Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Clin Anat. 2019 Oct;32(7):877-882. doi: 10.1002/ca.23381. Epub 2019 Apr 15.
The relationship between the plantar nerves and internal fascial structure of the calcaneal tunnel is clinically important to alleviate pain of the sole. The study aimed to investigate the three-dimensional (3D) anatomy of the calcaneal tunnel and its internal fascial septal structure by using microcomputed tomography (mCT) with a phosphotungstic acid preparation, histologic examination, and ultrasound-guided simulation. Twenty-one fixed cadavers and three fresh-frozen cadavers (13 men and 11 women, mean age 82.1 years at death) were used in this study. The 3D images of the calcaneal tunnel harvested by mCT were analyzed in detail. Modified Masson trichrome staining and serial sectional dissection after ultrasound-guided injection were conducted to verify the 3D anatomy. Within the calcaneal tunnel, the interfascicular septum (IFS) commenced proximal to the malleolar-calcaneal line and distal to the bifurcation of the tibial nerve into the plantar nerves. The medial and lateral plantar nerves were separated by the IFS, which divided the calcaneal tunnel into two compartments. The plantar nerves were ramified into two or three branches within each compartment. The IFS terminated around the talocalcaneonavicular joint, and the plantar nerves traveled into the sole. Clinical manipulation of the plantar nerves should be performed in consideration of the fact that they are clearly separated by the IFS. Clin. Anat. 32:877-882, 2019. © 2019 Wiley Periodicals, Inc.
足底神经与跟骨管内内部筋膜结构的关系对缓解足底疼痛具有重要的临床意义。本研究旨在通过使用微计算机断层扫描（mCT）结合磷钨酸制剂、组织学检查和超声引导模拟，研究跟骨管及其内部筋膜隔结构的三维（3D）解剖结构。本研究共使用了 21 具固定尸体和 3 具新鲜冷冻尸体（男性 13 名，女性 11 名，死亡时的平均年龄为 82.1 岁）。详细分析了 mCT 采集的跟骨管的 3D 图像。对 3D 解剖结构进行了改良的 Masson 三色染色和超声引导注射后的连续分段解剖验证。在跟骨管内，筋膜隔（IFS）起始于距踝跟线近端，止于胫神经分叉为足底神经处。内侧和外侧足底神经由 IFS 分隔，将跟骨管分为两个隔室。足底神经在每个隔室内分为两支或三支分支。IFS 终止于跟距舟关节周围，足底神经进入足底。在对足底神经进行临床操作时，应考虑到它们是由 IFS 明确分隔的这一事实。临床解剖学 32:877-882, 2019。© 2019 Wiley Periodicals, Inc.
