Abstract
Introduction
Surgical approaches to the dorsum of the foot are common for management of midfoot fracture dislocations and arthritis. The anatomy can be difficult to identify and neurovascular injury can be a serious complication.
Extensor hallucis brevis (EHB) is a consistent and easily identifiable structure encountered in these approaches. This study assesses the close relationship of the EHB musculotendinous junction to the neurovascular bundle for use as a reliable landmark.
Method
The relationship of the medial branch of the deep peroneal nerve (DPN) in the dorsum of the foot to the EHB tendon was examined by dissection of ten adult cadaveric feet preserved in formalin. Using a dorsal approach, the anatomy of the DPN neurovascular bundle was studied relative to its neighbouring structures. Local institutional review board approval was obtained.
Results
The neurovascular bundle runs parallel to the lateral border of extensor hallucis longus (EHL) over the dorsum of the midfoot. Lateral to the neurovascular bundle is the EHB muscle running obliquely towards the first metatarsal. The average length of transition of the musculotendinous junction is 11mm and the neurovascular bundle passes underneath this junction in nine out of ten cases, and through it in one specimen. This junction is directly over the 2nd tarsometatarsal joint.
Discussion
Although a cadaveric study where tissue characteristics are different to those of living tissue, this study has shown that the neurovascular bundle with the medial branch of the deep peroneal nerve and corresponding artery can be identified by finding the musculotendinous junction of the EHB.
