The sensory innervation pattern of the ankle: a systematic review

Purpose: The aim of this systematic review was to summarize the available evidence concerning the sensory innervation of the upper and lower ankle joints. Methods: A systematic literature search according to the PRISMA guidelines was conducted using the PubMed and Embase databases. The following search algorithm was used: “(innervation ankle joint)” OR “(denervation ankle joint)” OR “(nerve supply ankle joint)”. Human anatomical studies which provided information on the innervation of the ankle joints were included. Results: Ten studies met the inclusion criteria. The number of specimens included averaged 44.8 (range: 5–200). The tibial nerve innervates the posteromedial portion of the capsule of the upper ankle and subtalar joints and the medial-plantar portions of the talocalcaneonavicular joint. The sural nerve mainly supplies the dorso-lateral portion of the upper ankle joint, the dorsal and lateral portions of the subtalar joint and the region directly anterior to the lateral malleolus. Branches of the deep peroneal nerve innervate the anterior portion of the capsule of the upper ankle joint between the tip of the lateral malleolus and reach almost towards the medial malleolus. Innervation by the superficial peroneal nerve has been reported solely with highly variable patterns. The saphenous nerve innervates the joint capsule directly anterior and distal to the medial malleolus and the medial aspect of the capsule of the talocalcaneonavicular joint. Additionally, the accessory deep peroneal nerve may contribute to the innervation. Conclusion: The given data provide relevant guidelines for denervation procedures of both the upper and lower ankle joints.