Dreyer Mark A., Gibboney Michael D.
Intercoastal Medical Group
Naval Medical Center Camp Lejeune
Koppel and Thompson first described anterior tarsal tunnel syndrome (ATTS) in 1960. ATTS, also known as deep peroneal nerve (DPN) entrapment, is a compression neuropathy of the DPN most commonly caused by the tight fascia band in the anterior ankle called the inferior extensor retinaculum. Two other anatomic locations of entrapment have been described and include deep to the extensor hallucis longus tendon overlying the talonavicular joint and deep to the extensor hallucis brevis muscle overlying the first and second tarsometatarsal joints. The deep peroneal nerve is one of two terminal branches off the common peroneal nerve (CPN). The DPN bifurcates from the CPN in the anterior compartment of the lower leg and travels along the interosseous membrane. Just proximal to the ankle joint, the DPN courses between the extensor hallucis longus tendon and the extensor digitorum longus tendon. It then divides into the medial and lateral terminal branches. The EDB and EHB muscles are innervated by the lateral terminal branch of the DPN while the medial branch runs beside the dorsalis pedis artery in the dorsal foot and is purely sensory providing innervation to the first webspace. In the anterior leg, the DPN provides motor innervation to the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus tertius, and extensor hallucis longus (EHL) muscles. The anterior tarsal tunnel is a fibro-osseous tunnel along the anterior ankle in which the borders include the inferior extensor retinaculum (superficially/roof), medial malleolus (medially), lateral malleolus (laterally), and the talonavicular joint capsule (deep/floor). Contents of the anterior tarsal tunnel include the dorsalis pedis artery/vein, deep peroneal nerve, tibialis anterior tendon, extensor hallucis longus tendon, extensor digitorum longus tendon, and peroneus tertius. The common peroneal nerve receives contributions from the L4 through S2 nerve roots. Symptoms of tarsal tunnel syndrome may include the following: Motor dysfunction as a result of atrophy. Loss of pain. Gait abnormality.
科佩尔和汤普森于1960年首次描述了前跗管综合征（ATTS）。ATTS也被称为腓深神经（DPN）卡压，是一种DPN的压迫性神经病变，最常见的原因是踝关节前方的致密筋膜带，即下伸肌支持带。另外还描述了两个卡压的解剖位置，包括在距舟关节上方的拇长伸肌腱深层以及在第一和第二跗跖关节上方的拇短伸肌深层。腓深神经是腓总神经（CPN）的两个终末分支之一。DPN在小腿前侧间室从CPN分出，沿骨间膜走行。就在踝关节近端，DPN在拇长伸肌腱和趾长伸肌腱之间穿过。然后它分为内侧和外侧终末分支。趾短伸肌和拇短伸肌由DPN的外侧终末分支支配，而内侧分支在足背沿足背动脉走行，纯粹为感觉神经，为第一趾蹼间隙提供神经支配。在小腿前侧，DPN为胫骨前肌（TA）、趾长伸肌（EDL）、第三腓骨肌和拇长伸肌（EHL）提供运动神经支配。前跗管是沿踝关节前方的一个纤维骨性管道，其边界包括下伸肌支持带（浅面/顶部）、内踝（内侧）、外踝（外侧）和距舟关节囊（深面/底部）。前跗管的内容物包括足背动脉/静脉、腓深神经、胫骨前肌腱、拇长伸肌腱、趾长伸肌腱和第三腓骨肌。腓总神经接受来自L4至S2神经根的神经纤维。跗管综合征的症状可能包括以下几种：因萎缩导致的运动功能障碍。疼痛丧失。步态异常。
