Tibial nerve dynamics during ankle dorsiflexion: The relationship between stiffness and excursion of the tibial nerve

Peripheral nerves have excursions that allow longitudinal glide within the surrounding tissues and extend with reduction of the fiber waviness to adapt to joint movements, which are necessary for maintaining physiological function, such as sensory and motor (Sunderland, 1990). Nerve excursion is evaluated based on the extent of nerve movement seen on ultrasound imaging, but this method requires a large amount of time for analysis; thus, data are difficult to evaluate in real-time (Sierra-Silvestre et al., 2018, Shum et al., 2019, Shum et al., 2013). The nerve excursion process can be interpreted as the nerve movement itself and the tension of a winding nerve (Sunderland, 1990). Shear wave velocity (SWV) is directly related to the shear modulus of tissues (Bercoff et al., 2004) and can be easily assessed for tensioning or stiffness of peripheral nerve, such as tibial nerve (TN) (Carroll et al., 2012, Kawanishi et al., 2022, Alshami et al., 2007). Since the SWV may be faster for tensioning nerves than for winding nerves, we can hypothesize that the TN excursion measured by the nerve movement is closely related to the stiffness estimated by the SWV. However, the in vivo relationships between TN excursion and stiffness remain unclear, though a close relationship has been suggested in cadaveric studies (Alshami et al., 2008, Coppieters et al., 2006). This study aimed to measure the TN stiffness in the ankle joint at plantarflexion and dorsiflexion positions and its excursion during ankle dorsiflexion. We hypothesized that a significant relationship exists between TN excursion properties and stiffness, and measuring TN stiffness in ankle plantarflexion rather than in dorsiflexion better reflects TN excursion properties.

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