Applied anatomy of the posterior tibial nerve in the tarsal tunnel

Objective:To provide anatomic basis for the treatment of tarsal tunnel syndrome and heel pain.Methods:The course,branches of posterior tibial nerve in the tarsal tunnel were observed on 15 adult cadaver specimens,the gliding distance of tibial nerve were measured at the same time.Results:The posterior nerve were divided into two plantar medial nerve and plantar lateral nerve at 3 cm beneath the medial malleolus,then enter the plantar region of the foot,innervate the skin and intrinsic muscles.A small portion of tibial nerve divided into two branches in the superior medial malleolus.one or two branches(medial calcaneus nerve)were originated from the tibial nerve at about 1 cm beyond the medial malleolus,descending under the skin or deep fascia,entering the fat pad of the plantar region and calcaneus,dividing into branches like tree along its or their course.When the ankle joint moved passively the tibial nerve can gliding 5～ 12.5 mm (averaged 8.2 mm) in the tarsal tunnel.Conclusion:The tibial nerve and its main branches should be neurolysed thoroughly,entrapment of the medial calcaneus nerve may be related with the painful heel,local injection,neurolysis or ramisectomy could be advocated for the persistent painful heel.