Abstract：
OBJECTIVE: To determine whether high-resolution ultrasound (US) can identify the course and relations of the medial calcaneal nerve (MCN).
METHODS: This investigation was initially undertaken in eight cadaveric specimens and followed by a high-resolution US study in 20 healthy adult volunteers (40 nerves) by two musculoskeletal radiologists in consensus. The location and course of the MCN as well as its relationship to adjacent anatomical structures were evaluated.
RESULTS: The MCN was consistently identified by US along its entire course. The mean cross-sectional area of the nerve was 1 mm2 (range 0.5-2). The level at which the MCN branched from the tibial nerve was variable, located a mean of 7 mm (range - 7-60) proximal to the tip of the medial malleolus. At the level of the medial retromalleolar fossa, the MCN was located inside the proximal tarsal tunnel a mean of 8 mm (range 0-16) posterior to the medial malleolus. More distally, the nerve was depicted in the subcutaneous tissue at the surface of the abductor hallucis fascia with a mean direct distance to the fascia of 1.5 mm (range 0.4-2.8).
CONCLUSIONS: High-resolution US can identify the MCN at the level of the medial retromalleolar fossa, as well as more distally in the subcutaneous tissue at the surface of the abductor hallucis fascia. In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of nerve compression or neuroma, and perform selective US-guided treatments.
CONCLUSIONS: In the setting of heel pain, sonography is an attractive tool for diagnosing compression neuropathy or neuroma of the medial calcaneal nerve, and enables the radiologist to perform selective image-guided treatments such as diagnostic blocks and injections.
CONCLUSIONS: • The MCN is a small cutaneous nerve which rises from the tibial nerve in the medial retromalleolar fossa to the medial side of the heel. • The MCN can be depicted by high-resolution ultrasound along its entire course. • In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of neuroma or nerve entrapment, and perform selective ultrasound-guided treatments such as steroid injection or tarsal tunnel release.
METHODS: This investigation was initially undertaken in eight cadaveric specimens and followed by a high-resolution US study in 20 healthy adult volunteers (40 nerves) by two musculoskeletal radiologists in consensus. The location and course of the MCN as well as its relationship to adjacent anatomical structures were evaluated.
RESULTS: The MCN was consistently identified by US along its entire course. The mean cross-sectional area of the nerve was 1 mm2 (range 0.5-2). The level at which the MCN branched from the tibial nerve was variable, located a mean of 7 mm (range - 7-60) proximal to the tip of the medial malleolus. At the level of the medial retromalleolar fossa, the MCN was located inside the proximal tarsal tunnel a mean of 8 mm (range 0-16) posterior to the medial malleolus. More distally, the nerve was depicted in the subcutaneous tissue at the surface of the abductor hallucis fascia with a mean direct distance to the fascia of 1.5 mm (range 0.4-2.8).
CONCLUSIONS: High-resolution US can identify the MCN at the level of the medial retromalleolar fossa, as well as more distally in the subcutaneous tissue at the surface of the abductor hallucis fascia. In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of nerve compression or neuroma, and perform selective US-guided treatments.
CONCLUSIONS: In the setting of heel pain, sonography is an attractive tool for diagnosing compression neuropathy or neuroma of the medial calcaneal nerve, and enables the radiologist to perform selective image-guided treatments such as diagnostic blocks and injections.
CONCLUSIONS: • The MCN is a small cutaneous nerve which rises from the tibial nerve in the medial retromalleolar fossa to the medial side of the heel. • The MCN can be depicted by high-resolution ultrasound along its entire course. • In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of neuroma or nerve entrapment, and perform selective ultrasound-guided treatments such as steroid injection or tarsal tunnel release.
摘要：
目的：确定高分辨率超声（US）是否可以识别跟内侧神经（MCN）的病程和关系。
方法：这项研究最初是在8个尸体标本中进行的，随后由两名肌肉骨骼放射科医师在20名健康成年志愿者（40条神经）中进行了一项高分辨率的美国研究。评估了MCN的位置和走向及其与相邻解剖结构的关系。
结果：MCN在整个过程中始终被US识别。神经的平均横截面积是1mm2(范围0.5-2)。MCN从胫神经分支的水平是可变的，位于内踝尖端近端平均7毫米（范围-7-60）。在内踝后窝的水平，MCN位于胫骨近端隧道内,内踝后方平均8mm(范围0-16).更远端，神经描绘在外展肌筋膜表面的皮下组织中，与筋膜的平均直接距离为1.5mm（范围0.4-2.8）。
结论：高分辨率US可以识别内踝后窝水平的MCN，以及更远的外展肌筋膜表面的皮下组织。在脚跟疼痛的背景下，MCN课程的精确超声成像可以使放射科医生能够诊断神经压迫或神经瘤，并进行选择性美国指导的治疗。
结论：在足跟疼痛的情况下，超声检查是诊断内侧跟神经压迫性神经病或神经瘤的有吸引力的工具，并使放射科医师能够执行选择性的图像引导治疗，例如诊断块和注射。
结论：•MCN是一种小的皮神经，从内踝后窝的胫神经上升到足跟内侧。•MCN可以在其整个过程中通过高分辨率超声来描绘。•在脚跟疼痛的设置，MCN课程的精确超声成像可以使放射科医生能够诊断神经瘤或神经卡压，并进行选择性超声引导治疗，如类固醇注射或tar骨隧道释放。
方法：这项研究最初是在8个尸体标本中进行的，随后由两名肌肉骨骼放射科医师在20名健康成年志愿者（40条神经）中进行了一项高分辨率的美国研究。评估了MCN的位置和走向及其与相邻解剖结构的关系。
结果：MCN在整个过程中始终被US识别。神经的平均横截面积是1mm2(范围0.5-2)。MCN从胫神经分支的水平是可变的，位于内踝尖端近端平均7毫米（范围-7-60）。在内踝后窝的水平，MCN位于胫骨近端隧道内,内踝后方平均8mm(范围0-16).更远端，神经描绘在外展肌筋膜表面的皮下组织中，与筋膜的平均直接距离为1.5mm（范围0.4-2.8）。
结论：高分辨率US可以识别内踝后窝水平的MCN，以及更远的外展肌筋膜表面的皮下组织。在脚跟疼痛的背景下，MCN课程的精确超声成像可以使放射科医生能够诊断神经压迫或神经瘤，并进行选择性美国指导的治疗。
结论：在足跟疼痛的情况下，超声检查是诊断内侧跟神经压迫性神经病或神经瘤的有吸引力的工具，并使放射科医师能够执行选择性的图像引导治疗，例如诊断块和注射。
结论：•MCN是一种小的皮神经，从内踝后窝的胫神经上升到足跟内侧。•MCN可以在其整个过程中通过高分辨率超声来描绘。•在脚跟疼痛的设置，MCN课程的精确超声成像可以使放射科医生能够诊断神经瘤或神经卡压，并进行选择性超声引导治疗，如类固醇注射或tar骨隧道释放。
