Needle insertion into the tibialis posterior: ultrasonographic evaluation of an anterior approach

Abstract

OBJECTIVE: To investigate the ultrasonographic anatomy of the lower leg for safe and accurate needle placement into the tibialis posterior using the anterior approach.

DESIGN: Cross-sectional study.

SETTING: University rehabilitation hospital.

PARTICIPANTS: Healthy volunteers (N=62; 30 men, 32 women).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: The safety window (the tibia to the neurovascular bundle) and the depth to the midpoint of the safety window (skin to the tibialis posterior) at the upper third and the midpoint of the tibia were measured with a transverse ultrasonographic scan.

RESULTS: The safety window at the upper third of the tibia was significantly larger than that at the midpoint (P<.01). The safety window ranged from .64 cm to 2.13 cm at the upper third tibialis point and from .32 cm to 1.30 cm at the midpoint. The depth to the tibialis posterior at the upper third of the tibia was significantly deeper than that in the midpoint (P<.01). The depth ranged from 2.47 cm to 4.66 cm at the upper third tibias point and from 2.35 cm to 4.28 cm at the midpoint.

CONCLUSIONS: Ultrasonography is a useful tool in measuring the safety window and the depth to the tibialis posterior using the anterior approach. Considering the safety window, we suggest the needle placement at the upper third point of tibia rather than that at the midpoint.