Govsa Figen, Bilge Okan, Ozer M Asim
Department of Anatomy, Faculty of Medicine, Ege University, 35100, Bornova, Izmir-Turkey.
Arch Orthop Trauma Surg. 2006 Jan;126(1):6-14. doi: 10.1007/s00402-005-0088-z. Epub 2005 Dec 7.
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.
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.
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.
Knowledge of fine anatomy of the calcaneal nerves is necessary to ensure safe surgical intervention in the medial heel region.
足跟内侧区域神经卡压常被认为是足跟疼痛的一个可能原因。一些作者认为，跟骨内侧和下方神经可能与此类足跟疼痛有关，包括足底筋膜炎、足跟疼痛综合征和脂肪垫疾病。本研究的目的是详细描述足跟内侧，以确定跟骨内侧和下方神经的变异情况及分布模式，并将这些发现与目前足病医学中跗管手术切口线、外固定架治疗骨折、内侧移位截骨术及神经阻滞相关联。
使用3.5倍放大镜对25具经福尔马林固定的成年男性尸体足部进行解剖，研究跟骨内侧和下方神经的起源、关系、分布、变异及支配情况。发现38%的足部仅由一条跟骨内侧神经支配足跟内侧，46%由两条跟骨内侧神经支配，12%由三条跟骨内侧神经支配，4%由四条跟骨内侧神经支配。46%的足部发现有一条跟骨内侧神经起源于足底内侧神经。该神经最常支配足弓后内侧的皮肤。
在我们的解剖中，足跟内侧区域跟骨内侧和下方神经的出现率为100%。与跟骨下方神经相比，跟骨内侧神经位于后方、上方且更粗。跟骨下方神经支配更深层结构。在大多数情况下，跟骨下方神经起源于足底外侧神经，但也可能起源于胫神经，有时与跟骨内侧神经共干起源。
了解跟骨神经的精细解剖对于确保足跟内侧区域的安全手术干预是必要的。
