogram, which was initially misunderstood as achilles tendinitis.

• Journal of Pharmacopuncture
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• v.12 no.2
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• pp.21-29
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• 2009

Objective : This study was carried to identify the anatomical component of FTMM(Foot Taeyang Meridian Muscle) in human lower limb, and further to help the accurate application to real acupuncture. Methods : FTM at the surface of the lower limb was labelled with latex. And cadaver was stripped off to demonstrate muscles, nerves and the others and to display the internal structures of FTMM, being divided into outer, middle, and inner layer. Results : FTMM in human lower limb is composed of muscles, nerves, ligaments etc. The internal composition of the FTMM in human lower limb are as follows : 1) Muscle : Gluteus maximus. biceps femoris, semitendinosus, gastrocnemius, triceps calf, fibularis brevis tendon, superior peroneal retinacula, calcaneofibular ligament, inferior extensor retinaculum, abductor digiti minimi, sheath of flexor tendon at outer layer, biceps femoris, semimembranosus, plantaris, soleus, posterior tibialis, fibularis brevis, extensor digitorum brevis, flexor digiti minimi at middle layer, and for the last time semimembranosus, adductor magnus, plantaris, popliteus, posterior tibialis, flexor hallucis longus, dorsal calcaneocuboidal ligament at inner layer. 2) Nerve : Inferior cluneal nerve, posterior femoral cutaneous n., sural cutaneous n., proper plantar branch of lateral plantar n. at outer layer, sciatic nerve, common peroneal n., medial sural cutaneous n., tibial n. at middle layer, and for the last time tibial nerve, flexor hallucis longus branch of tibial n. at inner layer. Conclusions : This study proves comparative differences from already established studies from the viewpoint of constituent elements of FTMM in the lower limb, and also in the aspect of substantial assay method. We can guess that there are conceptional differences between terms (that is, nerves which control muscles of FTMM and those which pass near by FTMM) in human anatomy.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.106-111
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• 1996

Purpose : Propose a surgical technique in donor harvesting method in free vascularized proximal fibular epiphysis. Methodology : Concerned about growth potentials of the transplanted epiphysis in our long term results of the epiphyseal transplanted 13 cases more than 4 years follow-up, anterior tibial artery which contains anterior tibial recurrent artery is most reliable vessel to proximal fibular epiphysis which is the best donor of the free vascularized epiphyseal transplantation. In vascular anatomical aspect proximal fibular epiphysis norished by latearl inferior genicular artery from popliteal, posterior tibial recurrent artery and anterior tibial recurrent artery from anterior tibial artery and peroneal artery through metaphysis. The lateral inferior genicular artery is very small and difficult to isolate, peroneal artery from metaphysis through epiphyseal plate can not give enough blood supply to epiphysis itself. The anterior tibial artery which include anterior tibial recurrent and posterior tibial recurrent artery is the best choice in this procedure. But anterior tibial recurrent artery merge from within one inch from bifucating point of the anterior and posterior tibial arteries from popliteal artery. So it is very difficult to get enough vascular pedicle length to anastomose in recipient vessel without vein graft even harvested from bifucating point from popliteal artery. Authors took recipient artery from distal direction of anterior tibial artery after ligation of the proximal popliteal side vessel, which can get unlimited pedicle length and safer dissection of the harvesting proximal fibular epiphysis. Results : This harvesting procedure can performed supine position, direct anterolateral approach to proximal tibiofibular joint. Dissect and isolate the biceps muscle insertion from fibular head, micro-dissection is needed to identify the anterior tibial recurrent arteries to proximal epiphysis, soft tissue release down to distal and deeper plane to find main anterior tibial artery which overlying on interosseous membrane. Special care is needed to protect peroneal nerve damage which across the surgical field. Conclusions : Proximal fibular epiphyseal transplantation with distally directed anterior tibial artery harvesting technique is effective and easier dissect and versatile application with much longer arterial pedicle.

• Annals of Clinical Neurophysiology
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• v.1 no.2
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• pp.112-117
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• 1999

Background : Posterior tibial nerve somatosensory evoked potentials (PTSEP) have cortical potentials on primary sensory area of foot around 40 msec. The direct cortical recordings of the cortical potentials shows high voltage positive wave on medial hemisphere, especially on paracentral lobule (PCL). However, it is so difficult to record the potential directly on PCL that the cortical potential of PTSEP is not well understood. We investigated the cortical potential of PTSEP on subdural electrodes. Methods : We recorded cortical potentials to posterior tibial nerve stimulation on subdural electrodes which were on medial hemisphere near PCL in 15 intractable neocortical epilepsy patients. The numbers of subdural electrodes were 8 in 10 subjects ($1{\times}8array$) and 16 in 5 subjects ($2{\times}8arrays$). Seven subjects had three-dimensional imaging fusion (3D-fusion) of MRI and the electrodes using Analyze program. We investigated the amplitude, latency, polarity, and phase of the waves regarding location. Results : The waves had maximal amplitude on PCL in 4 subjects, precuneus in 1, cingulate gyrus nearest to PCL in 2 among 7 subjects with 3D-fusion. Also the electrodes were located on posterior area of PCL (2 out of 2 subjects with more than two electrodes put on PCL in 3D-fusion) and superior area of it (5 out of 5 subjects with $2{\times}8arrays $). All the high (more than 20 uV) amplitude around 40msec had positive polarity in 7 subjects. The phase reversals were detected between the electrodes with the highest amplitude and the just posterior (2 subjects) or anterior (6 subjects) located electrodes. The just posterior located electrodes had sharper phase reversal than the anterior one. Conclusion : PTSEP might have maximal amplitude of cortical potentials on the more superior and posterior area of PCL. The highest amplitude potential has positivity. The wave with maximal amplitude could have phase reversal of cortical potentials with surrounding electrodes, especially shaper with posterior part than with anterior one.

• Journal of Korean Foot and Ankle Society
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• v.27 no.2
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• pp.75-78
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• 2023

During bone tumor resection, many cases require medial malleolar osteotomy to achieve adequate access to the operative field. Various osteotomy methods have been developed to address this issue, including oblique, transverse, reverse V-shape, and step-cut osteotomies. However, medial malleolar osteotomy has several drawbacks, such as the excessive disruption of the joint surface, unstable screw fixation when fixing the medial malleolus, and iatrogenic medial ankle joint arthritis due to articular displacement during the reduction of the osteotomy site. In addition, there is a possibility of injury to the posterior tibial artery, tibial nerve, or posterior tibialis tendon if the osteotomy range is too aggressive. Therefore, the authors propose a new osteotomy method, which has shown promising clinical results, namely, partial posterior medial malleolar osteotomy. This method minimizes articular involvement and provides adequate access to the operative field during talar body bone tumor resection.