Martín-Oliva X, Elgueta-Grillo J, Veliz-Ayta P, Orosco-Villaseñor S, Elgueta-Grillo M, Viladot-Perice R
Acta Ortop Mex. 2013 Jan-Feb;27(1):38-42.
The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel.
跗管由内踝后缘、距骨后面和跟骨内侧构成。75%的病例中，跟内侧神经发自胫后神经后方，其余25%发自足底外侧神经。最后，79%的病例中跟内侧神经以单一终末支结束，其余21%有多个终末支。描述胫后神经及其终末支的解剖变异。描述跗管松解的步骤。描述巴克斯特神经松解。研究了跗管内胫后神经及其终末支的解剖变异。然后采用拉姆技术，该技术包括：1）切开屈肌支持带，2）切开拇展肌上方的筋膜，3）对胫后神经及其终末支进行神经外膜松解，确定跟内侧支、足底外侧神经及其巴克斯特神经支和足底内侧神经的发出部位及走行。100%的病例中发现了巴克斯特神经。在我们的系列病例中，100%发现了支配足部小趾展肌的神经；87.5%的病例有两个终末支。解剖证明，关键步骤是松解跗管远端。
