Iatrogenic injury to subcutaneous nerves on the dorsum of the foot is an established risk factor during the surgical procedures resulting in postoperative pain, sensation loss and painful neuroma. Previous studies have reported on the distribution pattern of the superficial peroneal, deep peroneal and sural nerves (SNs) and their branches with various classifications about specific populations. The purpose of the present study was to evaluate the distribution pattern and classification of the nerves on the dorsum of the foot and analyze the location of these nerves into five zones with clinical implications. Fifty-four lower limbs of fresh frozen cadavers were used in the present study. The anatomical patterns of the superficial peroneal, deep peroneal, SN and their branches were classified into eight, two and five patterns respectively. Type VI pattern, a classic distribution pattern of the superficial peroneal nerve was the most frequent type with a prevalence of 13 limbs (25.00%). In Zone 5, where the arthroscopic portal placements for the first metatarsophalangeal joint arthrodesis, 29 limbs (55.77%) showed three nerve branches located in this zone. The results of the present study provide anatomical knowledge that may help the surgeon to choose the appropriate treatment for their patients and reducing the rate of complications in surgery.

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The purpose of this study was to evaluate the attachment areas of the posterior talofibular ligament (PTFL) on the posterolateral tubercle of the talus and the remaining PTFL attachment areas after consequential bony excision. Methods: Thirty fresh cadaveric ankles were dissected to study the proximal and distal attachment of the PTFL and separated the PTFL into anterior and posterior bundles. The description of the PTFL footprint and the anatomic landmarks from the surrounding structures were analyzed during consequential posterolateral bony excision. Results: The average PTFL dimension was 26.11 mm (length), 7.65 mm (width), and 1.82 mm (thickness). The footprint area of the PTFL on the talar site consists of the posterior bundle (76.82%) and the anterior bundle (23.18%). If posterolateral tubercle excision was stayed up to a line of a bottom of the flexor hallucis longus (FHL) groove, at least 89% of the PTFL can be preserved. Conclusion:The posterior bundle of the PTFL is the main bundle on the talar footprint area. To maintain the majority of the attachment of the PTFL, the resection of the posterolateral process could be performed to the bottom of the FHL tendon groove. If resection reaches to the posterior articular cartilage, less than 50% of the PTFL will be preserved. Understanding the footprint of the PTFL plays a key role in posterior ankle impingement surgery. Clinical Relevance: This study provides guidance for resection of the posterolateral tubercle of the talus and a portion of the PTFL attachment for posterior ankle impingement syndrome. Too much resection of the tubercle may cause instability symptoms.

The rupture of ligament in the lateral part of ankle joint is a common injury and can lead to chronic ankle instability and lead to ankle osteoarthritis. Ankle arthroscopy is considered as a standard option to treat various ankle problems due to the need for only minimal incisions and fewer complications when compared to open surgery. However, there are complications associated with arthroscopic surgery e.g. damage to the anatomical structures around the portal placement areas. The present review provides anatomical knowledge of the superficial and deep neurovascular structures in the ankle region. These structures are important when ankle surgery is performed in order to avoid any intraoperative injury and prevent any complication following surgery.