Massage & Bodywork

MAY | JUNE 2021

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40 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 1 Tarsal Tunnel By Christy Cael TARSAL TUNNEL Borders • Medial: Flexor retinaculum • Lateral: Medial malleolus (anterosuperior) • Posterior: Talus and calcaneus (lateral)¦ Contents • Tendons: Tibialis posterior, flexor digitorum longus, and flexor hallucis longus • Nerve: Posterior tibial nerve • Blood Supply: Posterior tibial artery and vein education | FUNCTIONAL ANATOMY The tarsal tunnel is an anatomical structure located on the medial side of the ankle where the foot joins the lower leg. Specifically, it is located posterior and inferior to the medial malleolus. Unlike the carpal tunnel of the wrist, which is oriented horizontally and has an osseous floor and fibrous roof, the tarsal tunnel is oriented vertically. The osseous lateral portion of the tunnel is formed by the medial malleolus anteroposteriorly and the posterior talus and calcaneus bones laterally. A fibrous flexor retinaculum extending from the medial malleolus to the medial calcaneus forms the medial border of the tarsal tunnel. This structure holds the contents of the tarsal tunnel up against the bone, preventing medial displacement. Similar to the carpal tunnel of the wrist, the tarsal tunnel serves as an important passageway for several structures. These include the tendons of the tibialis posterior, flexor digitorum longus (FDL), and flexor hallucis longus (FHL). Running alongside these three tendons are the posterior tibial nerve, artery, and vein. Organized from medial to lateral, the contents of the tarsal tunnel are the tibialis posterior tendon, FDL tendon, posterior tibial artery and vein, posterior tibial nerve, and FHL tendon. The posterior tibial nerve bifurcates within the tarsal tunnel (most common) or just proximal to it (less common) into the medial and lateral plantar nerves. Both the medial plantar nerve and lateral plantar nerve have both sensory and motor fibers in the foot. Sensory function for the medial plantar nerve includes the medial half of the foot, the first three digits, and half of the fourth. Motor function includes the lumbricals, abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis. Sensory function for the lateral plantar nerve includes the medial calcaneus and lateral heel. Motor function includes the flexor digitorum brevis, quadratus plantae, and abductor digiti minimi. As is the case with the carpal tunnel, space within the tarsal tunnel is relatively limited with very little capacity for expansion. This space can be further Flexor hallucis longus Flexor digitorum longus Medial malleolus Medial malleolus Tarsal tunnel Talus Lateral malleolus Posterior tibial nerve Calcaneal tendon Flexor digitorum longus tendon Flexor hallucis longus tendon Calcaneus Calcaneus Tibialis posterior tendon Medial plantar nerve Lateral plantar nerve

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