An anatomical approach to the tarsal tunnel syndrome: what can ankle's medial side anatomy reveal to us?

BACKGROUND: The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle's medial side and if so, do they have a regular path after emerging from TN. METHODS: The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon-McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT). RESULTS: The TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter's nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p <  0.001). CONCLUSIONS: In our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.

Prolonged protein deprivation differentially affects calretinin- and parvalbumin-containing interneurons in the hippocampal dentate gyrus of adult rats.

Protein deprivation is a detrimental nutritional state that induces several deleterious changes in the rat hippocampal formation. In this study, we compared the effects of protein deprivation in the number of parvalbumin (PV)-immunoreactive and calretinin (CR)-immunoreactive interneurons of the dentate gyrus, which are involved in the control of calcium homeostasis and fine tuning of the hippocampal circuits. Two month-old rats were randomly assigned to control and low-protein diet groups. The rats of the latter group were fed with a low-protein diet (8% casein) for 6 months. All animals were perfused at 8 months of age. The number of neurons expressing CR in the molecular layer and in the hilus of dentate gyrus was reduced in protein-deprived rats. Conversely, protein deprivation increased the number of PV-containing interneurons in the dentate granule cell layer and hilus. These results support the view that protein deprivation may disturb calcium homeostasis, leading to neuronal death including GABAergic interneurons expressing CR. In the other hand, the up-regulation of PV cells may reflect a protective mechanism to counteract the calcium overload and protect the remaining neurons of the dentate gyrus.

Prolonged protein deprivation, but not food restriction, affects parvalbumin-containing interneurons in the dentate gyrus of adult rats.

Several studies have demonstrated the vulnerability of the hippocampal formation to malnutrition. In this study, we compared the effects of food restriction and protein malnutrition in the total number of neurons of the dentate gyrus and in the number of parvalbumin-immunoreactive (PV-IR) interneurons, which are related to the control of calcium homeostasis and fine tuning of the hippocampal circuits. Two month-old rats were randomly assigned to control, food-restricted and low-protein diet groups. After 6 months, 10 rats from the low-protein diet group were selected at random and fed with a normal protein diet for 2 months. The total number of granule and hilar cells was reduced in protein-deprived rats and the nutritional reestablishment with a normal protein diet did not recover neuron numbers. Protein deprivation increased the number of PV-IR interneurons in the granule cell layer and hilus, but their number returned to values similar to controls after nutritional rehabilitation. Food restriction did not affect the total number of neurons or the density of PV-IR interneurons in the dentate gyrus. These results support the view that protein deprivation may disturb calcium homeostasis, leading to neuronal death. The up-regulation of PV-IR cells may reflect a protective mechanism to counteract the calcium overload and protect the remaining neurons of the dentate gyrus. This imbalance in cell-ratio favoring GABAergic interneurons may justify some learning and memory impairments described in protein-deprived animals. This contrast between the results of food restriction and protein deprivation should be further analyzed in future studies.