Heel width as a simple parameter to prevent sural nerve entrapment in male patients during percutaneous Achilles tendon repair

The aim of the research was to evaluate an anatomical indicator that could be used to prevent sural nerve (SN) entrapment during percutaneous acute Achilles tendon (AT) repair. The indicator should be easily incorporated into surgical procedures, would not increase costs and could be used by any orthopedic surgeon. The crossing point between the medial margin of the SN and the lateral margin of the AT, proximal to the calcaneal tuberosity (CT), was identified and measured in 28 fresh male cadavers. The following measurements were taken: shin length, heel width, foot length and AT width 16 cm from CT. A significant relationship was found between heel width and the distance from the CT to the AT – SN crossing point (p = 0.04). The distance from the CT to the AT – SN crossing point was not related to the following: shin length, foot length, AT width 16 cm from CT, shin length/foot length index, shin length/heel width index, or foot length/heel width index. Only the estimated regression coefficient for heel width appeared to be significant (p < 0.05; linear regression), that is, if the heel width increases by one unit (1 mm), the AT and SN crossing point increases by an average of two units (2 mm). Of the parameters tested heel width showed a modest association with the SN and AT crossing point in male cadavers and may serve as a simple exploratory landmark, but further validation is required before clinical application. The SN–AT junction point may be located two heel widths proximal from the most prominent aspect of the CT. This result is easily applicable in surgical practice. Due to relatively small sample size the association may be modest and exploratory. The sural nerve crosses the lateral border of Achilles tendon at a point two heel widths proximal from the most prominent aspect of the calcaneal tuberosity. Heel width may be easily measured and introduced during percutaneous Achilles tendon repair; it would not raise the cost and could be used by any orthopedic surgeon.