Morphometric evaluation of the tibialis anterior muscle tendon

Morphometric evaluation of the tibialis anterior muscle tendon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Morphometric evaluation of the tibialis anterior muscle tendon Turan Koç, Alev BOBUŞ ÖRS, Gülden KAYAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6347099/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose The tendon insertion sites of the tibialis anterior muscle (TAM) are particularly important for ruptures and drop foot surgery procedures. The anatomical relationship between the morphometry of the TAM’s tendon (TAT), medial malleolus (MM), and tibialis posterior muscle tendon (TPT) has not yet been elucidated. This study aimed to examine the morphometric features of TAT, TPT, and MM and their relationships with sex and sides. Methods Dissections were performed on the dorsal and medial surfaces of 25 (15 males, 10 females) fixed lower extremities. The study has been approved by the Board of Ethics of Mersin University (Approval number: 2023/500). Bony structures were exposed together with the tendons and extensions of the TAM. MM height and width, inter-tendon distances, and tendon angles were measured. Additionally, the width, length, thickness, and cross-sectional area (CSA) of TATs and TPTs were recorded. Results It was found that TAT could have a minimum of 1 and a maximum of 3 slips in different combinations. The width of TAT (TATw) and the inter-tendon distances along the MM were found to be significantly greater in males than in females. TATw and MM widths were greater on the left feet compared to the right. A moderate negative correlation was also observed between TAT thicknesses and MM angulation. Strong positive correlations were found between the distances between TAT and TPTs at different levels of MM. Conclusion Understanding the morphometric features of TAT and its relationship with MM may optimize tendon transfer techniques for foot drop treatment. These findings contribute to improving surgical accuracy, anchorage placement, and graft sizing in reconstructive procedures. Health sciences/Medical research Health sciences/Anatomy Health sciences/Anatomy/Musculoskeletal system Tibialis anterior muscle tendon tibialis posterior tendon transfer morphometry medial malleolus foot drop tendon rupture Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The tibialis anterior muscle (TAM) is a powerful muscle located in the most medial part of the anterior compartment of the leg. It performs dorsiflexion and inversion of the foot [ 37 ]. It is the antagonist and synergist of tibialis posterior muscle. It helps to stabilize the ankle during walking (during the contact phase, i.e., eccentric contraction) and lifts the foot off the ground during the swing phase, i.e., concentric contraction. Additionally, it helps lock the ankle during isometric contraction, especially during sports [ 18 ]. Tendon rupture of anterior tibial (TAT) usually late diagnosed due to mild clinical signs and symptoms [ 43 ]. Although, it is a rare condition, it is the third most common tendon rupture in the lower extremity after the Achilles tendon and patellar tendon [ 2 , 5 , 10 ]. TAT rupture can be acute or chronic, resulting from different traumas including sharp shear injuries, blunt trauma, or hyperflexion trauma. Spontaneous ruptures are rare and are usually known to be the result of a long history of chronic degenerative tendon disease. Risk factors include systemic lupus erythematosus, hypoparathyroidism, diabetes mellitus, rheumatoid and psoriatic arthritis, and gout [ 17 ]. Paralysis or weakness of TAM, primary dorsiflexor of the ankle, results in a stepping gait characterized by a plantarflexed position of the ankle (foot drop) during the swing phase of walking and initial ground contact [ 21 , 39 ]. This condition is known to be most caused by peroneal nerve injury. Initial treatment for foot drop includes using an ankle foot orthosis, muscle strengthening, and tendon Achilles stretching. If no improvement occurs for more than a year, tendon transfer is usually required to achieve a balanced foot that is plantigrade and functional. Transfer of the tibialis posterior muscle (TPM) tendon (TPT) to the dorsum of the foot is one of the most frequently performed surgeries in the treatment of foot drop [ 42 ]. Surgical reconstructions of TAM, such as tendon transfer (posterior tibial tendon transfer, extensor hallucis longus transfer, etc.), muscle repair or allotransplantation are the preferred treatment methods, especially in cases where dorsal extension and supination of the foot are severely impaired [ 14 , 25 , 44 , 46 ]. It has been reported that repositioning TAM to its anatomical attachment site is important to restore the natural lever arm of TAM [ 2 ] and morphometric features of ligament and tendon connections may help optimize reconstruction procedures in terms of anchorage placement and graft sizing (Holt et al. 2015). Some studies have reported that the anatomical details regarding the relationship between TAT and TPT in foot drop surgery and the tendon transfer process are insufficient [ 8 , 32 ]. There is no morphometric data in the literature on the extent to which the morphometric features of the medial malleolus and TA and TP are related. In this cadaver study, it was aimed to evaluate the morphometric features of TAT along with its insertional features and its relationship with the medial malleolus through the TPT transfer relationship. Material and Methods The study was performed on 25 feet fixed with 10% formalin (15 men, 10 women) from the inventory of the Anatomy Department of Medical Faculty at Mersin University. The study was approved by the Mersin University Clinical Research Ethics Committee (Approval numbers: 2023/500). Human cadavers (obtained through a body donation program) used in this study are legally registered in the educational and research gross anatomical archive of the Anatomy Department of Mersin University, Faculty of Medicine. This study accordance with recognized standards of Helsinki Declaration. First, dissections were performed on the dorsal and medial parts of the foot. The tendon of the TAM passing in front of the medial malleolus was identified and the fascia and retinaculum on it were not completely removed to not disrupt its anatomical course. The tendon of the TPM passing behind the MM was identified and followed till it’s separation into slips is seen. In terms of integrity, the plantar part of the foot was preserved. Dissection protocol In anatomical position, dissection lines were determined by marking lines in the medial parts of the ankle, dorsum of the foot and sole. A transverse incision was made 3-4 cm above the MM in the distal medial part of the leg and then dissection of the skin and superficial fascia was initiated. After this stage, dissection on the dorsal and medial side continued with the removal of the dorsal fascia of the foot (DFF) and extensor retinaculum (ER). By carefully removing the dorsal and posterior parts of the DFF and ER, the TAT and TPT extending at the dorsum of the foot were exposed. Then, the remaining part of the ER and the superficial and deep parts of the medial sole were dissected and the abductor hallucis muscle (AHM), medial cuneiform bone (MC), first metatarsal bone (I.MT), and navicular bone (NV) were exposed. All dissections were performed by the same researcher (T.K). A digital caliper (0.01 mm precision) was used to measure the parameters. Under the same environmental conditions, at different times, all measurements were repeated in triplicates independently by two investigators (T.K. and A.B.Ö). Upon that, the following parameters were measured (Fig. 1). Foot length Width (w), length (l), thickness (t), and cross-sectional area (CSA) of TAT and TPT. Width (w) and length (l) of slips of MC (MCT) and I.MT (IMTT). Height (h) and width (w) of MM. Distance between TAT-TPT on superior (TA-TPsup), middle (TA-TPmid) and inferior (TA-TPinf) level of MM. Angles of TAT (TATang) and TPT (TPTang). Count of slips of TAT. Attachments status of TAT. Statistical Analyses Intraclass correlation coefficients were calculated for the examination of interobserver agreement and expressed with 95% confidence intervals. Normality control of continuous variables was assessed with Shapiro Wilk test. Parametric methods were used in the analysis of variables that showed normal distribution, and nonparametric methods were used in the analysis of those that did not. Student’s t test and Mann Whitney U test were used in the comparison of two independent groups. Pearson and Spearman Rho correlation coefficients were used in the examination of the linear relationship between two continuous variables. Data analyses were performed with Statistica v.13.3.1 program. Statistical significance level was accepted as p<0.05 in all analyses. Results General Findings In all variables, a statistically significant and high level of agreement was found between the researchers (T.K. and A.B.Ö) who performed the measurement (p < 0.001). The high level of these agreement coefficients indicates that the measurements used are reliable. Data regarding sex and side distribution of the feet included in the study are shown in Table 1 . No significant difference was found in age distribution between genders and sides (p = 0.186, p = 0.730). The average foot lengths were recorded as 24.88 ± 1.61 cm in males and 22.06 ± 1.15 cm in females. It was determined that men had statistically longer foot lengths (p < 0.001). Table 1 Evaluation of gender and sides in terms of age distribution. Age N % Mean ± SD Min-Max P Sex Male 15 58,8 66,33 ± 14,62 43–86 0,186 Female 10 41,2 74,20 ± 13,35 49–91 Sides Left 14 44,1 68,57 ± 16,04 43–91 0,730 Right 11 55,9 70,64 ± 12,64 49–85 Findings about the TAT and the TPT Morphometry Morphometric data of the tendons of the TPA and TPT are shown in Table 2 . In terms of gender, the averages of TATw, TA-TPsup, and TA-TPmid in male feet were higher than in females (p = 0.039, p = 0.036, and p = 0.041, respectively). In terms of sides, the means of TATW, MMw and TA-TPinf were higher in the left feet compared to the right feet (p = 0.029, p = 0.013 and p = 0.037, respectively). There was no significant difference between the remaining parameters and both gender and side groups (p > 0.05). Table 2 Evaluation of morphometric data of TAT, TPT, and MM according to gender and sides. Parameters Gender P Sides P Female (n = 10) Male (n = 15) Left (n = 14) Right (n = 11) Mean ± SD Min-Max Mean ± SD Min-Max Mean ± SD Min-Max Mean ± SD Min-Max TATw 8.69 ± 1.16 6.25–9.88 9.51 ± 2.06 5.31–12.39 0.039 9.33 ± 2.22 5.31–12.39 9.00 ± 1.04 7.27–10.61 0.029 TATt 2.25 ± 0.4 1.52–2.84 2.53 ± 0.84 1.68–5.17 0.428 2.33 ± 0.44 1.77–3.45 2.54 ± 0.95 1.52–5.17 0.647 TATCSA 14.64 ± 3.34 10.66–21.04 18.03 ± 7.44 10.27–41.14 0.238 16.14 ± 4.32 10.27–22.52 17.36 ± 8.31 10.66–41.14 0.683 MCTw 5.31 ± 0.71 4.60–6.02 5.65 ± 0.88 4.84–6.75 0.568 5.48 ± 0.88 4.84–6.02 5.65 ± 0.71 4.60–6.75 0.638 MCTl 7.50 ± 1.04 6.49–8.54 8.1 ± 1.16 6.95–9.30 0.546 7.75 ± 0.80 6.95–8.54 7.56 ± 1.20 6.49–9.30 0.724 IMTTw 5.22 ± 0,82 4.40–6.30 5.58 ± 0,78 4.80–6.16 0.448 5.10 ± 0.30 4.80–5.60 5.56 ± 6.30 4.50–6.16 0.665 IMTTl 5.80 ± 1.02 4.72–7.11 6.12 ± 1.02 4.72–6.95 0.238 6.10 ± 1.12 4.65–6.95 5.80 ± 8,31 4.79–7.11 0.288 TPTw 8.43 ± 1.07 6.37–10.71 9.35 ± 1,32 7.71–11.75 0.830 8.52 ± 1.05 7.30-10.71 8.64 ± 1.62 6.37–11.75 0.697 TPTt 2.33 ± 0.45 1.48–3.07 2.74 ± 0,45 2.20–3.54 0.039 2.46 ± 0.45 1.48–3.26 2.73 ± 0.52 2.14–3.54 0.200 TPTCSA 14.78 ± 3.80 9.62–22.81 17.89 ± 6,06 11.83–24.99 0.163 16.95 ± 4.69 9.62–24.99 16.24 ± 6.43 9.40-23.19 0.759 MMh 38.09 ± 3.97 33.33–46.69 38.91 ± 4,82 30.77–49.36 0.660 39.41 ± 5.50 30.77–49.36 37.54 ± 2.36 34.35–42.26 0.305 MMw 31.46 ± 3.39 26.74–39.09 30.36 ± 3,06 26.04–35.87 0.407 30.94 ± 3.51 26.04–39.09 30.62 ± 2.86 26.74–35.87 0.013 TA-TPsup 31.96 ± 2,39 28.91–35.73 35.03 ± 6,09 18.87–42.97 0.036 35.12 ± 3.95 29.76–42.97 32.13 ± 6.07 18.87–40.13 0.151 TA-TPmid 29.37 ± 2.53 26.55–32.55 32.73 ± 3,88 25.54–38.36 0.041 32.24 ± 4.,12 25.54–38.36 30.30 ± 3.03 26.57–37.75 0.205 TA-TPinf 29.48 ± 5.61 20.45–36.14 30.16 ± 7,23 9.40–39.60 0.723 31,73 ± 4,21 23.87–39.6 27.55 ± 8.24 9.40-36.68 0.037 TATang 51.40 ± 8.37 37.00–62.00 45.47 ± 12,62 21.00–65.00 0.205 49,57 ± 11,9 21.00–65.00 45.64 ± 10.65 25.00–62.00 0.809 TPTang 51,70 ± 13,91 30.00–74.00 55.13 ± 13,05 28.00–75.00 0.536 52,93 ± 10,16 35.00–75.00 54.82 ± 16.84 28.00–74.00 0.399 (TAT: tibialis anterior tendon, TPT: tibialis posterior tendon, MCT: tendon attaching to the medial cuneiform bone, IMTT: tendon attaching to the first metatarsal bone, MM: medial malleolus, w: width, t: thickness, l: length, CSA: cross-sectional area, h: height, sup: superior level of MM, mid: middle level of MM, inf: inferior level of MM, ang: angle) Among the morphometric data of TAT and TPT, a moderate positive correlation was found only between TATw and TA-TPap (r = 0.491, p = 0.013, Table 3 ). No significant relationship was found between the morphometric data of TAT and TPT and the morphometric data of MM (p > 0.05) (Table 3 ). When the relationship with angles was examined, a moderate negative correlation was found only between TATt and TATang (r=-0.406, p = 0.044, Table 3 ). When the distance between TAM and TPM tendons were evaluated along the course of MM, a moderate positive correlation was found between MMh and TA-TPmid (r = 0.434, p = 0.030, Table 3 ), and a moderate positive correlation was found between MMw and TA-TPsup (r = 0.399, p = 0.048, Table 3 ). It was determined that there were strong positive correlations between the distance between two tendons according to the MM and between the distances to each other at the upper, middle and lower levels of the MM (Table 3 ). Table 3 Analyses between morphometric data of TAT, TPT, and MM. Parameters Parameters TATCSA TPTw TPTt TPTCSA MMh MMw TA-TPsup TA-TPmid TA-TPinf TATang TPTang TATw r 0.515 ** 0.114 0.144 0.068 0.327 0.142 0.221 0.491 * 0.166 -0.137 -0.143 p 0.008 0.597 0.502 0.746 0.111 0.499 0.287 0.013 0.428 0.515 0.497 N 25 24 24 25 25 25 25 25 25 25 25 TATt r 0.857 ** 0.034 0.172 0.239 -0.104 0.067 -0.343 -0.042 -0.350 -0.406 -0.141 p 0.000 0.875 0.422 0.250 0.621 0.751 0.093 0.841 0.086 0.044 0.502 N 25 24 24 25 25 25 25 25 25 25 25 TPTw r 0.072 0.658 ** 0.050 0.246 0.294 -0.008 0.212 0.018 0.109 p 0.738 0.000 0.816 0.247 0.163 0.970 0.321 0.933 0.612 N 25 25 25 25 25 25 25 25 25 TPTt r 0.794 ** 0.018 0.058 0.077 0.209 0.083 -0.274 -0.220 p 0.000 0.933 0.786 0.720 0.328 0,699 0.196 0.303 N 25 25 25 25 25 25 25 25 MMh r 0.455 * 0.274 0.434 * 0.348 0.166 -0.101 p 0.022 0.184 0.030 0.089 0.426 0.632 N 25 25 25 25 25 25 MMw r 0.399 * 0.200 0.363 0.200 -0.127 p 0.048 0.339 0.075 0.338 0.544 N 25 25 25 25 25 TA-TPsup r 0,553 ** 0.729 ** 0.243 -0.067 p 0.004 0.000 0.241 0.752 N 25 25 25 25 *. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed). TAT Classification According to the Slip Count and Bone Attachment Status It was determined that TAT attached to MC, I.MT and first tarsometatarsal joint capsule (first TMTJ) in different combinations (Table 4 ). It was recorded that TAT could be in minimum 1 and maximum 3 slips. Typing process was done according to slip number first and subtypes were coded according to the variations of attachment (Table 4 ). 4 main types were created according to slip number as Type I, II and III. Table 4 Classification of TPTs according to their slips and attachment sites. Types Subtypes Attachment Sites & Configurations N (%) Total n (%) Type I Type I.A MC 2 (%8) 3 (%12) Type I.B I.MT 1 (%4) Type II Type II.A I.MT = MC 8 (%32) 14 (%56) Type II.B I.MT < MC 6 (%24) Type III - MC, IMT, and first TMTJ 8 (%32) 8 (%32) Type I: Attachment to MC was recorded as Type I.A (Fig. 1 & 2 A). Attachment to I.MT was recorded as Type I.B (Fig. 1 & 2 B) Type II: In case of 2 slips, there was attachment to MC and I.MT. If the tendons attached to MC and I.MT were of equal thickness, it was coded as Type II.A (Fig. 1 & 3 A), if the one attached to I.MT was thicker, it was coded as Type II.B (Fig. 1 & 3 B). Type III: In case of 3 slips, there was attachment to MC, I.MT and first tarsometatarsal joint capsule. If there was attachment to MC, I.MT and first tarsometatarsal joint capsule, it was coded as Type III.A (Fig. 1 & 4 ). Discussion Among a lot of studies on TAM and TAT, there was not enough data about its relation with MM and TPM. Therefore, the present study aimed to evaluate the precise insertion site of the TAT and its morphometric relation with MM and TPT. According to our findings, the most common TAT attachment pattern is the attachment of equal-sized bands to the base of the medial cuneiform and first metatarsal bones. Additionally, we found that the morphometry of the TAT was associated with MM and its relationship with the TPT tendon was also affected by MM. The most important asset in the TAT classification is the identification of anatomical variational attachment sites by dissection study and the simplification of the classification. The resulting classification provides a list of TAT types that are not only visually different but also show significant differences in their relationship with the bones and tendons located in the region such as MM and TPT and their morphological characteristics. Since 1963, different types of insertions have been described in literature and classifications have been performed in different combinations [ 2 – 4 , 13 , 20 , 23 , 24 , 44 , 46 ]. The first classification of TAT attachment sites was introduced by Musiał [ 22 ], and 4 main types were defined. Type 1 was coded as the attachment of the tendon to the MC and I.MT by two equal-sized bands and presented this type as the second most frequently observed type. Type 2 was reported For the most common type, that has two-slip; a thick one to MC, while a thinner attached to I.MT. In other types, they classified by taking the opposite thickness into account. In the following years, in 1990, Arthornhurasook and Im [ 3 ] made a classification in agreement with Musiał's classification and reported three additional subclasses. Brenner [ 4 ] defined five different attachment site variations and in the following years, Willegger et al. (2017) proposed a new revision of the classification introduced by Musiał [ 20 ]. In recent years, the last update was by Olewnik et al. [ 23 ], who systematized the classification and updated it based on 5 main types. When Olewnik et al.’s [ 23 ] classification is examined, it is obvious as being the current systematized version of the old literature. However, in that study, each attachment type was coded as a separate type, so that the number of types increased to 5. In our study, we classified by using criteria that we can include all literature and newly observed variations in the typing. First, main types were created by considering each band (slip) separated from the main tendon. For this, the first criterion was taken as the number of bands. Subtype definition was used for the subsequent observed attachment situations or combinations. In the subtype definition, the criteria were the bone structures which the slips are attached and the tendon thickness. In the current study, the most frequently observed type was the one having two bands (slips) (56%) and the subtype was the attachment with equal expansion to MC and I.MT (32%). Such a systematization is thought to be useful to improve the planning of surgical procedures and rehabilitation programs. Murley et al. [ 19 ] reported that the thickness of TAT was 2.6 − 0.4 mm and the thickness of TPT was 3-0.6 mm in 61 patients with ultrasound imaging. The thickness of TAT and TPT in our study (mean 2.25 ± 0.4 mm, 2.33 ± 0.45 mm, respectively) were consistent with Murley's study. Jarusriwanna and Chuckpaiwon [ 12 ] reported that the TAT attachments were found to be longer on the MC than on the base of the I.MT (means 8.3 and 5.4 mm), but the widths were nearly similar (means 11.0 and 10.4 mm). Additionally, tendon attachments on the medial and plantar surfaces of the MC were equivalent in width (means 5.4 and 5.6 mm). Our study’s results in terms of width were consistent with the literature (means were 5.48 mm, 7.80 mm, 5.40 mm, and 5.96 mm, respectively). In literature, it is reported that the average TPTw is between 8.00-11.60 mm and in TPTt it is between 3.78–3.96 mm [ 1 , 6 , 23 , 39 ]. It is thought that these wide frequency differences are due to the variety of study samples (patients, fixed cadavers, fresh cadavers etc.), method differences (MR, ultrasonography, manual caliper etc.) and demographic differences. Considering all these, it is thought that data of the TPT morphometry obtained in our study (average 8.89 mm for TPTw, average 2.54 mm for TPTt) are in the range reported in literature and are compatible. Considering tendon morphometries, the importance of TAT transfer (TATT) procedure in the treatment of relapsed clubfoot is remarkable [ 7 , 9 , 15 ]. Idiopathic clubfoot deformity continues to be a common pediatric orthopedic problem with an incidence of 1/1000 live births [ 11 ]. In general, successful results can be obtained with serial manipulations and casting, but, regardless of the initial treatment results and the correction obtained, relapse can be seen up to 50% of clubfoot treatment [ 7 ] (Farsetti et al. 2006). It is reported that relapse is the result of the same pathology that caused the primary deformity and is usually related to non-compliance with the Ponseti brace protocol [ 9 , 28 ]. However, in cases where correction is unsuccessful, operative treatment may be required for deformities [ 28 ] (Ponseti and Smoley, 2009). The TATT procedure is the most important surgical treatment method. First of all, the first criterion is to provide muscle balance after tendon transfer and correct dynamic supination gait [ 16 ]. As a result of the transfer of TAT to the lateral cuneiform, the cuneiforms and cuboid are shifted more laterally than normal, which contributes to the correction and stabilization of relapse clubfoot [ 9 ]. Presented anatomic information in our study regarding attachment sites and slip status could help diagnose TAT rupture and the anatomical reconstruction of the TAT. TPT transfer is frequently applied to treat various foot deformities related to poor ankle dorsiflexion and to restore normal heel-toe gait. It has been reported that after TPT is transferred to the anterior and dorsal regions of the ankle, dorsiflexion is restored and deforming forces in the medial region of the foot are eliminated [ 27 , 34 ]. Although an interosseous route is recommended due to conditions such as direct traction, high dorsiflexion power and low varus recurrence probability compared to alternative methods [ 22 , 35 , 38 ], it is reported that subcutaneous TPT transfer methods are preferred for patients with calcified and inelastic interosseous membranes [ 31 , 36 ]. It is noteworthy that studies in the literature have not yet revealed the optimum TPT placement site and there is no consensus on a standard method. For example, it has been suggested that the TPT placement sites on the dorsum of the foot may differ depending on unequal force between the medial and lateral sides, but the intermediate cuneiform may be the optimum location [ 33 , 40 ]. It is recommended that the TPT transfer can be performed at the midline of the foot, the intermediate cuneiform, or the lateral cuneiform, while some other researchers [ 26 , 30 ] suggest transferring TPT additional to the other dorsal region tendons (extensor halluces longus, extensor digitorum, and peroneus tertius). When comparing tendon-to-bone (TtoB) and tendon-to-tendon (TtoT) techniques, there may be insufficient TPT length, especially for the TtoB procedure. In terms of methodological difficulty, it has been determined that the TtoT suture may be more challenging surgically and the reconstruction may be more complicated [ 41 ]. In particular, it has been suggested that the angle between the TPT and the attached tendons impairs the tensile strength of the TPT and reduces the dorsiflexion strength [ 41 ]. Ryssman and Myerson [ 34 ] stated that the transferred tendon should be fixed with a TtoB interface whenever possible, and that this procedure is physiologically more effective than other methods. The main disadvantage of the TtoB procedure is the insufficient length, as described in previous studies [ 8 , 35 ]. However, some researchers have suggested that this disadvantage can be avoided by using the midpoints of the intermediate cuneiform, the lateral cuneiform, and the cuboid as the transferred insertion sites. In addition, it has been suggested that these sites can potentially be applied in surgeries [ 45 ]. In our study, important anatomical information regarding the morphometry and insertion sites of the TPT and TAT tendons has been provided. First, we believe that MM morphometry is one of the most important factors underlying the cases where the TPT tendon length is insufficient, as mentioned in the literature. The MMh and MMw values ​​cause the differences in the course of TAT and TPT reaching the dorsum and plantar parts of the foot and the formation of morphometric distances between each other. Considering this aspect, we agree with the opinion of Xu et al. [ 45 ] that the intermembranous transfer technique prevents the TPT length from being a disadvantage. As additional support to this opinion, we believe that MM morphometry is the underlying anatomical landmark. Conclusion TAT placement presents high morphological variability that can be observed in cadavers. Our new classification simplifies this anatomical diversity and systematizes it through criteria. We believe that the morphometric data we obtained will contribute to the awareness of TAT variations and attachment sites in surgical procedures planned in the region and will provide a basis for further biomechanical and clinical studies targeting to improve the rehabilitation of patients, especially after TAT injuries. Considering the complications of osteotomies in the treatment of metatarsus adductus deformity for recurrent clubfoot, we hope that TAT transfer may be a safe way and that surgeons would reconsider the necessity of osteotomy. Declarations Ethics approval and consent to participate The study has been approved by the Board of Ethics of Mersin University (Approval number: 2023/500). Written informed consent has been obtained from the relevant donor/legal representative regarding the use of cadavers and remains used in the study for educational and/or scientific research purposes. In the said consent document, it has been clearly stated that the use of cadaver remains in educational activities and/or scientific research within the university/institution is permitted. Accordingly, we undertake that the relevant cadaver remains will be used in accordance with ethical principles and the standards of the Helsinki Declaration and only for educational and scientific purposes. Availability of data and materials The data (accessible part) presented in this study is available upon reasonable request to the corresponding author. Competing interests The authors declare no conflict of interest. Funding None Authors’ Contribution • TK - Project development, Performed Dissections, Data analysis, Manuscript writing & editing. • ABÖ - Supervisor, Project development, Manuscript editing. • GK - Performed Dissections, Manuscript writing and editing. Acknowledgements We thank to donor of human cadavers. Additionally, we thank to the Pathology, Orthopedics and Traumatology Departments of Mersin University Hospital that contributed to the acquisition of the materials in the Anatomy inventory. References Albano, D. et al. Predictive role of ankle MRI for tendon graft choice and surgical reconstruction. Radiol. Med. 125 (8), 763–769 (2020). Anagnostakos, K., Bachelier, F., Fürst, O. A. & Kelm, J. Rupture of the anterior tibial tendon: three clinical cases, anatomical study, and literature review. Foot ankle Int. 27 (5), 330–339 (2006). Arthornthurasook, A. & Im, K. G. Anterior tibial tendon insertion: an anatomical study. J. Med. Association Thail. = Chotmaihet Thangphaet . 73 (12), 692–696 (1990). Brenner, E. Insertion of the tendon of the tibialis anterior muscle in feet with and without hallux valgus. Clin. Anatomy: Official J. Am. Association Clin. Anatomists Br. Association Clin. Anatomists . 15 (3), 217–223 (2002). Cohen, D. A. & Gordon, D. H. 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Treatment of acute and chronic tibialis anterior tendon rupture and tendinopathy. Foot Ankle Clin. 22 (4), 819–831 (2017). Holt, J. B., Oji, D. E., Yack, H. J. & Morcuende, J. A. Long-term results of tibialis anterior tendon transfer for relapsed idiopathic clubfoot treated with the ponseti method: a follow-up of thirty-seven to fifty-five years. J. Bone Joint Surg. Am. 97 (1), 47–55 (2015). Jarusriwanna, A. & Chuckpaiwong, B. Appropriate area for operative procedures near tibialis anterior tendon insertion: a cadaveric study. Foot Ankle Int. 39 (3), 349–354 (2018). Karauda, P., Podgórski, M., Paulsen, F., Polguj, M. & Olewnik, Ł. Anatomical variations of the tibialis anterior tendon. Clin. Anat. 34 (3), 397–404 (2021). Kopp, F. J., Backus, S., Deland, J. T. & O’Malley, M. J. Anterior tibial tendon rupture: results of operative treatment. Foot Ankle Int. 28 (10), 1045–1047 (2007). Kuo, K. N., Hennigan, S. P. & Hastings, M. E. Anterior tibial tendon transfer in residual dynamic clubfoot deformity. J. Pediatr. Orthop. 21 (1), 35–41 (2001). Lampasi, M., Bettuzzi, C., Palmonari, M. & Donzelli, O. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J. Bone Joint Surg. Br. 92 , 277–283 (2010). Miller, S. C., Korff, T., Waugh, C., Fath, F. & Blazevich, A. J. Tibialis anterior moment arm: effects of measurement errors and assumptions. Med. Sci. Sports Exerc. 47 (2), 428–439 (2015). Moore, K. & Dalley, A. Lower limb. Clinically oriented anatomy (Wilkins, Lippincott Williams and Wilkins, 2006). Murley, G. S. et al. Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and A chilles tendon. Scandinavian journal of medicine & science in sports 24 (3), 535–541. (2014). Musial, W. W. Variations of the terminal insertions of the anterior and posterior tibial muscles in man. Folia Morphol. 26 (22), 237–247 (1963). Myerson, M. S. Paralytic disorders of the lower extremity. In: (ed Myerson, M. S.) Foot and ankle disorders. Saunders, Philadelphia, USA, 885–891. (2000). O'Byrne, J. M., Kennedy, A. & Jenkinson, A. Split tibialis posterior tendon transfer in the treatment of spastic equinovarus foot. J. Pediatr. Orthop. 17 , 481–485 (1997). Olewnik, Ł. A proposal for a new classification for the tendon of insertion of tibialis posterior. Clin. Anat. 32 (4), 557–565 (2019). Olewnik, Ł., Podgórski, M., Polguj, M. & Topol, M. A cadaveric and sonographic study of the morphology of the tibialis anterior tendon–a proposal for a new classification. Journal of foot and ankle research 12 , 1–8. (2019). Ouzounian, T. J. & Anderson, R. Anterior tibial tendon rupture. Foot Ankle Int. 16 (7), 406–410 (1995). Ozkan, T., Tuncer, S. & Ozturk, K. Tibialis posterior tendon transfer for persistent drop foot after peroneal nerve repair. J. Reconstr. Microsurg . 25 , 157–164 (2009). Ozkan, T., Tuncer, S., Ozturk, K., Aydin, A. & Ozkan, S. Surgical restoration of drop foot deformity with tibialis posterior tendon transfer. Acta Orthop. Traumatol. Turc. 41 (4), 259–265 (2007). Ponseti, I. V. & Smoley, E. N. The classic: congenital club foot: the results of treatment. 1963. Clin Orthop Relat Res 467: 1133-45. (2009). Prahinski, J. R., McHale, K. A., Temple, H. T. & Jackson, J. P. Bridle transfer for paresis of the anterior and lateral compartment. Foot Ankle Int. 17 (10), 615–619 (1996). Reis, F. J., Knackfuss, I. & Vercosa, N. A method used to access the functional outcome of tibial posterior tendon transfer for foot drop in leprosy. Foot Ankle Spec. 5 , 45–50 (2012). Reis, F. J., Knackfuss, I. G. & Vercosa, N. The functional outcome of posterior tibial tendon transfer for foot drop in leprosy—the results of one to 5 years follow up. Lepr. Rev. 80 , 219–220 (2009). Rodriguez, R. P. The Bridle procedure in the treatment of paralysis of the foot. Foot Ankle . 13 , 63–69 (1992). Root, L., Miller, S. R. & Kirz, P. Posterior tibial-tendon transfer in patients with cerebral palsy. J. Bone Joint Surg. Am. 69 , 1133–1139 (1987). Ryssman, D. B. & Myerson, M. S. Tendon transfers for the adult flexible cavovarus foot. Foot Ankle Clin. 16 (3), 435–450 (2011). Shah, R. K. Tibialis posterior transfer by interosseous route for the correction of foot drop in leprosy. Int. Orthop. 33 , 1637–1640 (2009). Soares, D. Tibialis posterior transfer for the correction of foot drop in leprosy: long-term outcome. J. Bone Joint Surg. Br. Volume . 78 (1), 61–62 (1996). Standring, S. Gray's Anatomy E-Book: Gray's Anatomy E-Book (Elsevier Health Sciences, 2021). Steinau, H. U. et al. Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements. Archives of orthopaedic and trauma surgery 131 , 903–910. (2011). Swanton, E., Fisher, L., Fisher, A., Molloy, A. & Mason, L. An anatomic study of the naviculocuneiform ligament and its possible role maintaining the medial longitudinal arch. Foot Ankle Int. 40 (3), 352–355 (2019). Turner, J. W. & Cooper, R. R. Anterior transfer of the tibialis posterior through the interosseus membrane. Clin. Orthop. Relat. Res. 83 , 241–244 (1972). Vigasio, A., Marcoccio, I. & Patelli, A. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin. Orthop. Relat. Res. 466 , 1454–1466 (2008). Vohra, R., Thorat, B. & Singh, A. Bridle Procedure Revisited. Orthop. Rheumatol. Open. Access. Journals . 16 (5), 107–113 (2020). Vosoughi, A. R., Heyes, G., Molloy, A. P., Mason, L. W. & Hoveidaei, A. H. Management of tibialis anterior tendon rupture: recommendations based on the literature review. Foot Ankle Surg. 26 (5), 487–493 (2020). Willegger, M., Seyidova, N., Schuh, R., Windhager, R. & Hirtler, L. Anatomical footprint of the tibialis anterior tendon: surgical implications for foot and ankle reconstructions. Biomed. Res. Int. 9542125 . (2017). Xu, J. et al. Posterior tibialis tendon transfer via the circumtibial route: a cadaveric limb analysis. J. Orthop. Surg, Res. 9 , 1–6 (2014). Zielinska, N. et al. Anatomical variations of the tibialis anterior tendon insertion: an updated and comprehensive. Rev. J. Clin. Med. 10 (16), 3684 (2021). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6347099","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":449416026,"identity":"f6a9719b-cdb2-44f3-8dd4-445bbadb7445","order_by":0,"name":"Turan Koç","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYNCCAwwM/DxgFjNhxTwwLZI9MC1sxGoxOEOsFnuJ3IefC87YyBufOf5MgqHCOrFBvvcBflsk0o2lZ9xIM9x2tsdMguFMemIDG7sBAS1pDNI8Hw4nmJ3nYZNgbDsM1ELAZUAtzL9BWoz72Z9JMP4jTgubNM+NwwkGvA1mEowNxGg584zNmudMmuGMM2eMLRKOpRu3saXh18LensZ8m+eYjTx/T/rDGx9qrGX7mY/h14IKEhgIR8soGAWjYBSMAiIAAIlLO/dnQ3b+AAAAAElFTkSuQmCC","orcid":"","institution":"Kahramanmaraş Sütçü İmam University","correspondingAuthor":true,"prefix":"","firstName":"Turan","middleName":"","lastName":"Koç","suffix":""},{"id":449416027,"identity":"61981360-8117-41ea-a3e0-1b11b94c3987","order_by":1,"name":"Alev BOBUŞ ÖRS","email":"","orcid":"","institution":"Mersin University","correspondingAuthor":false,"prefix":"","firstName":"Alev","middleName":"BOBUŞ","lastName":"ÖRS","suffix":""},{"id":449416028,"identity":"4b4f3e1d-c398-476f-b449-440ee0162b7c","order_by":2,"name":"Gülden KAYAN","email":"","orcid":"","institution":"Mersin University","correspondingAuthor":false,"prefix":"","firstName":"Gülden","middleName":"","lastName":"KAYAN","suffix":""}],"badges":[],"createdAt":"2025-03-31 17:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6347099/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6347099/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84576245,"identity":"e1f12324-8733-4dac-8c2c-351964f571d2","added_by":"auto","created_at":"2025-06-13 16:51:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71277,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematic drawing of the classification of TPTs according to their slips and attachment sites.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedial view of the foot. TAM: tibialis anterior muscle, TAT: tibialis anterior muscle tendon, I.MT: first metatarsal bone, NV: navicular bone, MC: medial cuneiform bone.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6347099/v1/e5f14b9abfb40d606eefa0d4.jpg"},{"id":84576756,"identity":"bfa78896-3b9e-44c1-83cf-6efc27cfecb5","added_by":"auto","created_at":"2025-06-13 16:59:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":922720,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eType I configurations of the TAT.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eType I.A was shown in A and Type I.B was in B. \u003c/strong\u003eMedial view of the foot. TAT: tibialis anterior muscle tendon, TPT: tibialis posterior muscle tendon, MM: medial malleolus, I.MT: first metatarsal bone, NV: navicular bone, MC: medial cuneiform bone.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6347099/v1/0447361f0dd139ce9e0805ee.jpg"},{"id":84577012,"identity":"bb415547-8b7a-4ab8-bb4e-4677a0277b54","added_by":"auto","created_at":"2025-06-13 17:07:31","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2262704,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eType II configurations of the TAT.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eType II.A was shown in A and Type II.B was in B. \u003c/strong\u003eMedial view of the foot. TAT: tibialis anterior muscle tendon, TPT: tibialis posterior muscle tendon, MM: medial malleolus, I.MT: first metatarsal bone, NV: navicular bone, MC: medial cuneiform bone, 1,2: shows slips of the TPT.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6347099/v1/df5a1e069fb742730404d162.jpg"},{"id":84576252,"identity":"8cf2ec69-3b3c-453a-8b06-082b26930824","added_by":"auto","created_at":"2025-06-13 16:51:31","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":3336528,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eType III configurations of the TAT.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedial view of the foot. TAT: tibialis anterior muscle tendon, TPT: tibialis posterior muscle tendon, MM: medial malleolus, I.MT: first metatarsal bone, NV: navicular bone, MC: medial cuneiform bone, 1,2,3: shows slips of the TPT.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6347099/v1/d321fcffbcd495f94180f65c.jpg"},{"id":85240542,"identity":"ebb7e183-e1a5-41c9-ad37-cdd244c9207c","added_by":"auto","created_at":"2025-06-23 18:31:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7716183,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6347099/v1/2fa334a7-838d-4a9f-b303-5f6635b85b3b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Morphometric evaluation of the tibialis anterior muscle tendon","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe tibialis anterior muscle (TAM) is a powerful muscle located in the most medial part of the anterior compartment of the leg. It performs dorsiflexion and inversion of the foot [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. It is the antagonist and synergist of tibialis posterior muscle. It helps to stabilize the ankle during walking (during the contact phase, i.e., eccentric contraction) and lifts the foot off the ground during the swing phase, i.e., concentric contraction. Additionally, it helps lock the ankle during isometric contraction, especially during sports [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTendon rupture of anterior tibial (TAT) usually late diagnosed due to mild clinical signs and symptoms [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Although, it is a rare condition, it is the third most common tendon rupture in the lower extremity after the Achilles tendon and patellar tendon [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. TAT rupture can be acute or chronic, resulting from different traumas including sharp shear injuries, blunt trauma, or hyperflexion trauma. Spontaneous ruptures are rare and are usually known to be the result of a long history of chronic degenerative tendon disease. Risk factors include systemic lupus erythematosus, hypoparathyroidism, diabetes mellitus, rheumatoid and psoriatic arthritis, and gout [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParalysis or weakness of TAM, primary dorsiflexor of the ankle, results in a stepping gait characterized by a plantarflexed position of the ankle (foot drop) during the swing phase of walking and initial ground contact [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This condition is known to be most caused by peroneal nerve injury. Initial treatment for foot drop includes using an ankle foot orthosis, muscle strengthening, and tendon Achilles stretching. If no improvement occurs for more than a year, tendon transfer is usually required to achieve a balanced foot that is plantigrade and functional. Transfer of the tibialis posterior muscle (TPM) tendon (TPT) to the dorsum of the foot is one of the most frequently performed surgeries in the treatment of foot drop [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical reconstructions of TAM, such as tendon transfer (posterior tibial tendon transfer, extensor hallucis longus transfer, etc.), muscle repair or allotransplantation are the preferred treatment methods, especially in cases where dorsal extension and supination of the foot are severely impaired [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. It has been reported that repositioning TAM to its anatomical attachment site is important to restore the natural lever arm of TAM [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and morphometric features of ligament and tendon connections may help optimize reconstruction procedures in terms of anchorage placement and graft sizing (Holt et al. 2015). Some studies have reported that the anatomical details regarding the relationship between TAT and TPT in foot drop surgery and the tendon transfer process are insufficient [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. There is no morphometric data in the literature on the extent to which the morphometric features of the medial malleolus and TA and TP are related. In this cadaver study, it was aimed to evaluate the morphometric features of TAT along with its insertional features and its relationship with the medial malleolus through the TPT transfer relationship.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThe study was performed on\u0026nbsp;25 feet fixed with 10% formalin (15 men, 10 women) from\u0026nbsp;the inventory of the Anatomy Department of Medical Faculty at Mersin University. The study was approved by the Mersin University Clinical Research Ethics Committee (Approval numbers: 2023/500). Human cadavers (obtained through a body donation program) used in this study are legally registered in the educational and research gross anatomical archive of the Anatomy Department of Mersin University, Faculty of Medicine. This study accordance with recognized standards of Helsinki Declaration. First, dissections were performed on the dorsal and medial parts of the foot. The tendon of the TAM passing in front of the medial malleolus was identified and the fascia and retinaculum on it were not completely removed to not disrupt its anatomical course. The tendon of the TPM passing behind the MM was identified and followed till it’s separation into slips is seen. In terms of integrity, the plantar part of the foot was preserved.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDissection protocol\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn anatomical position, dissection lines were determined by marking lines in the medial parts of the ankle, dorsum of the foot and sole. A transverse incision was made 3-4 cm above the MM in the \u003cs\u003edistal\u003c/s\u003e medial part of the leg and then dissection of the skin and superficial fascia was initiated. After this stage, dissection on the dorsal and medial side continued with the removal of the dorsal fascia of the foot (DFF) and extensor retinaculum (ER). By carefully removing the dorsal and posterior parts of the DFF and ER, the TAT and TPT extending at the dorsum of the foot were exposed. Then, the remaining part of the ER and the superficial and deep parts of the medial sole were dissected and the abductor hallucis muscle (AHM), medial cuneiform bone (MC), first metatarsal bone (I.MT), and navicular bone (NV) were exposed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll dissections were performed by the same researcher (T.K). A digital caliper (0.01 mm precision) was used to measure the parameters. Under the same environmental conditions, at different times, all measurements were repeated in triplicates independently by two investigators (T.K. and A.B.Ö).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUpon that, the following parameters were measured (Fig. 1).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eFoot length\u003c/li\u003e\n \u003cli\u003eWidth (w), length (l), thickness (t), and cross-sectional area (CSA) of TAT and TPT.\u003c/li\u003e\n \u003cli\u003eWidth (w) and length (l) of slips of MC (MCT) and I.MT (IMTT).\u003c/li\u003e\n \u003cli\u003eHeight (h) and width (w) of MM.\u003c/li\u003e\n \u003cli\u003eDistance between TAT-TPT on superior (TA-TPsup), middle (TA-TPmid) and inferior (TA-TPinf) level of MM.\u003c/li\u003e\n \u003cli\u003eAngles of TAT (TATang) and TPT (TPTang).\u003c/li\u003e\n \u003cli\u003eCount of slips of TAT.\u003c/li\u003e\n \u003cli\u003eAttachments status of TAT.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analyses\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIntraclass correlation coefficients were calculated for the examination of interobserver agreement and expressed with 95% confidence intervals. Normality control of continuous variables was assessed with Shapiro Wilk test. Parametric methods were used in the analysis of variables that showed normal distribution, and nonparametric methods were used in the analysis of those that did not. Student’s t test and Mann Whitney U test were used in the comparison of two independent groups. Pearson and Spearman Rho correlation coefficients were used in the examination of the linear relationship between two continuous variables. Data analyses were performed with Statistica v.13.3.1 program. Statistical significance level was accepted as p\u0026lt;0.05 in all analyses.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Findings\u003c/h2\u003e \u003cp\u003eIn all variables, a statistically significant and high level of agreement was found between the researchers (T.K. and A.B.\u0026Ouml;) who performed the measurement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The high level of these agreement coefficients indicates that the measurements used are reliable. Data regarding sex and side distribution of the feet included in the study are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No significant difference was found in age distribution between genders and sides (p\u0026thinsp;=\u0026thinsp;0.186, p\u0026thinsp;=\u0026thinsp;0.730). The average foot lengths were recorded as 24.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61 cm in males and 22.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15 cm in females. It was determined that men had statistically longer foot lengths (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of gender and sides in terms of age distribution.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66,33\u0026thinsp;\u0026plusmn;\u0026thinsp;14,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u0026ndash;86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74,20\u0026thinsp;\u0026plusmn;\u0026thinsp;13,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49\u0026ndash;91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68,57\u0026thinsp;\u0026plusmn;\u0026thinsp;16,04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u0026ndash;91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70,64\u0026thinsp;\u0026plusmn;\u0026thinsp;12,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49\u0026ndash;85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFindings about the TAT and the TPT Morphometry\u003c/h3\u003e\n\u003cp\u003eMorphometric data of the tendons of the TPA and TPT are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. In terms of gender, the averages of TATw, TA-TPsup, and TA-TPmid in male feet were higher than in females (p\u0026thinsp;=\u0026thinsp;0.039, p\u0026thinsp;=\u0026thinsp;0.036, and p\u0026thinsp;=\u0026thinsp;0.041, respectively). In terms of sides, the means of TATW, MMw and TA-TPinf were higher in the left feet compared to the right feet (p\u0026thinsp;=\u0026thinsp;0.029, p\u0026thinsp;=\u0026thinsp;0.013 and p\u0026thinsp;=\u0026thinsp;0.037, respectively). There was no significant difference between the remaining parameters and both gender and side groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of morphometric data of TAT, TPT, and MM according to gender and sides.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eSides\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale (n\u0026thinsp;=\u0026thinsp;10)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMale (n\u0026thinsp;=\u0026thinsp;15)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003eLeft (n\u0026thinsp;=\u0026thinsp;14)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003eRight (n\u0026thinsp;=\u0026thinsp;11)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTATw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.25\u0026ndash;9.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.31\u0026ndash;12.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.31\u0026ndash;12.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7.27\u0026ndash;10.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTATt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.52\u0026ndash;2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.68\u0026ndash;5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.77\u0026ndash;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.52\u0026ndash;5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTATCSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.66\u0026ndash;21.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.03\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.27\u0026ndash;41.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e16.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10.27\u0026ndash;22.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e17.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e10.66\u0026ndash;41.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCTw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.60\u0026ndash;6.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.84\u0026ndash;6.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e5.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.84\u0026ndash;6.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e5.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4.60\u0026ndash;6.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCTl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.49\u0026ndash;8.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.95\u0026ndash;9.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6.95\u0026ndash;8.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e7.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6.49\u0026ndash;9.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMTTw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.40\u0026ndash;6.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0,78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.80\u0026ndash;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e5.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.80\u0026ndash;5.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e5.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4.50\u0026ndash;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMTTl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.72\u0026ndash;7.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.72\u0026ndash;6.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e6.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.65\u0026ndash;6.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e5.80\u0026thinsp;\u0026plusmn;\u0026thinsp;8,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4.79\u0026ndash;7.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPTw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.37\u0026ndash;10.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1,32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.71\u0026ndash;11.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e8.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7.30-10.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e8.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6.37\u0026ndash;11.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPTt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.48\u0026ndash;3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0,45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.20\u0026ndash;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.48\u0026ndash;3.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.14\u0026ndash;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPTCSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.62\u0026ndash;22.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e17.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.83\u0026ndash;24.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e16.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9.62\u0026ndash;24.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e16.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e9.40-23.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.33\u0026ndash;46.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e38.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.77\u0026ndash;49.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e39.41\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30.77\u0026ndash;49.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e37.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e34.35\u0026ndash;42.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.74\u0026ndash;39.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e30.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.04\u0026ndash;35.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e30.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26.04\u0026ndash;39.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e30.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e26.74\u0026ndash;35.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTA-TPsup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2,39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.91\u0026ndash;35.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e35.03\u0026thinsp;\u0026plusmn;\u0026thinsp;6,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.87\u0026ndash;42.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e35.12\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29.76\u0026ndash;42.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e32.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e18.87\u0026ndash;40.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTA-TPmid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.55\u0026ndash;32.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e32.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25.54\u0026ndash;38.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e32.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25.54\u0026ndash;38.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e30.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e26.57\u0026ndash;37.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTA-TPinf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.45\u0026ndash;36.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e30.16\u0026thinsp;\u0026plusmn;\u0026thinsp;7,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.40\u0026ndash;39.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e31,73\u0026thinsp;\u0026plusmn;\u0026thinsp;4,21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23.87\u0026ndash;39.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e27.55\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e9.40-36.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTATang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.00\u0026ndash;62.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e45.47\u0026thinsp;\u0026plusmn;\u0026thinsp;12,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.00\u0026ndash;65.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e49,57\u0026thinsp;\u0026plusmn;\u0026thinsp;11,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e21.00\u0026ndash;65.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e45.64\u0026thinsp;\u0026plusmn;\u0026thinsp;10.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e25.00\u0026ndash;62.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPTang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51,70\u0026thinsp;\u0026plusmn;\u0026thinsp;13,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.00\u0026ndash;74.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e55.13\u0026thinsp;\u0026plusmn;\u0026thinsp;13,05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.00\u0026ndash;75.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e52,93\u0026thinsp;\u0026plusmn;\u0026thinsp;10,16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e35.00\u0026ndash;75.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e54.82\u0026thinsp;\u0026plusmn;\u0026thinsp;16.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e28.00\u0026ndash;74.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e(TAT: tibialis anterior tendon, TPT: tibialis posterior tendon, MCT: tendon attaching to the medial cuneiform bone, IMTT: tendon attaching to the first metatarsal bone, MM: medial malleolus, w: width, t: thickness, l: length, CSA: cross-sectional area, h: height, sup: superior level of MM, mid: middle level of MM, inf: inferior level of MM, ang: angle)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the morphometric data of TAT and TPT, a moderate positive correlation was found only between TATw and TA-TPap (r\u0026thinsp;=\u0026thinsp;0.491, p\u0026thinsp;=\u0026thinsp;0.013, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). No significant relationship was found between the morphometric data of TAT and TPT and the morphometric data of MM (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When the relationship with angles was examined, a moderate negative correlation was found only between TATt and TATang (r=-0.406, p\u0026thinsp;=\u0026thinsp;0.044, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When the distance between TAM and TPM tendons were evaluated along the course of MM, a moderate positive correlation was found between MMh and TA-TPmid (r\u0026thinsp;=\u0026thinsp;0.434, p\u0026thinsp;=\u0026thinsp;0.030, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and a moderate positive correlation was found between MMw and TA-TPsup (r\u0026thinsp;=\u0026thinsp;0.399, p\u0026thinsp;=\u0026thinsp;0.048, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). It was determined that there were strong positive correlations between the distance between two tendons according to the MM and between the distances to each other at the upper, middle and lower levels of the MM (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalyses between morphometric data of TAT, TPT, and MM.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"11\" nameend=\"c13\" namest=\"c3\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTATCSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTPTw\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTPTt\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTPTCSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMMh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMMw\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTA-TPsup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eTA-TPmid\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTA-TPinf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTATang\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eTPTang\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTATw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.515\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.491\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25\u003c/p\u003e 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colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e 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\u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMMh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.455\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.434\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMMw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.399\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.048\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTA-TPsup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0,553\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.729\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"13\" nameend=\"c13\" namest=\"c1\"\u003e \u003cp\u003e*. Correlation is significant at the 0.05 level (2-tailed).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"13\" nameend=\"c13\" namest=\"c1\"\u003e \u003cp\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTAT Classification According to the Slip Count and Bone Attachment Status\u003c/h2\u003e \u003cp\u003eIt was determined that TAT attached to MC, I.MT and first tarsometatarsal joint capsule (first TMTJ) in different combinations (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). It was recorded that TAT could be in minimum 1 and maximum 3 slips. Typing process was done according to slip number first and subtypes were coded according to the variations of attachment (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). 4 main types were created according to slip number as Type I, II and III.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification of TPTs according to their slips and attachment sites.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTypes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtypes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAttachment Sites \u0026amp; Configurations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eType I\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType I.A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (%8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3 (%12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType I.B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI.MT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (%4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eType II\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType II.A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI.MT\u0026thinsp;=\u0026thinsp;MC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (%32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e14 (%56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType II.B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI.MT\u0026thinsp;\u0026lt;\u0026thinsp;MC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (%24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType III\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMC, IMT, and first TMTJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (%32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (%32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eType I: Attachment to MC was recorded as Type I.A (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026amp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Attachment to I.MT was recorded as Type I.B (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026amp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eType II: In case of 2 slips, there was attachment to MC and I.MT. If the tendons attached to MC and I.MT were of equal thickness, it was coded as Type II.A (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026amp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA), if the one attached to I.MT was thicker, it was coded as Type II.B (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026amp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eType III: In case of 3 slips, there was attachment to MC, I.MT and first tarsometatarsal joint capsule. If there was attachment to MC, I.MT and first tarsometatarsal joint capsule, it was coded as Type III.A (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026amp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAmong a lot of studies on TAM and TAT, there was not enough data about its relation with MM and TPM. Therefore, the present study aimed to evaluate the precise insertion site of the TAT and its morphometric relation with MM and TPT. According to our findings, the most common TAT attachment pattern is the attachment of equal-sized bands to the base of the medial cuneiform and first metatarsal bones. Additionally, we found that the morphometry of the TAT was associated with MM and its relationship with the TPT tendon was also affected by MM.\u003c/p\u003e \u003cp\u003eThe most important asset in the TAT classification is the identification of anatomical variational attachment sites by dissection study and the simplification of the classification. The resulting classification provides a list of TAT types that are not only visually different but also show significant differences in their relationship with the bones and tendons located in the region such as MM and TPT and their morphological characteristics. Since 1963, different types of insertions have been described in literature and classifications have been performed in different combinations [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The first classification of TAT attachment sites was introduced by Musiał [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and 4 main types were defined. Type 1 was coded as the attachment of the tendon to the MC and I.MT by two equal-sized bands and presented this type as the second most frequently observed type. Type 2 was reported For the most common type, that has two-slip; a thick one to MC, while a thinner attached to I.MT. In other types, they classified by taking the opposite thickness into account. In the following years, in 1990, Arthornhurasook and Im [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] made a classification in agreement with Musiał's classification and reported three additional subclasses. Brenner [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] defined five different attachment site variations and in the following years, Willegger et al. (2017) proposed a new revision of the classification introduced by Musiał [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In recent years, the last update was by Olewnik et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], who systematized the classification and updated it based on 5 main types. When Olewnik et al.\u0026rsquo;s [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] classification is examined, it is obvious as being the current systematized version of the old literature. However, in that study, each attachment type was coded as a separate type, so that the number of types increased to 5. In our study, we classified by using criteria that we can include all literature and newly observed variations in the typing. First, main types were created by considering each band (slip) separated from the main tendon. For this, the first criterion was taken as the number of bands. Subtype definition was used for the subsequent observed attachment situations or combinations. In the subtype definition, the criteria were the bone structures which the slips are attached and the tendon thickness. In the current study, the most frequently observed type was the one having two bands (slips) (56%) and the subtype was the attachment with equal expansion to MC and I.MT (32%). Such a systematization is thought to be useful to improve the planning of surgical procedures and rehabilitation programs.\u003c/p\u003e \u003cp\u003eMurley et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] reported that the thickness of TAT was 2.6\u0026thinsp;\u0026minus;\u0026thinsp;0.4 mm and the thickness of TPT was 3-0.6 mm in 61 patients with ultrasound imaging. The thickness of TAT and TPT in our study (mean 2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 mm, 2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45 mm, respectively) were consistent with Murley's study. Jarusriwanna and Chuckpaiwon [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] reported that the TAT attachments were found to be longer on the MC than on the base of the I.MT (means 8.3 and 5.4 mm), but the widths were nearly similar (means 11.0 and 10.4 mm). Additionally, tendon attachments on the medial and plantar surfaces of the MC were equivalent in width (means 5.4 and 5.6 mm). Our study\u0026rsquo;s results in terms of width were consistent with the literature (means were 5.48 mm, 7.80 mm, 5.40 mm, and 5.96 mm, respectively). In literature, it is reported that the average TPTw is between 8.00-11.60 mm and in TPTt it is between 3.78\u0026ndash;3.96 mm [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. It is thought that these wide frequency differences are due to the variety of study samples (patients, fixed cadavers, fresh cadavers etc.), method differences (MR, ultrasonography, manual caliper etc.) and demographic differences. Considering all these, it is thought that data of the TPT morphometry obtained in our study (average 8.89 mm for TPTw, average 2.54 mm for TPTt) are in the range reported in literature and are compatible.\u003c/p\u003e \u003cp\u003eConsidering tendon morphometries, the importance of TAT transfer (TATT) procedure in the treatment of relapsed clubfoot is remarkable [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Idiopathic clubfoot deformity continues to be a common pediatric orthopedic problem with an incidence of 1/1000 live births [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In general, successful results can be obtained with serial manipulations and casting, but, regardless of the initial treatment results and the correction obtained, relapse can be seen up to 50% of clubfoot treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] (Farsetti et al. 2006). It is reported that relapse is the result of the same pathology that caused the primary deformity and is usually related to non-compliance with the Ponseti brace protocol [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, in cases where correction is unsuccessful, operative treatment may be required for deformities [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] (Ponseti and Smoley, 2009). The TATT procedure is the most important surgical treatment method. First of all, the first criterion is to provide muscle balance after tendon transfer and correct dynamic supination gait [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As a result of the transfer of TAT to the lateral cuneiform, the cuneiforms and cuboid are shifted more laterally than normal, which contributes to the correction and stabilization of relapse clubfoot [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Presented anatomic information in our study regarding attachment sites and slip status could help diagnose TAT rupture and the anatomical reconstruction of the TAT.\u003c/p\u003e \u003cp\u003eTPT transfer is frequently applied to treat various foot deformities related to poor ankle dorsiflexion and to restore normal heel-toe gait. It has been reported that after TPT is transferred to the anterior and dorsal regions of the ankle, dorsiflexion is restored and deforming forces in the medial region of the foot are eliminated [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Although an interosseous route is recommended due to conditions such as direct traction, high dorsiflexion power and low varus recurrence probability compared to alternative methods [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], it is reported that subcutaneous TPT transfer methods are preferred for patients with calcified and inelastic interosseous membranes [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. It is noteworthy that studies in the literature have not yet revealed the optimum TPT placement site and there is no consensus on a standard method. For example, it has been suggested that the TPT placement sites on the dorsum of the foot may differ depending on unequal force between the medial and lateral sides, but the intermediate cuneiform may be the optimum location [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. It is recommended that the TPT transfer can be performed at the midline of the foot, the intermediate cuneiform, or the lateral cuneiform, while some other researchers [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] suggest transferring TPT additional to the other dorsal region tendons (extensor halluces longus, extensor digitorum, and peroneus tertius). When comparing tendon-to-bone (TtoB) and tendon-to-tendon (TtoT) techniques, there may be insufficient TPT length, especially for the TtoB procedure. In terms of methodological difficulty, it has been determined that the TtoT suture may be more challenging surgically and the reconstruction may be more complicated [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In particular, it has been suggested that the angle between the TPT and the attached tendons impairs the tensile strength of the TPT and reduces the dorsiflexion strength [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Ryssman and Myerson [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] stated that the transferred tendon should be fixed with a TtoB interface whenever possible, and that this procedure is physiologically more effective than other methods. The main disadvantage of the TtoB procedure is the insufficient length, as described in previous studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. However, some researchers have suggested that this disadvantage can be avoided by using the midpoints of the intermediate cuneiform, the lateral cuneiform, and the cuboid as the transferred insertion sites. In addition, it has been suggested that these sites can potentially be applied in surgeries [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In our study, important anatomical information regarding the morphometry and insertion sites of the TPT and TAT tendons has been provided. First, we believe that MM morphometry is one of the most important factors underlying the cases where the TPT tendon length is insufficient, as mentioned in the literature. The MMh and MMw values ​​cause the differences in the course of TAT and TPT reaching the dorsum and plantar parts of the foot and the formation of morphometric distances between each other. Considering this aspect, we agree with the opinion of Xu et al. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] that the intermembranous transfer technique prevents the TPT length from being a disadvantage. As additional support to this opinion, we believe that MM morphometry is the underlying anatomical landmark.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTAT placement presents high morphological variability that can be observed in cadavers. Our new classification simplifies this anatomical diversity and systematizes it through criteria. We believe that the morphometric data we obtained will contribute to the awareness of TAT variations and attachment sites in surgical procedures planned in the region and will provide a basis for further biomechanical and clinical studies targeting to improve the rehabilitation of patients, especially after TAT injuries. Considering the complications of osteotomies in the treatment of metatarsus adductus deformity for recurrent clubfoot, we hope that TAT transfer may be a safe way and that surgeons would reconsider the necessity of osteotomy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study has been approved by the Board of Ethics of Mersin University (Approval number: 2023/500). Written informed consent has been obtained from the relevant donor/legal representative regarding the use of cadavers and remains used in the study for educational and/or scientific research purposes. In the said consent document, it has been clearly stated that the use of cadaver remains in educational activities and/or scientific research within the university/institution is permitted. Accordingly, we undertake that the relevant cadaver remains will be used in accordance with ethical principles and the standards of the Helsinki Declaration and only for educational and scientific purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data (accessible part) presented in this study is available upon reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;TK - Project development, Performed Dissections, Data analysis, Manuscript writing \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;AB\u0026Ouml; - Supervisor, Project development, Manuscript editing.\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;GK - Performed Dissections, Manuscript writing and editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank to donor of human cadavers. Additionally, we thank to the Pathology, Orthopedics and Traumatology Departments of Mersin University Hospital that contributed to the acquisition of the materials in the Anatomy inventory.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlbano, D. et al. Predictive role of ankle MRI for tendon graft choice and surgical reconstruction. \u003cem\u003eRadiol. Med.\u003c/em\u003e \u003cb\u003e125\u003c/b\u003e (8), 763\u0026ndash;769 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnagnostakos, K., Bachelier, F., F\u0026uuml;rst, O. A. \u0026amp; Kelm, J. Rupture of the anterior tibial tendon: three clinical cases, anatomical study, and literature review. \u003cem\u003eFoot ankle Int.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e (5), 330\u0026ndash;339 (2006).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArthornthurasook, A. \u0026amp; Im, K. G. Anterior tibial tendon insertion: an anatomical study. \u003cem\u003eJ. Med. Association Thail. = Chotmaihet Thangphaet\u003c/em\u003e. \u003cb\u003e73\u003c/b\u003e (12), 692\u0026ndash;696 (1990).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrenner, E. Insertion of the tendon of the tibialis anterior muscle in feet with and without hallux valgus. \u003cem\u003eClin. Anatomy: Official J. Am. Association Clin. Anatomists Br. Association Clin. Anatomists\u003c/em\u003e. \u003cb\u003e15\u003c/b\u003e (3), 217\u0026ndash;223 (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen, D. A. \u0026amp; Gordon, D. H. The long-term effects of an untreated tibialis anterior tendon rupture. \u003cem\u003eJ. Am. Podiatr. Med. Assoc.\u003c/em\u003e \u003cb\u003e89\u003c/b\u003e (3), 149\u0026ndash;152 (1999).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmekli, E. \u0026amp; Toprak, U. 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(2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSwanton, E., Fisher, L., Fisher, A., Molloy, A. \u0026amp; Mason, L. An anatomic study of the naviculocuneiform ligament and its possible role maintaining the medial longitudinal arch. \u003cem\u003eFoot Ankle Int.\u003c/em\u003e \u003cb\u003e40\u003c/b\u003e (3), 352\u0026ndash;355 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurner, J. W. \u0026amp; Cooper, R. R. Anterior transfer of the tibialis posterior through the interosseus membrane. \u003cem\u003eClin. Orthop. Relat. Res.\u003c/em\u003e \u003cb\u003e83\u003c/b\u003e, 241\u0026ndash;244 (1972).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVigasio, A., Marcoccio, I. \u0026amp; Patelli, A. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. \u003cem\u003eClin. Orthop. Relat. 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Int.\u003c/em\u003e \u003cb\u003e9542125\u003c/b\u003e. (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu, J. et al. Posterior tibialis tendon transfer via the circumtibial route: a cadaveric limb analysis. \u003cem\u003eJ. Orthop. Surg, Res.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e, 1\u0026ndash;6 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZielinska, N. et al. Anatomical variations of the tibialis anterior tendon insertion: an updated and comprehensive. \u003cem\u003eRev. J. Clin. Med.\u003c/em\u003e \u003cb\u003e10\u003c/b\u003e (16), 3684 (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tibialis anterior muscle tendon, tibialis posterior tendon transfer, morphometry, medial malleolus, foot drop, tendon rupture","lastPublishedDoi":"10.21203/rs.3.rs-6347099/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6347099/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe tendon insertion sites of the tibialis anterior muscle (TAM) are particularly important for ruptures and drop foot surgery procedures. The anatomical relationship between the morphometry of the TAM\u0026rsquo;s tendon (TAT), medial malleolus (MM), and tibialis posterior muscle tendon (TPT) has not yet been elucidated. This study aimed to examine the morphometric features of TAT, TPT, and MM and their relationships with sex and sides.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eDissections were performed on the dorsal and medial surfaces of 25 (15 males, 10 females) fixed lower extremities. The study has been approved by the Board of Ethics of Mersin University (Approval number: 2023/500). Bony structures were exposed together with the tendons and extensions of the TAM. MM height and width, inter-tendon distances, and tendon angles were measured. Additionally, the width, length, thickness, and cross-sectional area (CSA) of TATs and TPTs were recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIt was found that TAT could have a minimum of 1 and a maximum of 3 slips in different combinations. The width of TAT (TATw) and the inter-tendon distances along the MM were found to be significantly greater in males than in females. TATw and MM widths were greater on the left feet compared to the right. A moderate negative correlation was also observed between TAT thicknesses and MM angulation. Strong positive correlations were found between the distances between TAT and TPTs at different levels of MM.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eUnderstanding the morphometric features of TAT and its relationship with MM may optimize tendon transfer techniques for foot drop treatment. These findings contribute to improving surgical accuracy, anchorage placement, and graft sizing in reconstructive procedures.\u003c/p\u003e","manuscriptTitle":"Morphometric evaluation of the tibialis anterior muscle tendon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-13 16:51:27","doi":"10.21203/rs.3.rs-6347099/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60810a53-a224-4956-bfe1-6c495b510e9e","owner":[],"postedDate":"June 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47822281,"name":"Health sciences/Medical research"},{"id":47822282,"name":"Health sciences/Anatomy"},{"id":47822283,"name":"Health sciences/Anatomy/Musculoskeletal system"}],"tags":[],"updatedAt":"2025-06-23T18:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-13 16:51:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6347099","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6347099","identity":"rs-6347099","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}