title: Arterial Anatomy of the Posterior Tibial Nerve in the Tarsal Tunnel.
abstract: BACKGROUND
  Both vascular and compression etiologies have been proposed as the source of neurologic symptoms in tarsal tunnel syndrome. Advancing the understanding of the arterial anatomy supplying the posterior tibial nerve (PTN) and its branches may provide insight into the cause of tarsal tunnel symptoms. The purpose of this study was to describe the arterial anatomy of the PTN and its branches.
  
  
  METHODS
  Sixty adult cadaveric lower extremities (thirty previously frozen and thirty fresh specimens) were amputated distal to the knee. The vascular supply to the PTN and its branches was identified, measured, and described macroscopically (the thirty previously frozen specimens, prepared using a formerly described debridement technique) and microscopically (the thirty fresh specimens, processed using the Spälteholz technique).
  
  
  RESULTS
  On both macroscopic and microscopic evaluation, the PTN and the medial and lateral plantar nerves were observed to have multiple entering vessels within the tarsal tunnel. On microscopic evaluation, a vessel was observed to enter the nerve at the bifurcation of the PTN into the medial and lateral plantar nerves in twenty-two (73%) of the thirty specimens. There was a significant difference (p < 0.05) in vascular density between the PTN and each of its branches.
  
  
  CONCLUSIONS
  The abundant blood supply to the PTN and its branches identified in this study is consistent with observations of other peripheral nerves. This rich vascular network may render the PTN and its branches susceptible to nerve compression related to vascular congestion. The combination of vascular and structural compression may also elicit neurologic symptoms.
  
  
  CONCLUSIONS
  Advancing the understanding of the arterial anatomy supplying the PTN and its branches may provide insight into the cause and treatment of tarsal tunnel syndrome.
authors.affiliation: Department of Orthopaedic Sports Medicine, University of Washington, Seattle, Washington Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri mclairemanske@gmail.com.
authors.forename: Mary Claire
authors.initials: MC
authors.lastname: Manske
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama mckeon.kathleen@gmail.com.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: McKeon
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri mccormickj@wustl.edu.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: McCormick
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri johnsonje@wustl.edu.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri kleins@wustl.edu.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Klein
mesh_terms: D000843:Ankle Joint / Q000033:anatomy & histology / Q000098:blood supply*; D002102:Cadaver; D004210:Dissection; D006801:Humans; D013641:Tarsal Tunnel Syndrome / Q000503:physiopathology*; D013979:Tibial Nerve / Q000098:blood supply*