Phòng khám: XƯƠNG KHỚP- BÀ RỊA

26/09/2025

23/09/2025

5 SỰ THẬT ÍT AI NÓI VỀ BÀI TẬP VẸO CỘT SỐNG

Vẹo cột sống (scoliosis) không chỉ là chuyện “xương cong”. Nó là câu chuyện về sinh học tăng trưởng, tư thế, não bộ và thói quen sống. Tin tốt là bạn hoàn toàn có thể can thiệp – kể cả khi chưa cần nẹp hay phẫu thuật.

1️⃣ “Chờ xem” không còn là lựa chọn tốt nhất

- Trước đây, trẻ được chẩn đoán vẹo nhẹ (10°–25°) thường chỉ được theo dõi định kỳ. Nhưng nghiên cứu 10 năm qua cho thấy “chờ xem” đồng nghĩa với để đường cong tiến triển thầm lặng.

- Nguy cơ tiến triển: nếu phát hiện ở tuổi dậy thì, đường cong >20° có nguy cơ tăng thêm 10°–30° trong 2 năm.

- Khuyến nghị mới (SOSORT 2022): bắt đầu bài tập PSSE càng sớm càng tốt, đặc biệt trong giai đoạn tăng trưởng.

2️⃣ Không phải bài tập nào cũng hiệu quả

- Tập “cho khỏe lưng” (bơi, plank, yoga) tuy tốt cho sức khỏe tổng quát nhưng không điều chỉnh được 3D.

- PSSE (Physiotherapeutic Scoliosis-Specific Exercises) được thiết kế riêng cho từng dạng đường cong, với nguyên tắc tự điều chỉnh cột sống 3D + ổn định tư thế chủ động.

Kết quả nghiên cứu: 69% người tập PSSE giảm hoặc giữ ổn định góc Cobb, trong khi nhóm tập chung chỉ 20–30%.

3️⃣ Tái lập trình não – không chỉ cơ bắp

Phương pháp SEAS (Italy) coi vẹo cột sống là vấn đề điều khiển tư thế.

- Giai đoạn 1: học cách đưa cột sống về vị trí tối ưu (self-correction).

- Giai đoạn 2: lồng ghép vào hoạt động hằng ngày: đứng, ngồi, mang cặp.

- Kết quả: giảm “sụp đổ tư thế”, cải thiện vóc dáng bền vững kể cả khi không tập.

4️⃣ Người lớn vẫn còn cơ hội

Nhiều người nghĩ “hết tuổi dậy thì thì hết cách”. Thực ra:

- Đường cong mềm dẻo vẫn có thể cải thiện vài độ.

- Tư thế và đau lưng cải thiện rõ rệt, giảm nhu cầu phẫu thuật.

Nghiên cứu SEAS 2018 cho thấy người lớn tập 6 tháng có giảm đau 40% và tăng khả năng giữ tư thế tự nhiên.

5️⃣ Đừng sợ bắt đầu

Sai tư thế một chút sẽ không làm vẹo nặng thêm. Quan trọng là:

- Đánh giá ban đầu bởi chuyên gia (loại đường cong, độ mềm dẻo).

- Tập thường xuyên: ít nhất 3 buổi/tuần, mỗi buổi 20–30 phút.

- Gia đình hỗ trợ: nhắc nhở tư thế, khuyến khích trẻ kiên trì.

✨ Thông điệp: Vẹo cột sống không phải bản án chung thân. Hiểu đúng, tập đúng – bạn có thể giúp cột sống mình khỏe, đẹp và vững vàng suốt đời.

Minh Dat Rehab

23/09/2025

BÀI TẬP CONG VẸO CỘT SỐNG

5 SỰ THẬT ÍT AI NÓI VỀ BÀI TẬP VẸO CỘT SỐNG

Vẹo cột sống (scoliosis) không chỉ là chuyện “xương cong”. Nó là câu chuyện về sinh học tăng trưởng, tư thế, não bộ và thói quen sống. Tin tốt là bạn hoàn toàn có thể can thiệp – kể cả khi chưa cần nẹp hay phẫu thuật.

1️⃣ “Chờ xem” không còn là lựa chọn tốt nhất

- Trước đây, trẻ được chẩn đoán vẹo nhẹ (10°–25°) thường chỉ được theo dõi định kỳ. Nhưng nghiên cứu 10 năm qua cho thấy “chờ xem” đồng nghĩa với để đường cong tiến triển thầm lặng.

- Nguy cơ tiến triển: nếu phát hiện ở tuổi dậy thì, đường cong >20° có nguy cơ tăng thêm 10°–30° trong 2 năm.

- Khuyến nghị mới (SOSORT 2022): bắt đầu bài tập PSSE càng sớm càng tốt, đặc biệt trong giai đoạn tăng trưởng.

2️⃣ Không phải bài tập nào cũng hiệu quả

- Tập “cho khỏe lưng” (bơi, plank, yoga) tuy tốt cho sức khỏe tổng quát nhưng không điều chỉnh được 3D.

- PSSE (Physiotherapeutic Scoliosis-Specific Exercises) được thiết kế riêng cho từng dạng đường cong, với nguyên tắc tự điều chỉnh cột sống 3D + ổn định tư thế chủ động.

Kết quả nghiên cứu: 69% người tập PSSE giảm hoặc giữ ổn định góc Cobb, trong khi nhóm tập chung chỉ 20–30%.

3️⃣ Tái lập trình não – không chỉ cơ bắp

Phương pháp SEAS (Italy) coi vẹo cột sống là vấn đề điều khiển tư thế.

- Giai đoạn 1: học cách đưa cột sống về vị trí tối ưu (self-correction).

- Giai đoạn 2: lồng ghép vào hoạt động hằng ngày: đứng, ngồi, mang cặp.

- Kết quả: giảm “sụp đổ tư thế”, cải thiện vóc dáng bền vững kể cả khi không tập.

4️⃣ Người lớn vẫn còn cơ hội

Nhiều người nghĩ “hết tuổi dậy thì thì hết cách”. Thực ra:

- Đường cong mềm dẻo vẫn có thể cải thiện vài độ.

- Tư thế và đau lưng cải thiện rõ rệt, giảm nhu cầu phẫu thuật.

Nghiên cứu SEAS 2018 cho thấy người lớn tập 6 tháng có giảm đau 40% và tăng khả năng giữ tư thế tự nhiên.

5️⃣ Đừng sợ bắt đầu

Sai tư thế một chút sẽ không làm vẹo nặng thêm. Quan trọng là:

- Đánh giá ban đầu bởi chuyên gia (loại đường cong, độ mềm dẻo).

- Tập thường xuyên: ít nhất 3 buổi/tuần, mỗi buổi 20–30 phút.

- Gia đình hỗ trợ: nhắc nhở tư thế, khuyến khích trẻ kiên trì.

✨ Thông điệp: Vẹo cột sống không phải bản án chung thân. Hiểu đúng, tập đúng – bạn có thể giúp cột sống mình khỏe, đẹp và vững vàng suốt đời.

Minh Dat Rehab

19/09/2025

https://www.facebook.com/share/r/1Ti24prFNm/?mibextid=rS40aB7S9Ucbxw6v

19/09/2025

07/09/2025

📃Baxter’s nerve: the hidden culprit of chronic heel pain

📌Highlights :

👉Baxter’s nerve entrapment, an underrecognized cause of medial plantar heel pain, is frequently misdiagnosed as plantar fasciitis, leading to inadequate treatment.

👉This condition involves compression of the first branch of the lateral plantar nerve, often resulting in chronic, burning pain with neurological symptoms.

👉Despite accounting for up to 20% of chronic heel pain cases, clinical awareness remains low, delaying diagnosis and management.

👉Differential diagnosis from plantar fasciitis, tarsal tunnel syndrome, and calcaneal stress fractures is crucial.

👉High-resolution ultrasound, electromyography, and targeted clinical evaluation improve diagnostic accuracy.

👉Management includes conservative interventions such as physical therapy, orthotics, and neuromodulation, with interventional options like corticosteroid injections and surgical decompression reserved for refractory cases.

👉Increasing clinician awareness and integrating advanced imaging into routine practice are essential for improving patient outcomes.

🦶 Anatomical and clinical considerations

Baxter’s nerve has traditionally been described predominantly as a motor nerve, innervating the abductor digiti minimi muscle; however, studies indicate it also possesses a sensory component supplying the periosteum of the calcaneus.

Given its anatomical pathway, the nerve is predisposed to entrapment at various points, particularly at the level of the deep fascia near the medial calcaneal tuberosity or due to compression from adjacent structures such as the plantar fascia or hypertrophic abductor hallucis muscle.

Patients with Baxter’s neuropathy typically present with chronic, medial plantar heel pain, often described as burning or aching, which may worsen with activity or at night.

Unlike plantar fasciitis, which classically presents with pain upon the first steps in the morning and improves with activity, Baxter’s neuropathy may remain persistent throughout the day and exhibit neurological signs such as tingling, dysesthesia, or hypoesthesia.

📊 Prevalence and incidence

Baxter’s nerve entrapment may account for 15–20% of chronic heel pain cases in clinical practice.

The prevalence appears to be higher in individuals who engage in repetitive high-impact activities, such as runners and athletes.

More common in middle-aged and older adults, particularly those with predisposing biomechanical abnormalities such as excessive pronation or a history of plantar fasciitis.

⚠️ Challenges in diagnosis and clinical awareness

Overlap with plantar fasciitis leads to frequent misdiagnosis.

Lack of well-defined diagnostic criteria contributes to underdiagnosis.

EMG and ultrasound can aid identification, but are not always accessible or systematically employed.

🔍 Differential diagnosis

Plantar fasciitis

Tarsal tunnel syndrome

Calcaneal stress fractures

Fat pad atrophy

🧪 Diagnostic approaches

Clinical assessment: Manual palpation, Tinel’s test.

EMG and NCS: Detect denervation potentials, conduction velocity changes.

High-resolution ultrasound: Detect swelling, echogenicity changes, adjacent anomalies.

MRI: Rule out soft tissue masses or stress fractures.

💡 Treatment considerations

Step-by-step therapeutic approach beginning with conservative interventions.

Minimally invasive procedures (corticosteroid or botulinum toxin injections) if symptoms persist.

Surgical decompression as a final option for refractory cases.

🩴 Conservative treatment

Footwear modifications and orthotics.

Physical therapy (stretching of plantar fascia, Achilles tendon, intrinsic muscles).

Neuromodulation techniques (TENS, LILT).

Pharmacologic interventions (NSAIDs, gabapentinoids).

💉 Interventional approaches

Ultrasound-guided corticosteroid injections.

Botulinum toxin injections.

Pulsed Radiofrequency neuromodulation.

Surgical decompression.

🏥 Implications for clinical practice

Increased awareness among clinicians is imperative.

Integration of ultrasound and EMG into routine practice may aid early identification.

Further research into epidemiology, biomechanical factors, and optimal treatment strategies is warranted.

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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.

Link to Article 👇

05/09/2025

📃Muscle Injury: Pathophysiology, Diagnosis, and Treatment

📚 Introduction
🏋️ Muscle injuries are the most frequent cause of physical disability in sports practice
📊 It is estimated that between 30 and 50% of all sports-associated injuries are caused by soft tissue injuries
🧠 Knowledge of some basic principles of skeletal muscle regeneration and repair mechanisms can help prevent imminent dangers and accelerate the return to sport

>>>

🤔 Mechanisms of Injury
⚡ The cause of muscle injury can be considered indirect or direct
🚫 Indirect injury is related to lack of contact, which may be of functional cause (mechanical overload or neurological injury) or structural (partial or complete muscle rupture)
🤕 Direct injury occurs at the contact site, which may cause a laceration or contusion
📉 More than 90% of all sports-related injuries are bruises or stretches
✂️ Muscle lacerations are the least frequent injuries in sports

>>>>

📊 Classification
📌 Classically, systems describe muscle injury at 3 different levels: mild, moderate, and severe (or grade I, II, and III) from imaging evaluation or clinical aspects
1️⃣ Grade I lesions: edema and discomfort
2️⃣ Grade II lesions: loss of function, gaps, and possible ecchymosis
3️⃣ Grade III lesions: complete rupture, severe pain, and extensive hematoma
📖 The classification proposed by Mueller-Wohlfarht et al. (Munich Consensus) and Mafulli et al. also consider etiological aspects: direct (contusion or laceration) and indirect (functional or structural)
📍 The system described by Po***ck et al. (British athletics muscle injury classification) uses the anatomical location and extension of the lesion
🔄 The classification by Valle et al. seeks to group four characteristics: mechanism of injury (M), location (L), degree of injury (G), and number of re-injuries (R)

>>>

🔬 Pathophysiology (Healing Phases)
🔄 Skeletal muscle healing follows a constant order, with three identified phases: destruction, repair, and remodeling
🩸 Phase 1: Destruction – rupture and subsequent necrosis of myofibrils, hematoma formation, and proliferation of inflammatory cells
🔧 Phase 2: Repair and Remodeling – phagocytosis of necrotic tissue, regeneration of myofibrils, connective scar tissue production, vascular neoformation, and neural growth
🔁 Phase 3: Remodeling – maturation of regenerated myofibrils, contraction and reorganization of scar tissue, and recovery of muscle functional capacity
🌱 The regenerative capacity of skeletal muscle is guaranteed by an intrinsic mechanism involving satellite cells
💉 Restoration of vascular supply is the first sign of regeneration and a prerequisite for recovery

>>>>

🩺 Diagnosis
📖 Begins with a detailed clinical history of the trauma followed by a physical examination
🖥️ Ultrasound (US) is traditionally considered the method of choice for initial evaluation; it is inexpensive, accessible, and allows dynamic evaluation, but is examiner-dependent
🎥 Magnetic Resonance Imaging (MRI) allows detailed evaluation of muscle morphology, generating multi-planar, high-resolution soft tissue images, and is used by many authors for classification
🌡️ Infrared medical thermography enables noninvasive assessment of body temperature, detecting physiological changes related to increased risk of muscle injuries

>>>>>

🩹 Treatment
🛡️ Initial phase: Protection, Rest, Optimal Use of the Affected Limb (POLICE protocol), and Cryotherapy
⏳ A short immobilization period with firm or similar adhesive bandage is recommended
❄️ Ice application and compression in shifts of 15 to 20 minutes, repeated every 30 to 60 minutes, decreases intramuscular temperature and blood flow
💊 Nonsteroidal anti-inflammatory drugs (NSAIDs): short-term use in early stages may decrease inflammatory reaction without side effects on healing, but chronic use may be harmful
⚠️ Glucocorticoids: reported delays in hematoma elimination, necrotic tissue removal, regeneration, and reduction of biomechanical strength
🏋️ Post-acute phase: Isometric, isotonic, and isokinetic training, initiated painlessly and gradually
🔥 Local application of heat or "contrast therapy", accompanied by careful passive and active stretching, is valuable
🛠️ Surgical treatment: precise indications include large intramuscular hematomas, complete ruptures (grade III) with little associated agonist musculature, and partial lesions where more than half of the muscle is ruptured
🧬 New perspectives: therapeutic use of growth factors and gene therapy, and application of stem cells are promising, but need greater scientific validation

>>>>

🦵 Specific Muscle Injuries
🦵 Quadriceps muscle injury: more frequent in individuals >40 years old, often due to forced eccentric contraction during a fall. Complete ruptures require early surgical treatment for better functional results
🏃 Hamstring muscles injury: the most common lesion in athletes, often neglected in the acute phase. MRI is valuable for differentiation and planning
👉 Adductor muscle injury: common in athletes requiring repetitive kicks, starts, or changes of direction, often due to imbalance between adductor musculature and abdominal wall. Initial treatment is conservative, but acute ruptures may require surgical repair
👉 Gastrocnemius muscles injury: prone to injury because it crosses two joints; medial head is more commonly injured. Term "tennis leg" describes calf pain and injury. Most lesions are treated conservatively
💪 Pectoral muscle injury: more common due to increased weightlifting practice, typically indirect injury during eccentric phase. Loss of upper limb adduction strength leads to surgical treatment need
🖐️ Distal lesion of the brachial biceps muscle: uncommon, mainly in the dominant limb of males, mechanism is eccentric contraction during elbow extension. Surgical treatment often involves reinsertion

>>>>

✅ Final Considerations
🧠 Understanding pathophysiological mechanisms is essential for prevention, proper treatment, and rehabilitation
🔄 Decision for return to training can be based on the ability to lengthen the injured muscle as much as the healthy contralateral side, and absence of pain in basic movements
👨‍⚕️ The final phase of rehabilitation should be carried out under the supervision of a qualified professional

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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.

Link to Article 👇

04/09/2025

Plantar vault illustrating the general location of the anterior and transverse arches as well as the medial and lateral longitudinal arches. The mechanical coupling of these arches is critical to the maintenance of foot stability and the optimal distribution of ground reaction forces

04/09/2025

📃Management of chronic knee pain caused by postsurgical or posttraumatic neuroma of the infrapatellar branch of the saphenous nerve

📌 Key Takeaways

-Injury to the infrapatellar branch of the saphenous nerve (IBSN) is a relatively common complication after knee surgery, which can interfere with patient satisfaction and functional outcome.

-Symptomatic IBSN injury has been reported in 55–100% of patients following Total Knee Arthroplasty (TKA) , in 37–86% following ACL reconstruction, and in up to 28% following surgical meniscectomy.

-Injury to the IBSN may also result in neuroma formation due to Wallerian degeneration and subsequent axonal growth, leading to severe and debilitating pain.

-Following surgery, 80.0% reported improvement in leg pain, 68.0% reported clinically meaningful improvement, and 68.0% reported improvement in health-related quality of life.

-Overall, 72.0% reported they were satisfied with the surgical outcome.

-Lack of postoperative improvement was significantly associated with older age, female gender, multiple prior knee surgeries, and prior resection of IBSN neuroma.

~~~~~~~~~~~~

🩺 Clinical Implications

-Neuroma of the IBSN should be suspected in patients who develop neuropathic medial knee pain following orthopedic surgery or trauma.

-IBSN neuroma as a cause of debilitating chronic knee pain is likely under-recognized, particularly in community hospitals and other institutions without a dedicated peripheral nerve surgery unit.

-In properly diagnosed and selected patients, surgical neurolysis and resection of painful IBSN neuroma provide clinically meaningful pain improvement in a majority of patients as well as improvement in health-related quality of life.

-Future research should verify risk factors for poor postsurgical outcome and optimize selection criteria for surgical intervention.

👉Link to article in the comments 👇

📌Whay about physiotherapy?(out of the article)

🏥 Role of Physical Therapy in IBSN Neuroma Management

🔹 Before Surgery (Conservative Phase)

-Pain modulation:

Desensitization techniques (gentle massage, tapping, graded exposure to textures).

-TENS or other neuromodulation methods for neuropathic pain relief.

-Edema and scar management:

Soft tissue mobilization, scar massage, silicone pads if surgical scar sensitivity is present.

-Activity modification:

Avoiding positions or activities that overstretch or compress the nerve.

-Functional maintenance:

Gentle quadriceps strengthening, ROM exercises, avoiding aggravation of neuropathic symptoms.

🔹 After Surgery (Post-Neuroma Resection / Neurolysis)

-Wound care & protection: Early phase focus on healing, avoiding excessive stretch on the medial knee.

-Gradual desensitization: Continued sensory re-education to reduce hypersensitivity.

-Strength & mobility: Restore knee ROM, quadriceps and hip strength, and gait training.

-Neuropathic pain management: TENS, graded motor imagery, mirror therapy if central sensitization develops.

-Functional rehab: Progression to ADL training, balance work, and gradual return to activity.

⚠️ Key Considerations for PT

👉If neuroma pain is severe and refractory → physiotherapy alone is usually insufficient, and surgery may be required.

👉PT is most beneficial for symptom modulation, function maintenance, and postoperative rehabilitation.

👉Collaboration with pain specialists and orthopedic/nerve surgeons is crucial for comprehensive management.

04/09/2025

👣 Gait Analysis : Summary of Kinematics and Kinetics

📌Involves the study of both kinematics and kinetics to understand human locomotion.

👉Kinematics: Describes motion without considering the forces involved.

👉Kinetics: Focuses on the forces that cause the movement.

>>>>

📐 Kinematics of Gait

Includes concepts that allow for the description of displacement or motion of body segments.

⏱️ Time and Distance Terms

-Stance time: Duration of the stance phase for one extremity.

-Single-support time: Duration when only one extremity is on the ground.

-Double-support time: Duration with both feet on the ground.

Increases in elderly individuals or those with balance disorders.

Decreases as walking speed increases.

-Stride length: Linear distance between two successive events of the same extremity (heel strike to heel strike).

Normal adult: 1.25–1.50 m.

Decreases in elderly; increases with gait speed.

-Stride duration: Time for one stride (~ 1 sec for normal adult).

-Step length: Linear distance between successive contacts of opposite extremities.

-Step duration: Time spent in a single step (may decrease on affected side due to weakness or pain).

-Cadence: Number of steps per unit time.

Men: ~ 110 steps/min.

Women: ~ 116 steps/min.

At ~ 180 steps/min, double support disappears → running.

-Walking velocity: Rate of linear forward motion of the body.

Normal adult: 1.22–1.37 m/sec.

-Degree of toe-out: Angle of foot placement.

~ 7° for men at free speed.

Decreases as walking speed increases.

🦵 Joint Angles

Expressed as relative angles between adjacent segments.

Sagittal Plane ROM (Normal walking):

Hip: +20° flexion (initial contact) → –20° extension (~50% gait cycle).

Total ROM: 20° extension – 20° flexion.

Knee: 0° at initial contact → +60° flexion (swing ~70%).

Total ROM: 0–60° flexion.

Ankle: +7° dorsiflexion (heel-off ~40%) → –25° plantarflexion (toe-off ~60%).

Total ROM: 25° plantarflexion – 7° dorsiflexion.

Frontal Plane Joint Angles: Recorded.

Transverse Plane Data: Often inconsistent.

🎥 Measurement of Kinematics

Historical: Cinematographic film + hand-digitizing markers.

Modern: Motion analysis systems with markers + computerized 3D processing.

>>>>

⚡ Kinetics of Gait

Focuses on forces acting on the body and causing movement.

🔗 Link-Segment Model

Body treated as rigid segments (foot, lower leg, thigh) connected at joints.

Uses Newtonian mechanics.

Requires: Marker positions, ground reaction forces, body part weights, inertia.

⬇️ Ground Reaction Forces (GRFs)

Forces exerted by ground on foot = equal & opposite to foot forces on ground.

Analyzed in vertical, anteroposterior, mediolateral axes.

GRFV = composite vector sum.

CoP = point of resultant foot-floor forces; has characteristic path in gait.

🔄 Moments of Force (Torque)

Moment = Force × perpendicular distance to joint center.

Internal moments: From muscles/internal structures.

External moments: From external forces (GRFV).

Equal in magnitude, opposite in direction.

🔹 Sagittal Plane Moments

Hip extensors: Positive (extensor) moment in early stance.

Knee extensors: Contribute after hip.

Ankle plantarflexors: Major support later in stance.

🔹 Frontal Plane Moments

Large abduction moments at hip and knee.

Smaller one at ankle.

Maintained by ligaments + some muscle action.

⚙️ Power and Work

Work = Force × distance (Joules).

Power = Rate of work (Watts).

Power generation = Concentric (shortening) contractions → positive work.

Power absorption = Eccentric (lengthening) contractions → negative work.

🔹 Sagittal Plane Powers

Major positive work:

Ankle plantarflexors (push-off A2-S).

Hip extensors (early stance H1-S).

Hip flexors (late stance/early swing H3-S).

Knee extensors: Mainly absorb energy (K1-S, K3-S), small positive (K2-S).

🔹 Frontal Plane Powers

Initial absorption: Hip abductors (H1-F).

Small positive bursts (H2-F, H3-F) for fine control of center of mass.

🔋 Mechanical Energy of Walking

Walking at constant speed = passive exchange of potential ↔ kinetic energy (head, arms, trunk).

Potential energy lowest at initial contact, rises in midstance.

💡 Muscle Activity (EMG)

EMG = electrical activation of muscles (timing & relative activity, not force).

🔹 Hip

Extensors (gluteus maximus, hamstrings): Active early stance (support & power H1-S).

Abductors (gluteus medius): Control lateral pelvic drop.

🔹 Knee

Extensors (quadriceps): Contribute early stance (K2-S), absorb energy.

🔹 Ankle

Plantarflexors (soleus, gastrocnemius):

Eccentric early stance (control tibia).

Concentric late stance (push-off A2-S).

Dorsiflexors (tibialis anterior):

Eccentric early stance (lower foot).

Concentric swing phase (foot clearance).

>>>>

✅ Understanding these kinematic and kinetic principles is fundamental for analyzing normal gait and identifying deviations from structural or functional impairments.

Reformatted info[Joint Structure and Function/5th]

04/09/2025

🦵 Tibial nerve origin and pathway
• Branches from the sciatic nerve slightly above the popliteal fossa
• Runs behind the knee
• Passes through the tarsal tunnel around the medial malleolus

🦶 Plantar nerve branching
• Branches to the medial and lateral plantar nerves around the tarsal tunnel
• Pe*****te into the fascia of the abductor hallucis muscle
• Run from the sole to the toes
• Innervate the sensory of the anterior part of the plantar

⚪ Medial calcaneal nerve
• Branches from the posterior tibial nerve at the proximal end of the tarsal tunnel
• Pierces the flexor retinaculum
• Innervates the sensory of the medial calcaneus

🏗️ Tarsal tunnel structure
• Composed of a rigid bone at the bottom
• Covered by the flexor retinaculum

📍 Structures passing through the tarsal tunnel
• Tibialis posterior tendon
• Flexor digitorum longus tendon
• Posterior tibial artery and veins
• Posterior tibial nerve
• Flexor hallucis longus tendon

🔗 Neurovascular relation
• Posterior tibial nerve runs with the posterior tibial artery and veins in the tarsal tunnel

⚠️ Clinical relevance
• Because of these anatomical features, the posterior tibial nerve may be damaged at the tarsal tunnel (tarsal tunnel syndrome: TTS)
• TTS was first reported by Keck and Lam in 1962 [1, 2]