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It is necessary to install ventilation facilities in the laboratory and to regularly monitor harmful gases including formalin for safe environment of the dissection laboratory. However, there are no indicators that can identify the current status of ventilation facilities, safety equipment, and protective equipment in the dissection laboratory. In this study, the status of safety management of anatomical lab at domestic medical, dental, and oriental medical universities are investigated through an online questionnaire. Of the total 32 universities, 7 universities (21.8%) regularly monitor harmful gases such as formalin in the dissection lab, 13 universities (40.6%) do it on an irregular basis, and 12 do not do it at all. Seven universities (21.8%) are using the exhaust-type dissection table, 24 universities (75%) are not using it. Regarding the need for standards for manpower and facilities in the management of the anatomy lab, 7 universities (21.8%) are mediocre, 21 universities are necessary (65.6%), and 4 universities (12.5%) are very necessary. The responsibility for anatomy lab is 27 universities (84.3%) of the schools that responded as head professors of the department of anatomy, 3 universities (9.3%) of technicians, and 2 universities (6.2%) of the dean of the medical school. Regarding the need for standards for the anatomical lab, 7 universities (21.8%) are very necessary, 21 universities (65.6%) are necessary, and 4 universities (12.5%) are mediocre. Based on this data, the standard for the quality improvement and safety of anatomical education should be prepared.

The purpose of this study is to ascertain the morphological characteristics of the extensor hallucis longus (EHL) tendon variation using larger-scale dissection of Korean cadavers and to classify the types of variation along with incidence. A total of 158 feet from adult formalin-fixed cadavers (50 males, 29 females) were dissected. The morphological characteristics and measurements of the EHL tendon variants were evaluated. Three types of the EHL tendon variation were classified, wherein the most common type was Type 2 (106 feet, 67.1%), Type 3 (3 feet, 1.9%) was the rarest type, and Type 1 without accessory tendon was found in 49 feet (31.0%). Type 2K (11 feet, 7%) and Type 3K (1 foot, 0.6%) were described as new subtypes. The present study suggests morphological characteristics of the EHL tendon variation in Korean populations and high morphological variability of the EHL tendon along with the possibility of differences according to race or ethnicity and gender. Furthermore, a newly updated classification complemented by new subtypes of variation will help foot and ankle surgeons in diagnosis and surgical planning with hallux problems.

The purposes of this study were to ascertain the morphological characteristics of a plantaris tendon (PT) insertion using a larger-scale dissection of Korean cadavers and to classify the types of PT insertion related to the calcaneal tendon (CT). A total of 108 feet from adult formalin-fixed cadavers (34 males, 20 females) were dissected. The morphological characteristics and measurements of the PT insertion were evaluated. Five types of PT insertion were classified, wherein the most common type was Type 1 (39 feet, 63.1%). Type 2 and Type 3 were similar, with 16 feet (14.8%) and 15 feet (13.9%), respectively. Type 4 (6 feet, 5.6%) was the rarest type, and Type 5 had 25 feet (23.1%). The case of an absent PT was noted in 7 feet (6.5%). In the proximal portion, the tendon had a thick and narrow shape, became thin and wide in the middle portion, and then changed to thick and narrow again just before the insertion into the calcaneal tuberosity. This study confirmed the five types according to the location of the PT and the area of its insertion-related CT. The morphology of the PT insertion may be anatomically likely to influence the occurrence of tendinopathy in the CT.

The precise location of the Master Knot of Henry (MKH) has important clinical significance, but its anatomical definition has not been agreed upon. The purpose of this study is to present a linear regression equation for predicting length variables based on foot length, by evaluating the correlation of length variables related to flexor hallucis longus (FHL) and flexor digitorum longus (FDL), with respect to the location of the MKH. A total of 95 limbs were dissected from 48 adult cadavers, and were fixed in formalin. Measurements were made for the length parameter, with reference to the landmark. The relevance between length variables was analyzed through simple correlation analysis and linear regression analysis. The foot length was 213.69 ± 17.53 mm, MKH-great toe distal phalanx was 140.16 ± 14.69 mm, MKH-FHL insertion was 124.55 ± 13.46 mm, MKH-little toe distal phalanx was 121.79 ± 13.41 mm, MKH-FDL little toe insertion was 109.07 ± 14.16 mm, and the FHL-FDL angle was 33.15 ± 5.39. The correlation coefficient between all the length variables for foot length showed a high positive correlation. We derived a regression equation that can predict the length of each variable. This regression formula is considered to be highly useful because it can estimate the positional relationship of the MKH relatively simply.

The variations in the tibialis posterior tendon (TPT) could not be defined by previous classification, thus, this study used a larger-scale cadaver with the aim to classify the types of TPT insertion based on the combination of the number and location of TPT insertions. A total of 118 feet from adult formalin-fixed cadavers were dissected (68 males, 50 females). The morphological characteristics and measurements of TPT insertion were evaluated. Four types of TPT insertions were classified, wherein the most common type was type 4 (quadruple insertions, 78 feet, 66.1%), which was divided into four new subtypes that were not defined in the previous classification. The second most common type was type 3 (triple insertions, 25 feet, 21.2%) with three subtypes, including the new subtype. Type 2 was found in 13 feet (11%), and the rarest type was type 1 (2 feet, 1.7%), wherein the main tendon was only attached to the navicular bone and the medial cuneiform bone. We suggest high morphological variability of the TPT in relation to the insertion location, along with the possibility of significant differences according to race and gender. Moreover, this classification will help clinicians understand adult flatfoot deformity-related posterior tibial tendon dysfunction (PTTD).

We aimed to describe the location of fibular footprint of each anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), as well as their common origin in relation to bony landmarks of the fibula in order to determine the location of the fibular tunnel. In 105 ankle specimens, the center of the footprints of the ATFL and CFL (cATFL and cCFL, respectively) and the intersection point of their origin (intATFL-CFL) were investigated, and the distances from selected bony landmarks (the articular tip (AT) and the inferior tip (IT) of the fibula) were measured. Forty-two (40%) specimens had single-bundle ATFL, and 63 (60%) had double-bundle patterns. The distance between intATFL-CFL and IT was 12.0 ± 2.5 mm , and a significant difference was observed between the two groups ( p = 0.001 ). Moreover, the ratio of the intATFL-CFL location based on the anterior fibular border for all cadavers was 0.386. The present study suggests a reference ratio that can help surgeons locate the fibular tunnel for a more anatomically accurate reconstruction of the lateral ankle ligament. Also, it may be necessary to make a difference in the location of the fibular tunnel according to the number of ATFL bundles during surgery.

Extensor hallucis capsularis (EHC) is an accessory tendon located medially to extensor halluces longus (EHL) tendon. Most EHC is known to originate as a tendinous slip of the EHL tendon, although it may be splitted from the tibialis anterior (TA) tendon or the extensor halluces brevis (EHB) tendon. During routine dissection of a 49-year-old male cadaver, independent muscle bellies of EHC were discovered bilaterally. The EHL muscle arose from the middle anteromedial aspect of fibula, lateral to the origin of TA muscle and medial to extensor digitorum longus (EDL) muscle. An additional muscle bellies were separated from EHL muscle at the point of 6 cm away from EHL origin in the right leg, and 3 cm away in the left. They coursed downward as EHC to reach the first metatarsophalangeal joint capsule. This muscle, unlike the variations identified to date, is considered to extend to EHC, and the name “extensor hallucis capsularis muscle” is offered. This kind of variation may be important for investigating the development of deformity at the first metatarsophalangeal joint, such as hallux valgus.

The most frequent mononeuropathy in the lower extremity has been reported as the common peroneal nerve entrapment neuropathy (CPNe) around the head and neck of the fibula, although the mechanism of the neuropathy in this area cannot be fully explained. Therefore, the aim of this cadaveric study was to evaluate the relationship between morphologic variations of the distal biceps femoris muscle (BFM) and the course of the common peroneal nerve (CPN) and to investigate the incidence and morphological characteristics of anatomical variations in the BFM associated with CPNe. The popliteal region and the thigh were dissected in 115 formalin-fixed lower limbs. We evaluated consensus for (1) normal anatomy of the distal BFM, (2) anatomic variations of this muscle, and (3) the relationship of the muscle to the CPN. Measurements of the distal extents of the short and long heads of the BFM from insertion (fibular head) were performed. Two anatomic patterns were seen. First, in 93 knees (80.8%), the CPN ran obliquely along the lateral side of the BFM and then superficial to the lateral head of the gastrocnemius muscle. Second, in 22 cases (19.2%), the CPN coursed within a tunnel between the biceps femoris and lateral head of the gastrocnemius muscle (LGCM). There was a positive correlation between the distal extents of the short heads of the biceps femoris muscle (SHBFM) and the presence of the tunnel. The “popliteal intermuscular tunnel” in which the CPN travels can be produced between the more distal extension variant of the SHBFM and the LGCM. This anatomical variation of BFM may have a clinical significance as an entrapment area of the CPN in the patients in which the mechanism of CPNe around the fibula head and neck is not understood.

This study aimed to investigate the effects of suboccipital muscle inhibition technique (SMIT) on active range of motion (AROM) of the ankle joint, lunge angle (LA), and balance in healthy adults, according to the duration of its application. A total of 80 participants were randomly allocated to the 4-min suboccipital muscle inhibition (SMI) group (SMI_4M, n = 20), 8-min SMI group (n = 20), 4-min sham-SMI (SSMI) group (n = 20), and 8-min SSMI group (n = 20). Accordingly, the SMIT and sham SMIT were applied for 4 min or 8 min in the respective groups. AROM of dorsiflexion and LA were assessed, and a single leg balance test (SLBT) was performed before and after the intervention. AROM (4 min, p &lt, 0.001, 8 min, p &lt, 0.001), LA (4 min, p &lt, 0.001), and SLBT (4 min, p &lt, 0.001) significantly improved after SMI application. Compared with the SSMI group, the SMI group showed a significant increase in AROM (p &lt, 0.001), LA (p &lt, 0.001), and SLBT (p &lt, 0.001). Except for SLBT (p = 0.016), there were no significant interactions between intervention and application duration. The results suggest that the SMIT, at durations of both 4 and 8 min, could be effective tools for improving AROM, LA, and balance.

Rationale: The anatomical variant of the distal biceps femoris muscle with regard to common peroneal nerve entrapment neuropathy (CPNe) was suggested through magnetic resonance images (MRI) study. Patient concerns: An unusual variant of distal biceps femoris muscle was observed in 78 years old male cadaver. Diagnoses: The short head of biceps femoris muscle (SHBFM) was extended more distal and posteriorly. Intervention: The popliteal area was dissected at knee joint level in a cadaveric limb. Outcomes: Common peroeal nerve (CPN) was situated within tunnel formed between the lateral head of the gastrocnemius muscle (LGCM) and the SHBFM. Also, the length of tunnel was 4.4 cm. Lessons: The case illustrated here, to the best of our knowledge, is the first one with cadaveric findings of variant of distal biceps femoris muscle associated with CPNe. The tunnel formed between the more posterior or distal extension of the SHBFM and the LGCM could be possible entrapment area of CPN, clinically.

There is no consensus regarding the references to determine the exact location of the skin incision to minimize iatrogenic sural nerve injury in the sinus tarsi approach for calcaneal fracture. The purpose of this cadaveric study was to describe the anatomical course of the sural nerve in relation to easily identifiable landmarks during the sinus tarsi approach and to provide a more practical reference for surgeons to avoid sural nerve injury. Twenty-four foot and ankle specimens were dissected. The bony landmarks used in the following reference points were the tip of the lateral malleolus (point A), lateral border of the Achilles tendon on the collinear line with point A (point B), posteroinferior apex of the calcaneus (point C), inferior margin of the calcaneus on the plumb line through point A (point D), and tip of the fifth metatarsal base (point E). After careful dissection, the distances of the sural nerve to points A and B in the horizontal direction (lines D1 and D2), points A and C in the diagonal direction (lines D3 and D4), points A and D in the vertical direction (lines D5 and D6), and points A and E in the diagonal direction (lines D7 and D8) were measured. The median ratio of D1 to D1+D2, D3 to D3+D4, D5 to D5+D6, and D7 to D7+D8 were 0.37 (range, 0.26–0.50), 0.23 (range, 016–0.33), 0.35 (range, 0.25–0.45), and 0.32 (range, 0.20–0.45), respectively. The distance ratios from this study can be helpful to avoid sural nerve injury during the sinus tarsi approach for calcaneal fractures. Established standard incision may have to be modified to minimize sural nerve injury.