Changes in tibial nerve stiffness during ankle dorsiflexion according to in-vivo analysis with shear wave elastography

Abstract

A more detailed assessment of pathological changes in the tibial nerve (TN) is needed to better assess how physical therapy influences TN pathologies. The cross-sectional nerve area can be used for TN assessment but may be influenced by individual differences in parameters, such as body height, body weight, and foot length. Therefore, there are no known reliable noninvasive quantitative methods for assessing TN neuropathy. Although recent ultrasonographic studies reported that TN stiffness changes could be used to assess TN neuropathies of the foot, these studies did not consider the joint position, and peripheral nerve tension can change with joint movement. Therefore, we considered that TN stiffness assessment could be improved by analyzing the relationship between ankle joint position and TN stiffness. This study aimed to investigate the relationship between TN stiffness and ankle angle changes using shear wave elastography. We hypothesized that the TN shear wave velocity significantly increases with ankle dorsiflexion and that the total ankle range or maximum dorsiflexion range correlates with the shear wave velocity. This cross-sectional study included 20 TNs of 20 healthy adults. Ultrasonography and shear wave elastography were used to evaluate the TN. TN stiffness was measured at 5 ankle positions as follows: maximum dorsiflexion (100% df), plantar flexion in the resting position (0% df), and 3 intermediate points (25% df, 50% df, and 75% df). TN shear wave velocity increased with an increase in ankle df angle. While total ankle range was significantly and negatively correlated with TN stiffness in all ankle positions, the maximum ankle df angle was significantly and negatively correlated only at 75% and 100% df. TN stiffness below 50% df may be affected by gliding or decreased nerve loosening, and TN stiffness above 75% df may be influenced by nerve tensioning. When measuring TN stiffness for diagnostic purposes, TN should be assessed at an ankle joint angle below 50% df.