Intramuscular nerve distribution pattern of ankle invertor muscles in human cadaver using sihler stain

Kyu Ho Yi, Dong Wook Rha, Sang Chul Lee, Liyao Cong, Hyung Jin Lee, Yong Woong Lee, Hee Jin Kim, Kyung Seok Hu

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)


Introduction: We sought to the ideal sites for botulinum toxin injection by examining the intramuscular nerve patterns of the ankle invertors. Methods: A modified Sihler method was performed on the flexor hallucis longus, tibialis posterior, and flexor digitorum longus muscles (10 specimens each). The muscle origins, nerve entry points, and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the lateral malleolus (0%) to the fibular head (100%). Results: Intramuscular arborization patterns were observed at 20-50% for the flexor hallucis longus, 70-80% for the tibialis posterior, and 30-40% for the flexor digitorum longus. Conclusions: These findings suggest that treatment of muscle spasticity of the ankle invertors involves botulinum toxin injections in specific areas. These areas, corresponding to the areas of maximum arborization, are recommended as the most effective and safest points for injection.

Original languageEnglish
Pages (from-to)742-747
Number of pages6
JournalMuscle and Nerve
Issue number5
Publication statusPublished - 2016 May 1

Bibliographical note

Publisher Copyright:
© 2016 Wiley Periodicals, Inc.

All Science Journal Classification (ASJC) codes

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)


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