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Zegarra-Chávez, DanielAuthor

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January 28, 2026
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The posterior/medial dry needling approach of the tibialis posterior muscle is an accurate and safe procedure: a cadaveric study

Publicated to: Bmc Musculoskeletal Disorders. 23 (1): 570- - 2022-06-14 23(1), DOI: 10.1186/s12891-022-05530-3

Authors:

Perez-Bellmunt, Albert; Lopez-de-Celis, Carlos; Rodriguez-Sanz, Jacobo; Koppenhaver, Shane L; Zegarra-Chavez, Daniel; Ortiz-Miguel, Sara; Fernandez-de-las-Penas, Cesar
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Affiliations

ACTIUM Funct Anat Grp, Barcelona, Spain - Author
Baylor Univ, Doctoral Program Phys Therapy, Waco, TX USA - Author
Univ Int Catalunya UIC Barcelona, Fac Med & Hlth Sci, C Josep Trueta S-N St Cugat Valles, Barcelona, Spain - Author
Univ Rey Juan Carlos URJC, Dept Phys Therapy Occupat Therapy Phys Med & Reha, Madrid, Spain - Author
Univ Rey Juan Carlos, Catedra Inst Docencia Punc Seca & Ejercicio Terap, Clin & Invest Fisioterapia Terapia Manual, Madrid, Spain - Author
Univ Rey Juan Carlos, Fac Ciencias Salud, Ave Atenas S-N, Madrid 28922, Spain - Author
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Abstract

Background Evidence suggests that tibialis posterior muscle plays an important role in equinovarus foot deformity in patients who had suffered a stroke and it is one of the most frequently injected lower-extremity muscles for the management of spasticity. Our aim was to assess if a needle accurately and safely penetrates the tibialis posterior muscle during the application of dry needling. Methods We conducted a cadaveric descriptive study. Needling insertion of the tibialis posterior was conducted in 11 cryopreserved cadavers with a 70 mm needle. The needle was inserted using two common approaches, at midpoint (posterior/medial approach) and at upper third (anterior approach) of the leg towards the tibialis posterior. The needle was advanced into the tibialis posterior based upon clinician judgement. Cross-sectional anatomical dissections were photographed and analyzed by photometry. Safety was assessed by calculating the distances from the tip and the path of the needle to proximate neurovascular structures. Results Accurate needle penetration of the tibialis posterior muscle was observed in all cadavers with both approaches. In general, distances from the needle to the neurovascular bundles were larger with the posterior/medial approach than with the anterior approach, reaching statistically significance for needle tip to nerve (mean difference: 0.6 cm, 95%CI 0.35 to 0.85 cm) and vascular bundle (mean difference: 0.55 cm, 95%CI 0.3 to 0.8 cm) distances (P < 0.001) and needle path to vascular bundle distance (difference: 0.25 cm, 95%CI 0.1 to 0.4 cm, P = 0.045). Age and gender did not influence the main results. Conclusions This cadaveric study suggests that needling of the tibialis posterior muscle can be accurately and safely conducted. Safety seems to be larger with the posterior/medial approach when compared with the anterior approach.
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Keywords

AnteriorAnterior approachCadaverCross-sectional studiesDry needlingHumansInsertionLegMedial approachMuscle, skeletalPlacementSafetyTibialis posteriorUltrasonographic evaluation

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal BMC MUSCULOSKELETAL DISORDERS due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 42/86, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Orthopedics. Notably, the journal is positioned en el Cuartil Q2 para la agencia Scopus (SJR) en la categoría Orthopedics and Sports Medicine.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2026-04-13:

  • WoS: 3
  • Scopus: 3
  • Europe PMC: 2
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-13:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 25.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 25 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 2.
  • The number of mentions on the social network X (formerly Twitter): 2 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United States of America.

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