-
Journal of Reconstructive Microsurgery Jan 2021There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and... (Review)
Review
BACKGROUND
There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation.
METHODS
In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population.
RESULTS
The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease.
CONCLUSION
Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.
Topics: Amputation, Surgical; Artificial Limbs; Humans; Limb Salvage; Lower Extremity; Retrospective Studies; Treatment Outcome
PubMed: 31499559
DOI: 10.1055/s-0039-1696733 -
Muscle & Nerve May 2024Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for... (Review)
Review
Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non-radiating pain, tenderness, and give-way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high-yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.
PubMed: 38726566
DOI: 10.1002/mus.28106 -
Insights Into Imaging Oct 2023Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the... (Review)
Review
Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the mainstay of diagnosis, there are multiple imaging options, specifically ultrasound and magnetic resonance imaging (MRI), which offer important information about the potential cause and location of nerve entrapment that can help guide management. This article overviews the anatomical course of various lower limb nerves, including the sciatic nerve, tibial nerve, medial plantar nerve, lateral plantar nerve, digital nerves, common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, obturator nerve, lateral femoral cutaneous nerve and femoral nerve. The common locations and causes of entrapments for each of the nerves are explained. Common ultrasound and MRI findings of nerve entrapments, direct and indirect, are described, and various examples of the more commonly observed cases of lower limb nerve entrapments are provided.Critical relevance statement This article describes the common sites of lower limb nerve entrapments and their imaging features. It equips radiologists with the knowledge needed to approach the assessment of entrapment neuropathies, which are a critically important cause of pain and functional impairment.Key points• Ultrasound and MRI are commonly used to investigate nerve entrapment syndromes.• Ultrasound findings include nerve hypo-echogenicity, calibre changes and the sonographic Tinel's sign.• MRI findings include increased nerve T2 signal, muscle atrophy and denervation oedema.• Imaging can reveal causative lesions, including scarring, masses and anatomical variants.
PubMed: 37782348
DOI: 10.1186/s13244-023-01514-6 -
Journal of Nippon Medical School =... 2024Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel.
BACKGROUND
Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel.
METHODS
Between August 2020 and July 2022, we operated on 117 sides with TTS. This retrospective study examined data from 8 consecutive patients (8 sides: 5 men, 3 women; average age 67.8 years) with an extraneural ganglion in the tarsal tunnel. We investigated the clinical characteristics and surgical outcomes for these patients.
RESULTS
The mass was palpable through the skin in 1 patient, detected intraoperatively in 1 patient, and visualized on MRI scanning in the other 6 patients. Symptoms involved the medial plantar nerve area (n = 5), lateral plantar nerve area (n = 1), and medial and lateral plantar nerve areas (n = 2). The interval between symptom onset and surgery ranged from 4 to 168 months. Adhesion between large (≥20 mm) ganglia and surrounding tissue and nerves was observed intraoperatively in 4 patients. Of the 8 patients, 7 underwent total ganglion resection. There were no surgery-related complications. On their last postoperative visit, 3 patients with a duration of symptoms not exceeding 10 months reported favorable outcomes.
CONCLUSIONS
Because ganglia eliciting TTS are often undetectable by skin palpation, imaging studies may be necessary. Early surgical intervention appears to yield favorable outcomes.
Topics: Male; Humans; Female; Aged; Tarsal Tunnel Syndrome; Retrospective Studies; Magnetic Resonance Imaging; Skin
PubMed: 38462440
DOI: 10.1272/jnms.JNMS.2024_91-203 -
Skeletal Radiology Dec 2020To characterize the MRI findings present in patients with clinically proven or suspected jogger's foot.
OBJECTIVE
To characterize the MRI findings present in patients with clinically proven or suspected jogger's foot.
MATERIALS AND METHODS
Ten years of medical charts in patients clinically suspected of having jogger's foot and who had MRI studies completed were identified utilizing a computer database search. Six study cases were identified. The MRI examinations of the study cases and an age- and gender-matched control group were reviewed in a blinded fashion by two musculoskeletal radiologists. Size and signal intensity of the medial plantar nerve were measured and characterized. The medial foot musculature was assessed for acute or chronic denervation changes.
RESULTS
The medial plantar nerve was found to have moderately increased T2 signal compared with normal skeletal muscle in 3/6 study group cases and markedly increased T2 signal in the remaining 3/6 cases. In all control cases, the nerve was reported to have T2 signal equal or minimally higher than normal skeletal muscle. The mean total size of the medial plantar nerve was significantly larger in the study group when compared with that in the control group at all measured locations (p < 0.04).
CONCLUSIONS
Abnormal thickness and T2 hyperintensity of the medial plantar nerve centered at the master knot of Henry are characteristic MRI findings in patients with jogger's foot when compared with control subjects. Muscular denervation changes may also be seen, most commonly in the flexor hallucis brevis muscle.
Topics: Foot; Humans; Magnetic Resonance Imaging; Muscle, Skeletal; Physical Examination; Tibial Nerve
PubMed: 32556951
DOI: 10.1007/s00256-020-03494-w -
Journal of Wound Care Jun 2022Leprosy is a neglected disease caused by and s, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic... (Review)
Review
Leprosy is a neglected disease caused by and s, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic ulcers-lesions that can appear at the plantar and extra-plantar levels-are one such disability, and diagnosis requires an adequate dermatological, neurological and microbiological evaluation. The treatment of these lesions is based on a multidisciplinary approach that includes debridement of the necrotic tissue, controlling infections, reducing pressure areas, optimising blood flow, and nerve decompression. This review aims to describe the clinical features, diagnostic methods and treatment of neuropathic ulcers in leprosy. The diagnostic methods and medical management used in leprosy ulcers are based on those used for diabetic foot. This requires radical change as these diseases are immunologically and physiologically very different.
Topics: Diabetic Foot; Humans; Leprosy; Skin Ulcer; Ulcer
PubMed: 35678776
DOI: 10.12968/jowc.2022.31.Sup6.S32 -
Foot and Ankle Clinics Sep 2023High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows... (Review)
Review
High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows portability and dynamic assessment. US is an excellent method to evaluate foot and ankle tendon injuries, ligament tears, plantar fascia, peripheral nerves, and the different causes of metatarsalgia.
Topics: Humans; Ankle; Ankle Joint; Ultrasonography; Ligaments; Tendons; Ankle Injuries
PubMed: 37536826
DOI: 10.1016/j.fcl.2023.04.008 -
Journal of Ultrasonography Sep 2023Plantar intrinsic muscles play a pivotal role in posture control and gait dynamics. They help maintain the longitudinal and transverse arches of the foot, and they...
Plantar intrinsic muscles play a pivotal role in posture control and gait dynamics. They help maintain the longitudinal and transverse arches of the foot, and they regulate the degree and velocity of arch deformation during walking or running. Consequently, pathologies affecting the plantar intrinsic muscles (for instance, acquired and inherited neuropathies) lead to foot deformity, gait disorders, and painful syndromes. Intrinsic muscle malfunctioning is also associated with multifactorial overuse or degenerative conditions such as pes planus, hallux valgus, and plantar fasciitis. As the clinical examination of each intrinsic muscle is challenging, ultrasound is gaining a growing interest as an imaging tool to investigate the trophism of these muscular structures and the pattern of their alterations, and potentially to follow up on the effects of dedicated rehabilitation protocols. The ten plantar intrinsic muscles can be dived into three groups (medial, central and lateral) and four layers. Here, we propose a regional and landmark-based approach to the complex sonoanatomy of the plantar intrinsic muscles in order to facilitate the correct identification of each muscle from the superficial to the deepest layer. We also summarize the pathological ultrasound findings that can be encountered when scanning the plantar muscles, pointing out the patterns of alterations specific to certain conditions, such as plantar nerves mononeuropathies.
PubMed: 37732108
DOI: 10.15557/jou.2023.0024 -
Clinics in Podiatric Medicine and... Apr 2021Active individuals can experience exercise-induced pain along the medial, plantar central, and plantarmedial proximal arch. In many cases, these symptoms are consistent... (Review)
Review
Active individuals can experience exercise-induced pain along the medial, plantar central, and plantarmedial proximal arch. In many cases, these symptoms are consistent with conditions involving the plantar fascia, posterior tibial tendon, or entrapment of branches of the posterior tibial nerve. Unlike these other conditions, chronic exertional compartment syndrome (CECS) of the foot can be aggravated by interventions that impart any pressure or compression to the foot. Practitioners should have a high index of suspicion for CECS when classic treatments tend to aggravate patient's symptoms.
Topics: Chronic Exertional Compartment Syndrome; Conservative Treatment; Decompression, Surgical; Diagnosis, Differential; Foot; Humans; Medical History Taking; Physical Examination
PubMed: 33745648
DOI: 10.1016/j.cpm.2020.12.002