Moroni Simone, Zwierzina Marit, Starke Vasco, Moriggl Bernhard, Montesi Ferruccio, Konschake Marko
Minimally invasive Foot and Ankle Surgery, Faculty of Physical Therapy and Podiatry, Catholic University Saint Vincent Martyr, Valencia, Spain.
Faculty of Health Sciences at Manresa, Universitat de Vic-Universitat Central de Catalunya (Uvic-Ucc), Barcelona, Spain.
Surg Radiol Anat. 2019 Jan;41(1):29-41. doi: 10.1007/s00276-018-2124-z. Epub 2018 Oct 27.
Neuropathy of the Baxter nerve (BN) seems to be the first cause of the heel pain syndrome (HPS) of neurological origin.
41 alcohol-glycerol embalmed feet were dissected. We documented the pattern of the branches of the tibial nerve (TN) and describe all relevant osteofibrous structures. Measurements for the TN branches were related to the Dellon-McKinnon malleolar-calcaneal line also called DM line (DML) for the proximal TT and the Heimkes Triangle for the distal TT. Additionally, we performed an ultrasound-guided injection procedure of the BN and provide an algorithm for clinical usage.
The division of the TN was 16.4 mm proximal to the DML. The BN branches off 20 mm above the DML center or 30 mm distally to it. In most of the cases, the medial calcaneal branch (MCB) originated from the TN proximal to the bifurcation. Possible entrapment spots for the medial and lateral plantar nerve (MPN, LPN), the BN and the MCB are found within a circle of 5 mm radius with a probability of 80%, 83%, and 84%, respectively. In ten out of ten feet, the US-guided injection was precisely allocated around the BN.
Our detailed mapping of the TN branches and their osteofibrous tubes at the TT might be of importance for foot and ankle surgeons during minimally invasive procedures in HPS such as ultrasound-guided ankle and foot decompression surgery (UGAFDS).
巴克斯特神经（BN）神经病变似乎是神经源性足跟痛综合征（HPS）的首要病因。
解剖41只经酒精 - 甘油防腐处理的足部。我们记录了胫神经（TN）分支的形态，并描述了所有相关的骨纤维结构。对TN分支的测量与近端跗管的德龙 - 麦金农踝 - 跟骨线（也称为DM线，DML）以及远端跗管的海姆克斯三角相关。此外，我们进行了BN的超声引导注射操作，并提供了临床应用算法。
TN的分支位于DML近端16.4毫米处。BN在DML中心上方20毫米处或其远端30毫米处发出分支。在大多数情况下，跟内侧支（MCB）起源于TN分叉近端。足底内侧神经（MPN）、足底外侧神经（LPN）、BN和MCB可能的卡压部位分别在半径5毫米的圆内被发现，概率分别为80%、83%和84%。在所有10只足部中，超声引导注射均准确地定位在BN周围。
我们对TN分支及其在跗管处的骨纤维管的详细测绘，对于足踝外科医生在HPS的微创手术（如超声引导下的踝足部减压手术，UGAFDS）中可能具有重要意义。
