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Anatomical study of the motor branches of the tibial nerve and incision design for hyperselective neurectomy

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Abstract

Purpose

Selective tibial neurotomy (STN) is a surgical procedure for treating spastic equinovarus foot. Hyperselective neurectomy (HSN) of tibial nerve is a modified STN procedure, which was rarely discussed. This study aimed to describe the branching patterns of the tibial nerve and propose an optimal surgical incision of HSN for treatment of spastic equinovarus foot.

Methods

Sixteen lower limbs were dissected to determine the various branching patterns of the tibial nerve and categorized according to these branching patterns. The mean distances from the nerve entry points to the tip of femur’s medial epicondyle were measured, as well as their percentage to the overall length of the leg. The surgical incision was designed according to the range of these nerve entry points.

Results

The tibial nerve sent out proximal and distal motor branches based on their position relative to the soleus muscle’s tendinous arch. For proximal motor branches, the branches innervating the medial gastrocnemius, lateral gastrocnemius and proximal soleus were categorized into types I (9/16), II (5/16) and III (2/16). Measurements from the medial epicondyle to the nerve entry points into the medial gastrocnemius, lateral gastrocnemius and proximal soleus ranged from 14 to 33 mm (4–9% of leg length), 22–45 mm (6–12%) and 35–81 mm (10–22%), respectively. Distal motor branches including the distal soleus, posterior tibialis, flexor digitorum longus and flexor hallucis longus, were classified as types A (8/14), B (4/14) and C (2/14), with the distances from their respective terminal points to the medial epicondyle were 67–137 mm (19–39%), 74–125 mm (20–35%), 116–243 mm (33–69%) and 125–272 mm (35–77%).

Conclusions

The motor branches of tibial nerve were classified into two groups and each subdivided into three types. Detailed location parameters may serve as an anatomical basis for designing incision of HSN.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

STN:

selective tibial neurotomy

HSN:

hyperselective neurectomy

SEF:

spastic equinovarus foot

MHG:

medial head of gastrocnemius muscle

LHG:

lateral head of gastrocnemius muscle

PSM:

proximal soleus muscle

DSM:

distal soleus muscle

PT:

posterior tibialis muscle

FDL:

flexor digitorum longus

FHL:

flexor hallucis longus

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Funding

This work was supported by National Natural Science Foundation of China [grant number 82071406, 82271417 and 82201522] and Program of Shanghai Subject Chief Scientist [grant number 20XD1420700].

Author information

Author notes

  1. Kun Huang and Xuan Ye contributed equally to this work.

Authors and Affiliations

  1. Department of Hand Surgery, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China

    Kun Huang, Shuai Zhu, Yuchen Liu, Fengchi Sun, Xiangmeng Su, Huawei Yin, Wendong Xu & Yundong Shen

  2. Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Fudan University, Shanghai, China

    Kun Huang, Shuai Zhu, Yuchen Liu, Fengchi Sun, Xiangmeng Su, Huawei Yin, Wendong Xu & Yundong Shen

  3. Department of Breast and Thyroid Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Xuan Ye

  4. The National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China

    Huawei Yin, Wendong Xu & Yundong Shen

  5. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China

    Huawei Yin, Wendong Xu & Yundong Shen

  6. NHC Key Laboratory of Hand Reconstruction, Fudan University, Shanghai, China

    Huawei Yin, Wendong Xu & Yundong Shen

  7. Institute of Hand Surgery, Fudan University, Shanghai, China

    Huawei Yin, Wendong Xu & Yundong Shen

Authors
  1. Kun Huang
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Contributions

In this study, each author played a significant role, ensuring the comprehensiveness and integrity of the work. Kun Huang and Yundong Shen were instrumental in the conception and design of the study. The acquisition of data was diligently carried out by Kun Huang and Xuan Ye. These two authors also played a crucial role in analyzing and interpreting the gathered data. Wendong Xu, Yundong Shen, Kun Huang, Shuai Zhu and Yuchen Liu provided substantial surgical technical support, a cornerstone of the study’s practical application. The initial draft of the manuscript was prepared by Kun Huang and Xuan Ye, while Wendong Xu, Yundong Shen, Huawei Yin, Fengchi Sun and Xiangmeng Su made critical contributions to its revision, enhancing its scholarly value. Finally, all authors have given their approval for the manuscript to be submitted, signifying their collective responsibility and endorsement of the work presented.

Corresponding author

Correspondence to Yundong Shen.

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Huang, K., Ye, X., Zhu, S. et al. Anatomical study of the motor branches of the tibial nerve and incision design for hyperselective neurectomy. Surg Radiol Anat (2024). https://doi.org/10.1007/s00276-024-03383-0

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