Unravelling the Anatomy of the Anterior Tarsal Tunnel and Its Clinical Implications

TL;DR

This paper studies the anatomy of the anterior tarsal tunnel to help prevent nerve and blood vessel injuries during ankle surgeries.

Contribution

The study provides detailed anatomical measurements and spatial relationships of structures within the anterior tarsal tunnel.

Findings

The medial border of the anterior tarsal tunnel averaged 31.42 mm, while the lateral border averaged 20.39 mm.

The width of the tunnel increased from the proximal to the distal end.

The deep fibular nerve was found laterally in 15 limbs and medially in five limbs relative to the dorsalis pedis artery.

Abstract

Background: Anterior tarsal tunnel (ATT) syndrome is caused by the compression of the deep fibular nerve (DFN) within the ATT beneath the inferior extensor retinaculum, bounded by the tendons of the extensor hallucis longus (EHL) and extensor digitorum longus (EDL). Compression may result from direct trauma, repetitive mechanical irritation, and thrombosis of the dorsalis pedis artery. Injury to the contents of ATT could occur during ankle arthroscopy. Therefore, this study was undertaken to provide a detailed description of the anatomy of the ATT and its clinical implications.

Materials and methods: Ten formalin-fixed cadavers were utilized for the study. The ATT was identified between the tendons of the EHL and EDL. The length at the medial and lateral boundaries and the width at the proximal end, middle, and distal end of the ATT were measured using a digital Vernier calliper.

Result: The mean length of the medial border of the tunnel was 31.42±8.44 mm, while the lateral border was 20.39±4.39 mm. The width of the ATT increased from the proximal to the distal end. DFN was related to the DPA laterally in 15 limbs and medially in five limbs within the tunnel.

Conclusion: The present study not only describes the intricate anatomy of the ATT but also describes the patterns of DFN and DPA within the tunnel. Understanding the anatomy of ATT is crucial, as it paves the way for safe and efficient surgical interventions, thereby significantly reducing the risk of neurovascular damage during surgical procedures.

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