Needle insertion into the tibialis posterior: ultrasonographic evaluation of an anterior approach.
OBJECTIVE
To investigate the ultrasonographic anatomy of the lower leg for safe and accurate needle placement into the tibialis posterior using the anterior approach.


METHODS
Cross-sectional study.


METHODS
University rehabilitation hospital.


METHODS
Healthy volunteers (N=62; 30 men, 32 women).


METHODS
Not applicable.


METHODS
The safety window (the tibia to the neurovascular bundle) and the depth to the midpoint of the safety window (skin to the tibialis posterior) at the upper third and the midpoint of the tibia were measured with a transverse ultrasonographic scan.


RESULTS
The safety window at the upper third of the tibia was significantly larger than that at the midpoint (P<.01). The safety window ranged from .64 cm to 2.13 cm at the upper third tibialis point and from .32 cm to 1.30 cm at the midpoint. The depth to the tibialis posterior at the upper third of the tibia was significantly deeper than that in the midpoint (P<.01). The depth ranged from 2.47 cm to 4.66 cm at the upper third tibias point and from 2.35 cm to 4.28 cm at the midpoint.


CONCLUSIONS
Ultrasonography is a useful tool in measuring the safety window and the depth to the tibialis posterior using the anterior approach. Considering the safety window, we suggest the needle placement at the upper third point of tibia rather than that at the midpoint.
Rha
Dong-Wook
DW
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Im
Sang Hee
SH
Lee
Sang Chul
SC
Kim
Seong-Kyun
SK
D000328:Adult; D003430:Cross-Sectional Studies; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007267:Injections; D007866:Leg / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D009339:Needles; D012016:Reference Values; D013710:Tendons / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D013979:Tibial Nerve / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult