title: Intramuscular nerve distribution pattern of ankle invertor muscles in human cadaver using sihler stain.
abstract: BACKGROUND
  We sought to the ideal sites for botulinum toxin injection by examining the intramuscular nerve patterns of the ankle invertors.
  
  
  METHODS
  A modified Sihler method was performed on the flexor hallucis longus, tibialis posterior, and flexor digitorum longus muscles (10 specimens each). The muscle origins, nerve entry points, and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the lateral malleolus (0%) to the fibular head (100%).
  
  
  RESULTS
  Intramuscular arborization patterns were observed at 20-50% for the flexor hallucis longus, 70-80% for the tibialis posterior, and 30-40% for the flexor digitorum longus.
  
  
  CONCLUSIONS
  These findings suggest that treatment of muscle spasticity of the ankle invertors involves botulinum toxin injections in specific areas. These areas, corresponding to the areas of maximum arborization, are recommended as the most effective and safest points for injection.
authors.affiliation: Division in Anatomy and Developmental Biology, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Kyu-Ho
authors.initials: KH
authors.lastname: Yi
authors.affiliation: Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Rha
authors.affiliation: Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Division in Anatomy and Developmental Biology, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Liyao
authors.initials: L
authors.lastname: Cong
authors.affiliation: Division in Anatomy and Developmental Biology, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Hyung-Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Division in Anatomy and Developmental Biology, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Yong-Woong
authors.initials: YW
authors.lastname: Lee
authors.affiliation: Division in Anatomy and Developmental Biology, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Division in Anatomy and Developmental Biology, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Kyung-Seok
authors.initials: KS
authors.lastname: Hu
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle; D001905:Botulinum Toxins / Q000008:administration & dosage; D002102:Cadaver; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy; D018482:Muscle, Skeletal / Q000294:innervation*; D010525:Peripheral Nerves / Q000033:anatomy & histology*
chemical_list: D065087:Acetylcholine Release Inhibitors; D004396:Coloring Agents; D001905:Botulinum Toxins
keywords: Sihler method; botulinum toxin; flexor digitorum longus; flexor hallucis longus; spasticity; tibialis posterior