Lateromedial and dorsoplantar borders among supplying areas of the nerves innervating the intrinsic muscles of the foot

The branching patterns of nerves supplying the intrinsic muscles of the foot were analyzed as a basis to confirm the muscle layer structure. Thirty‐eight feet of 20 Japanese cadavers were examined in detail in this study. The first dorsal interosseus was innervated by a branch from the deep peroneal nerve as well as a branch of the lateral plantar nerve in 92.1%, the second dorsal interosseus in 10.5% and the third dorsal interosseus in 2.6%. In three specimens, branches from the deep peroneal nerve innervated the oblique head of the adductor hallucis or the lateral head the flexor hallucis brevis. In addition, branches from the medial and lateral plantar nerves and the deep peroneal nerve formed communication loops in three specimens. The first dorsal interosseus, the oblique head of the adductor hallucis and the lateral head of the flexor hallucis and their innervating nerve branches are closely related within the first intermetatarsal space. Since the tibial part of the first interosseus muscle primordium is occupied in the space during development, the variations of innervation patterns and formation of the communicating nerve loops may be explained by various combinations of the part and the other muscle primordia. Anat Rec 255:465–470, 1999. © 1999 Wiley‐Liss, Inc.     

足底内侧和外侧群肌的肌内神经整体分布模式及临床意义

目的 揭示足底内侧和外侧群肌的肌内神经整体分布模式,探讨其临床意义.方法 24具成年尸体,完整取下足底内侧和外侧群肌,采用改良Sihler染色显示肌内神经分布模式.结果 (足母)收肌的神经支从肌止端的深面入肌,而(足母)展肌、(足母)短屈肌、小趾展肌和小趾短屈肌的神经支常从肌起端的深面入肌.(足母)展肌中有1个半月形和...     

Ramification pattern of the deep branch of the lateral plantar nerve in the human foot

To understand how the oblique and transverse heads of the adductor hallucis muscle of the human foot are phylogenitically and ontogenetically developed, it is essential to know nerve supplies of these two heads of the muscle. In the present study, we dissected seven feet of five Japanese cadavers in detail to clarify the ramification patterns of the deep branch of the lateral plantar nerve by peeling off its epineurium (the nerve fascicle analysis method). We found that the muscular branch to the oblique head of the adductor hallucis muscle directly separated from nerve fascicles constituting the deep branch of the lateral plantar nerve, whereas the muscular branch to the transverse head arose in common with branches which innervated other intrinsic muscles of the foot, i.e., the 2nd and 3rd lumbrical muscles and the 1st and 2nd dorsal interossei muscles. The present study revealed that two heads of the adductor hallucis muscle, the oblique and transverse, had different innervating patterns, suggesting that two heads of the human adductor hallucis muscle develop from different primordia, and not from common ancestors.     

Intramuscular nerve distribution pattern of the oblique and transverse heads of the adductor hallucis muscles in the human foot

To understand which layer of the intrinsic muscles of the foot the adductor hallucis muscle belongs to, it is essential to investigate the innervation patterns of this muscle. In the present study, we examined the innervation patterns of the adductor hallucis muscles in 17 feet of 15 Japanese cadavers. We investigated the intramuscular nerve supplies of the adductor hallucis muscles in six feet and performed nerve fiber analysis in three feet. The results indicate that: (i) the oblique head of the adductor hallucis muscle is divided into three compartments (i.e. lateral, dorsal and medial parts) or two compartments (i.e. dorsal and medial parts) based on its intramuscular nerve supplies, but we could not classify the transverse head into any parts; (ii) the communicating twig between the lateral and medial plantar nerves penetrated the oblique head of the adductor hallucis muscle in 13 of 17 feet (76.5%); (iii) the penetrating twig entered between the lateral and dorsal parts of the oblique head, passed between the lateral and medial parts of this muscle and then connected with the medial plantar nerve; and (iv) the majority of the nerve fibers of the penetrating twig derived from the lateral plantar nerve. The present study demonstrated that only the lateral part of the oblique head of the adductor hallucis muscle had a unique innervating pattern different from other parts of this muscle, suggesting that the lateral part of the oblique head has a different origin from other parts of this muscle.     

足底的血管构筑与跖弓皮瓣、肌皮瓣对足跟缺损的修复

目的：用跖弓皮瓣、肌皮瓣足跟缺损、提供足底三套血管网分布特点的解剖学依据。方法：在２０例福尔马林、４例红色乳胶灌注的成人尸体标本上、观察足底内、外侧动脉的起始、行径、分支及其吻合情况。结果：足底共有三套血管网供血：１．足底内侧动脉的内、外侧支在嘴展肌深面分支分布,形成足底内侧血管网。２．足底内侧动脉外侧支与足底外侧动脉的分支在足底腱膜与趾短屈肌之间吻合形成足底浅弓。３．足底内侧动脉的内侧支与足底外     

The innervation of the joints of the foot

The nerve supply of the ankle joint and of the joints of the foot was studied in dissections of fetal and adult feet and in serial sections of fetal feet stained with silver. The ankle joint was supplied by the tibial, sural, deep peroneal, and saphenous nerves, and by the accessory deep peroneal nerve when present. The tarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves, and on their dorsal aspects chiefly by the deep peroneal nerve. The joint between the lateral and intermediate cuneiform received branches from the intermediate dorsal cutaneous nerve also. The lateral dorsal cutaneous nerve and the accessory deep peroneal nerve when present provided additional branches to the subtalar and calcaneocuboid joints. The tarsometatarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves. Most of them were supplied on their dorsal aspects by the deep peroneal nerve, but the cuboid-metatarsal joints received their supply from the intermediate dorsal cutaneous nerve. The intermetatarsal joints had a similar but sparser supply. The joint between the fourth and fifth metatarsal received branches from the intermediate dorsal cutaneous nerve. The plantar digital nerves provided the main supply to the metatarsophalangeal joints. The dorsal aspect of the first metatarsophalangeal joint was supplied by the deep peroneal and the medial dorsal cutaneous nerves, of the second metatarsophalangeal joint by the deep peroneal nerve, and of the fourth and fifth metatarsophalangeal joints by the lateral dorsal cutaneous nerve. The interphalangeal joints did not receive articular branches from the dorsal digital nerves, except in the case of the interphalangeal joint of the big toe, which was supplied by the deep peroneal and the medial dorsal cutaneous nerves.     

Pseudoganglion on the connecting branch between the deep branch of the lateral plantar nerve and medial plantar nerve

The connecting branch between the deep branch of the lateral plantar nerve and medial plantar nerve often has an enlarged site. We investigated these enlarged sites of the connecting branches. We observed the 22 human feet of 20 Japanese cadavers. We investigated the connecting branch macroscopically and histologically. We found the connecting branches between the deep branch of the lateral plantar nerve and medial plantar nerve in 19 feet out of 22 feet. This connecting nerve branch was interposed between the tendon of the flexor hallucis longus and the flexor hallucis brevis, and there enlarged in the anteroposterior direction. After penetration, numbers of fascicles of this connecting branch were increased at the enlarged site. In this region, the connective tissues surrounding the nerve fascicles and vessels were more developed compared with the adjoining sides of this branch. A few fascicles at this enlarged site innervated the first metatarsophalangeal joint capsule. Other nerve fascicles arose from the connecting branch and branched off muscular branches to the flexor hallucis brevis. This branch possibly receives the physical exertion or friction during gait due to its position. Deformity and overload of the foot can cause sensory disorders of the foot, but the anatomical basis for the relationship between the deformity/overload and sensory disorders of the foot is unclear. We discussed that this connecting branch can be a potential cause of pressure neuropathies in the human foot.     

足底中间群肌和足背肌肌内神经整体分布模式及意义

目的 揭示足底中间群和足背肌的肌内神经整体分布模式，探讨其意义。 方法 取下12具经福尔马林固定的成人尸体足底中间群肌和足背肌，改良的Sihler’s染色法显示肌内神经整体分布模式。 结果 接受足底内侧神经支配的趾短屈肌、第1和第2蚓状肌的神经支，分别从肌的内侧深面和浅面入肌；接受足底外侧神经支配的足底方肌、第3和第4蚓状肌的神经支从肌止端走向起端；骨间足底肌和骨间背侧肌的神经支从肌起端走向止端。趾短伸肌和母短伸肌的神经支共干。蚓状肌、第1和第2骨间足底肌、第1骨间背侧、母短伸肌和趾短伸肌仅在肌腹中部形成1个肌内神经密集区；趾短屈肌、足底方肌、第3骨间足底肌以及第2~4骨间背侧肌有2个肌内神经密集区，位于肌腹两侧，这些肌可分为2个神经肌亚部。 结论 这些结果可为外科手术免于神经损伤、肌移植的选材匹配，以及注射肉毒毒素A阻滞这些肌的痉挛提供形态学指导。     

Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study

Traction injuries of the common fibular (peroneal) nerve frequently result in significant morbidity due to tibialis anterior muscle paralysis and the associated loss of ankle dorsiflexion. Because current treatment options are often unsuccessful or unsatisfactory, other treatment approaches need to be explored. In this investigation, the anatomical feasibility of an alternative option, consisting of nerve transfer of motor branches from the tibial nerve to the deep fibular nerve, was studied. In ten cadaveric limbs, the branching pattern, length, and diameter of motor branches of the tibial nerve in the proximal leg were characterized; nerve transfer of each of these motor branches was then simulated to the proximal deep fibular nerve. A consistent, reproducible pattern of tibial nerve innervation was seen with minor variability. Branches to the flexor hallucis longus and flexor digitorum longus muscles were determined to be adequate, based on their branch point, branch pattern, and length, for direct nerve transfer in all specimens. Other branches, including those to the tibialis posterior, popliteus, gastrocnemius, and soleus muscles were not consistently adequate for direct nerve transfer for injuries extending to the bifurcation of the common fibular nerve or distal to it. For neuromas of the common fibular nerve that do not extend as far distally, branches to the soleus and lateral head of the gastrocnemius may be adequate for direct transfer if the intramuscular portions of these nerves are dissected. This study confirms the anatomical feasibility of direct nerve transfer using nerves to toe-flexor muscles as a treatment option to restore ankle dorsiflexion in cases of common fibular nerve injury.     

足部相关肌肉、肌腱组织材料弹性模量的测定

背景：目前,几乎所有足部三维有限元模型的材料参数均来自国外研究,尚未见有关国人组织材料参数的测量与报道。 目的：对国人足部的相关肌肉、肌腱材料做测量,获得初步的参数数据。 方法：解剖成年女性左小腿足新鲜标本拇长屈肌及其肌腱、拇短屈肌内外侧头、拇长伸肌及其肌腱、拇收肌横头及斜头、拇展肌,分别测量和计算各试样的截面积和位于夹具之间的长度并记录数值,将标本加载载荷,1个测样反复测量4次,采集强度极限、最大载荷等数据,以及载荷-位移曲线。根据胡克定律,计算各标本的弹性模量。 结果与结论：共得到了包括拇长伸肌、拇长屈肌、拇收肌、拇展肌横头和斜头、拇短屈肌内外侧头、拇长屈肌腱、拇长伸肌腱9个样本的相关测量数据,主要包括长度、宽度、厚度、横截面积、最大载荷、强度极限和弹性模量。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

吻合血管神经第1跖趾关节移植重建肘关节的解剖学基础

目的：为吻合血管神经第1跖趾关节移植重建肘关节提供解剖学基础。法：20侧灌注红色乳胶的成人下肢标本解剖观察第1跖趾关节的血管神经分布及关节的构造，24只足部动脉铸型标本对关节支作对照观察。结果：第1跖趾关节的血供有背胫侧、背腓侧，跖胫侧、踊腓侧和关节后5部分关节支，腓侧关节支多和粗于胫侧，关节支外径0．3～0．5mm。关节支发自第1跖背动脉、腓侧趾背动脉、第1跖底动脉、趾底动脉和横动脉近侧支。关节的神经支与动脉相似，主要发自腓深神经、腓浅神经内侧支、第1趾足底总神经和趾底固有神经。结论：吻合血管神经的第1跖趾关节移植适用于修复重建单纯性肘关节缺损或强直，供区移植骨融合对足的外形功能影响不大。     

Sural--lateral plantar nerve communications in Japanese macaque

It is generally accepted that the sural nerve in humans contains exclusively sensory and autonomic fibers. Recently, however, a few clinical reports have suggested that the human sural nerve contains motor fibers. On the other hand, it is known that motor fibers are present in the sural nerve of rats and dogs, and that the fibers reach intrinsic muscles of the foot via a communicating branch to the lateral plantar nerve. The author investigated the communicating branch between the sural and lateral plantar nerves in Japanese macaques, and examined both nerves by the fiber analysis method, removing the perineurium under a stereoscopic microscope. The communicating branch was found in all examined macaques. Nerve fibers which derived from the sural nerve via the branch reached the abductor digiti quinti, the flexor digiti quinti brevis, the contrahentes digitorum, the adductor hallucis, the interosseous and the lumbrical muscles. Furthermore, these fibers supplied the lateral part of the skin of the sole and the metatarsophalangeal joints. These findings in the Japanese macaques suggest that we may encounter the communicating branch between the sural and lateral plantar nerves in other primates including humans as in rats and dogs.     

Innervation of the abductor digiti minimi muscle of the human foot: anatomical basis of the entrapment of the abductor digiti minimi nerve

The origin, relationships and innervation of the abductor digiti minimi muscle were determined in 145 human feet, from formaldehyde-fixed cadavers. The muscle arises from both processes of the calcaneal tuberosity, from the plantar aponeurosis and from the septum which separates it from the flexor digitorum brevis muscle. The nerve to the abductor digiti minimi muscle arises next to the origin of the lateral plantar nerve, close to the abductor hallucis muscle, and descends becoming closely related to the medial face of the calcaneus and the deep face of the abductor hallucis muscle. Then, it passes inferiorly through the origin of the quadratus plantae muscle and later divides into two branches for the two heads of the muscle.     

First dorsal interosseous muscle of the foot and its innervation

During dissection of the foot region, it is frequently found that some nerve branches run close to the tibial surface of the second metatarsal bone. To investigate the nerve branches, detailed dissection of the first dorsal interosseous muscle was performed in 10 Japanese adult feet with special reference to its innervation. In all specimens the muscle was clearly separated into lateral and medial parts. The branches ran between these parts and innervated the parts. The small dorsal region of the medial part of the muscle was also innervated by a branch of the deep peroneal nerve. Based on its innervation, the muscle appears to be composed of two elements from the flexores breves profundi and an element from the dorsal primordium. A possible schematic model of the origins of this muscle is proposed. Clin. Anat. 12:12–15, 1999. © 1999 Wiley‐Liss, Inc.     

Dimensions of the anterior tarsal tunnel and features of the deep peroneal nerve in relation to clinical application

Background The aim of this study was to demonstrate anatomical features of the anterior tarsal tunnel and the deep peroneal nerve and to discuss the importance of these structures for the anterior tarsal tunnel syndrome and some other surgical approaches to minimize the injury risk. Methods Lower limbs of 18 formalin fixed cadavers were examined. The limbs showed no evidence of pathology or trauma. Results The lateral length of the tunnel was 21.7 ± 4.3 mm and the medial length of the tunnel was 55.0 ± 9.0 mm. The width of the tunnel at the inferior border between the extensor hallucis longus and extensor digitorum longus tendons was 12.6 ± 2.1 mm. The location of the deep peroneal nerve bifurcation was in the anterior tarsal tunnel in 31 specimens (86.1%) and distal to the tunnel in two specimens (5.6%). In three specimens (8.3%) there was no bifurcation because of the absence of the medial terminal branch of the deep peroneal nerve. In these three specimens, the superficial peroneal nerve distributed to the adjacent sides of the great and second toes. Bifurcation above the tunnel was not observed in our specimens. There was connection between the deep peroneal nerve and the superficial peroneal nerve in 10 specimens (27.8%) in the first interdigital space. During the observations, the presence of a fibrous band over the nerve and vessel was noted in 22 specimens (61.1%). Conclusions We believe that a detailed anatomic knowledge of the anterior tarsal tunnel and the deep peroneal nerve will be of help during surgical approaches to this area and the diagnosis of the problems related to the peripheral nerves on the dorsum of the foot. This study was presented on the 4th Asian-Pacific International Congress of Anatomists (APICA 2005) in Kusadasi, Turkey on 7-10 September 2005.     

第一跖底动脉的外科解剖

目前第二趾移植和(?)趾甲皮瓣移植重建手功能的术式,常采用足背动脉与第一跖背动脉为血管蒂。但该血管蒂常有变异,据临床的实践经验,改用第一跖底动脉是一种可行的方法。但分离第一跖底动脉难度较大,故在55例足标本和13例血管铸型标本上观察了第一跖底动脉有关的外科解剖,讨论了利用第一跖底动脉的应用解剖学要点。     

Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle

The abductor hallucis muscle flap is commonly used as a proximally-based flap in the management of ankle, heel, and midfoot lesions, where it is ideally suited for closing defects. This study investigates the anatomical details of this muscle in 13 fresh male cadavers. The medial plantar artery (MPA) was studied by dissection and macroscopic analyses to document the relationship of its superficial and deep branches with respect to the abductor hallucis muscle (AHM). Three main patterns could be described. In Pattern A (54%) the MPA divides into two branches. The deep branch reaches the deep surface of the AHM, supplying its proximal part, and the superficial branch courses between the AHM and the flexor digitorum brevis, to end as the first plantar metatarsal artery. The latter supplies two to three small branches to the distal part of the AHM. The fibers of the AHM end symmetrically on the two sides of the tendon and the muscle presents an arciform shape. The MPA, in Pattern B (38%), lacks a deep branch and continues along the lateral border of the AHM as a superficial branch that supplies proximal and distal collaterals to the muscle. The muscle fibers of the AHM end mainly on the medial side of the tendon. The muscle belly presents an arciform shape and is located on the medial margin of the foot superomedially with respect to Pattern A. In Pattern C (8%) the MPA continues as a large deep branch on the deep surface of the AHM and ends as the medial collateral artery of the big toe. A smaller superficial branch of the MPA provides a few collaterals to the AHM from its proximal part and to the flexor digitorum brevis in its distal part. The AHM fibers end mainly on the lateral side of the tendon and morphologically the muscle presents a straight line on the sole of the foot compared to Pattern A. Although Patterns B and C, from a surgical point of view, necessitate interruption of the main trunk of the MPA, Pattern A may permit the vascularization of the muscles of the medial side of the sole of the foot by the superficial trunk of the MPA. Because preoperative radiological study of the plantar vessels correlate with the morphological characteristics of the AHM observed during surgery, such imaging may be useful in determining the appropriate flap design based on the patient's unique pattern of MPA branching.     

人鱼际肌的肌内神经分支分布和肌梭密度研究

目的探索鱼际肌肌肌内神经分支和肌梭密度的分布。方法采用改良Sihler’s肌内神经染色法和HE染色法进行解剖学研究。结果鱼际肌的神经常从肌起端深面入肌,神经入肌后在拇短展肌、拇对掌肌、拇收肌横头内与肌长轴垂直走向,拇收肌斜头和拇短屈肌内沿肌长轴平行走形。80%～82.5%的拇短屈肌和拇指对掌肌接受正中神经和尺神经的双重支配。拇短屈肌浅头和深头、拇收肌横头和斜头有独立的神经支配,可分出神经肌肉亚部。4块肌内神经分支分布密集区多在肌的中部与近端,可见"Y"、"O"、"H"或"U"型等不同的神经吻合形式。鱼际肌肌梭密度高达16.19～27.14个/g,高低顺序为拇指对掌肌拇短屈肌拇短展肌拇收肌。结论鱼际肌肌内神经吻合丰富,肌梭密度高,除拇对掌肌外,其余肌块可作整肌或半肌移植的供体。     

Anatomical study of human adductor hallucis muscle with respect to its origin and insertion

The adductor hallucis muscle (ADH) is evolutionally and functionally important, but no detailed morphological data about this muscle in the human body is available. In the present study, we examined the origin and insertion of the oblique and transverse heads of the ADH. Forty-five feet (20 right, 25 left) of 34 cadavers (13 men, 21 women, average age of 80 years old) were used in the present study. The origin, insertion and nerve supplies of the oblique and transverse heads of the ADH were macroscopically examined in detail. Most commonly, the oblique head of the ADH arose from the bases of the 2nd, 3rd and 4th metatarsal bones, the plantar metatarsal ligaments spanned between the bases of the 2nd, 3rd and 4th metatarsal bones, the lateral cuneiform bone, the fibrous sheath of the tendon of the peroneus longus muscle and the long plantar ligament, and inserted into the lateral sesamoid bone of the great toe and the capsule of the 1st metatarsophalangeal joint. Most commonly, the transverse head of the ADH originated from the capsules of the 3rd and 4th (and occasionally 5th) metatarsophalangeal joint and the deep transverse metatarsal ligaments, and inserted into the lateral sesamoid bone of the great toe, the capsule of the 1st metatarsophalangeal joint and lateral surface of the base of the 1st proximal phalanx. This muscle was classified into four types based on the origin of its oblique head and was classified into three types based on the origin of its transverse head. The percent ratio of the weight of the oblique head to the total weight of all the intrinsic muscles of the foot was 9.4% ± 1.5, and the transverse head was 1.5% ± 0.6 (n = 14). The transverse head of ADH tends to be reduced in size in the human, but the oblique head is well developed with no sign of reduction.