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Jun 2020 DOI 10.14302/issn.2577-2279.ijha-20-3445
Musa Fadlelmula Awadelseid KhalidCorresponding author
Jazan University, Faculty of Medicine, Anatomy and Embryology Department, Sudan
The passage of the posterior tibial nerve in the tarsal tunnel has a great clinical significance, thus detailed anatomical knowledge is mandatory for safe clinical intervention. This study was to identify the morphological appearance of the tibial nerve and its bifurcation. Sixty lower limbs of formalin embalmed cadavers were randomly selected. Data were collected through the application of standard dissection method of the tarsal tunnel of lower limbs (30 rights and 30 left) of formalin embalmed cadavers. The posterior tibial nerve and its branches were exposed from the distal end of the leg toward plantar surface beyond its bifurcation by resecting the skin and flexor retinaculum. The study triggered several findings: The posterior tibial nerve is flattened shaped in 21 specimens 70% and has a rounded shape in 9 specimens 30%in the right foot. In the left foot it is flattened in 17 specimens 56.7% and rounded shape in 13 specimens 43.3%. Posterior tibial nerve bifurcates into medial and lateral planter nerves inside tarsal tunnel in 20 specimens 66.7% in the right foot and in 21 specimens 70% in the left foot. This study concludes that posterior tibial nerve commonly has flattened shape and divided into medial and lateral planter nerves inside tarsal tunnel.
Sep 2019 DOI 10.14302/issn.2577-2279.ijha-19-3013
Musa Fadlelmula Awadelseid KhalidCorresponding author
Jazan University -Faculty of Medicine, Anatomy &Embryology department, Kingdom of Saudi Arabia –Jazan
The medial calcaneal nerve (MCN) is the first branch of the posterior tibial nerve (PTN) in the porta pedis, enervates the skin of the heel and medial side of the foot. Heel pain is a common condition encountered by physicians, and this may have a significant clinical association with the MCN’s branching pattern. This study was to identify branching pattern variations in the medial calcaneal neurovascular bundle. This study was carried out using 60lower limbs of formalin-embalmed cadavers, using the tarsal tunnel dissection method for 30right and 30 left lower limbs. The medial calcaneal neurovascular bundle course was identified by exposing the PTN and its branches from the distal end of the leg toward the plantar surface beyond its bifurcation and resecting the skin and flexor retinaculum. Many MCN branching pattern variations (specifically concerning origins, numbers, and levels of branching) were observed. In the right foot a single branch was present in 21 specimens (70%), while two branches were observed in nine specimens (30%). In the left foot, a single branch was present in 22 specimens (73.3%) and two branches were present in 8 specimens (26.7%). In this study, two branches originate from lateral planter artery is the most common observation. This study concludes that a single MCN originating from the TN is the most common variant. Two medial calcaneal arteries (MCAs) originating from the LPA is also common.
Jun 2019 DOI 10.14302/issn.2474-3585.jpmc-19-2750
Konadu-Yeboah DominicCorresponding author
Orthopaedic and Trauma Surgeon, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Part-Time Lecturer, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Purpose Foot injuries are common in low- and middle-income countries and continue to increase in incidence due to the surge in the use of motorcycles as means of transport.Yet, there is scanty data on the incidence and outcomes of treatment of open injuries to the foot in the developing world.We aimed to determine the incidence and functional outcomes of open foot injuries that are treated in a teaching hospital in Ghana. Methods We used a structured questionnaire to record the type of open foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the hospital for treatment as well as the type of treatment instituted. Recruited patients were followed up for six months, complications resulting from the injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using a questionnaire-based visual analogue outcome scale of the American Foot and Ankle Society. Regression and chi-square analysis were used to evaluate potential associations. Results Over a four-month period, a total of 81 cases of open injuries to the foot were recorded. Out of this figure, 55 patients (67.9%) were males and 26 (32.1%) were females. It was found, that 66.7% aged between 19 and 49 years, 76.5% of the injuries occurred on the road and 29.7% was motor cycle related. Pedestrians are the most afflicted (61.7%). The treatment outcomes of traumatic amputations, open phalangeal fractures, dorsal skin degloving and lacerations were good. Gustillo-Anderson grade IIIB open fractures with associated plantar skin degloving had the worst outcomes with residual pain on weight bearing, bigger foot, inability to wear previous shoes and inability to tiptoe on the affected foot. Conclusions Open injuries to the foot are common in Ghana and exert a significant health burden, particularly on active young males. Long term disability may occur, even after adequate treatment of open fractures involving the foot.