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Cureus Aug 2021Running is an athletic activity that is increasingly gaining popularity. Despite its benefits, there are many suspected risk factors for running-related overuse... (Review)
Review
Running is an athletic activity that is increasingly gaining popularity. Despite its benefits, there are many suspected risk factors for running-related overuse injuries. The objective of this study is to describe injuries and clinical symptoms observed on the sole of the foot in runners, giving special attention to the weekly running volume. The literature presented in this narrative review is based on a non-systematic search of the Medline, Google Scholar, and ResearchGate databases and focuses on foot injuries (the full spectrum of the foot pathology from bones to tendons and plantar fascia, nerve, and joint disorders) in runners, which represents an important topic for both professional and recreational runners. The weekly running distance appeared to be one of the strongest predictors for future overuse injuries. Marathon training and average weekly running of over 20 km are possible predictive factors in the development of plantar foot injuries. The plantar medial aspect of the foot is the anatomic area of the foot that most frequently experiences pain, with numerous pathologic conditions. As a result, diagnosis is always a challenging task. The ability to obtain an accurate medical history and carefully perform a physical examination, together with good knowledge of the foot anatomy and kinesiology, are also proven to be key players in ensuring proper diagnosis.
PubMed: 34646594
DOI: 10.7759/cureus.17537 -
Investigative and Clinical Urology Jul 2023To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and... (Clinical Trial)
Clinical Trial
PURPOSE
To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and clinical parameters associated with incontinence in women with idiopathic overactive bladder (OAB).
MATERIALS AND METHODS
Twenty-one women were included in this study. All women received T-MPNS. Two self-adhesive surface electrodes were positioned with the negative electrode near the metatarsal-phalangeal joint of the great toe on the medial aspect of the foot and the positive electrode 2 cm inferior-posterior of the medial malleolus (in front of the medio-malleolar-calcaneal axis). T-MPNS was performed 2 days a week, 30 minutes a day, for a total of 12 sessions for 6 weeks. Women were evaluated for incontinence severity (24-h pad test), 3-day voiding diary, symptom severity (Overactive Bladder Questionnaire [OAB-V8]), QoL (Quality of Life-Incontinence Impact Questionnaire [IIQ-7]), positive response and cure-improvement rates, and treatment satisfaction at baseline and at the 6th week.
RESULTS
Statistically significant improvement was found in the severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters at the 6th week compared with baseline. Treatment satisfaction, treatment success, and cure or improvement rates were found to be high at the 6th week.
CONCLUSIONS
T-MPNS was first described in the literature as a new neuromodulation method. We conclude that T-MPNS is effective on both clinical parameters and QoL associated with incontinence in women with idiopathic OAB. Randomized controlled multicenter studies are needed to validate the effectiveness of T-MPNS.
Topics: Female; Humans; Quality of Life; Tibial Nerve; Transcutaneous Electric Nerve Stimulation; Treatment Outcome; Urinary Bladder, Overactive; Urinary Incontinence
PubMed: 37417565
DOI: 10.4111/icu.20230009 -
Neurological Sciences : Official... Nov 2022Here , we aimed to assess the frequency and phenomenology of autonomic and neuropathic complaints of long-COVID and to evaluate them by means of electrophysiology.
PURPOSE
Here , we aimed to assess the frequency and phenomenology of autonomic and neuropathic complaints of long-COVID and to evaluate them by means of electrophysiology.
METHODS
Step 1. Patients with prior COVID-19 infection were screened by COMPASS-31 and mTORONTO to create the target population for further evaluation. Step 2. Patients with high scores were invited for a detailed history of their complaints and electrophysiological analysis, which included nerve conduction studies, cutaneous silent period (CSP), and sympathetic skin response (SSR). We also constituted a control group composed of healthy subjects of similar age and sex for electrophysiological analysis.
RESULTS
There were 106 patients, who matched the study criteria. Among them, thirty-eight patients (%35.8) had neuropathic or autonomic complaints or both. Fatigue and headache were significantly more frequent in patients with autonomic and neuropathic complaints. Detailed examination and electrophysiological evaluation were performed in 14 of 38 patients. Neuropathic complaints were patchy and proximally located in the majority. The entire CSP suppression index was higher in the patients (p = 0.002). There was no difference in palmar and plantar SSR between patients and healthy subjects. mTORONTO scores were negatively correlated with palmar and plantar SSR amplitudes, and the correlation was moderate.
CONCLUSION
Neuropathic or autonomic complaints were seen in more than one-third of patients with long-COVID. Neuropathic complaints were generally patchy, proximally predominant, asymmetric, or diffuse. The CSP suppression index was abnormal whereas SSRs were normal.
Topics: Humans; COVID-19; Autonomic Nervous System; Galvanic Skin Response; Diabetic Neuropathies; Skin; Post-Acute COVID-19 Syndrome
PubMed: 35994135
DOI: 10.1007/s10072-022-06350-y -
Cureus Nov 2022Contrast-induced encephalopathy (CIE) is a rare but well-known complication of mostly intra-arterial contrast administration and presents with a variety of neurological...
Contrast-induced encephalopathy (CIE) is a rare but well-known complication of mostly intra-arterial contrast administration and presents with a variety of neurological deficits due to disruption of the blood-brain barrier. We present a case of CIE after administration of intravenous contrast for computed tomography pulmonary angiogram (CTPE). A woman in her mid-70s with history of chronic obstructive pulmonary disease (COPD) presented with progressively worsening shortness of breath. She was diagnosed with multifocal pneumonia and started on IV antibiotics, IV steroids, and bilevel positive airway pressure (BiPAP) ventilation. A CTPE was done to rule out a pulmonary embolism during which she received 100 cc of Isovue 370 (iopamidol 76%), a low-osmolar, non-ionic, monomeric, iodine-based contrast agent. Within minutes of the contrast administration, the patient developed confusion and agitation with elevated blood pressure. Neurological evaluation revealed no gross focal motor or cranial nerve deficits and bilateral 2+ reflexes with mute plantar reflexes. Laboratory investigations were unchanged. She was shifted to the ICU but continued to remain drowsy and disoriented. CT brain done within two hours of onset revealed no intracranial abnormality. She was managed conservatively with IV fluids, neuro-checks, and blood pressure control. Her sensorium improved within 48 hours with supportive treatment. Repeat neuroimaging was not performed. She was discharged after four days with the resolution of her respiratory symptoms. CIE is a known but uncommon complication associated with the use of intraarterial contrast media but has been found to occur even after intravenous administration, which has been reported only once in literature. The presentation is highly variable, ranging from headache to coma, with transient cortical blindness being the most commonly identified. The diagnosis requires a high index of suspicion, and brain imaging is usually pathognomonic; however, cases in the absence of radiological signs have also been diagnosed. Typically, symptoms resolve within 48-72 hours and the disease runs a benign course, but cases of persistent neurological deficit and even cases of fatal cerebral edema have been reported.Treatment is usually supportive with intravenous hydra-tion and anticonvulsants and the occasional use of IV steroids and mannitol with favorable outcomes.
PubMed: 36523732
DOI: 10.7759/cureus.31360 -
Annals of Indian Academy of Neurology 2022The medial plantar nerve (MP) sensory nerve action potential (SNAP) has been shown to be a sensitive indicator for detecting a length-dependent axonal peripheral...
CONTEXT
The medial plantar nerve (MP) sensory nerve action potential (SNAP) has been shown to be a sensitive indicator for detecting a length-dependent axonal peripheral neuropathy. However, literature survey shows paucity of age stratified data. This study was undertaken to obtain age stratified reference data for MP SNAP amplitude and latency.
AIM
To establish age-stratified reference data in Indian subjects for the MP SNAP.
STUDY SETTING AND DESIGN
The study was conducted in the electrodiagnostic laboratory of a tertiary city hospital and is retrospective study.
MATERIALS AND METHODS
A retrospective study was conducted using the nerve conduction study reports of 173 patients with only upper limb symptoms and findings. Patients were between the ages of 18 and 86 years, stratified into six groups, a = 18-30 years, b = 31- 40 years, c = 41-50 years, d = 51- 60 years, e = 61-70 years, f ≥70 years.
STATISTICAL METHODS
Stata 12.1 statistical program was used. Lower limit of the SNAP amplitude was obtained using mean-2SD of transformed data. Analysis of variance defined the intergroup variability, linear regression and Pearson's correlation assessed the statistical significance.
RESULTS
The lower limit of normal MP SNAP amplitude for each age group is as follows: a: 8.7uv b: 7.5uv c: 3.7 uv d: 2.9uv e: 2.0 uv f: 1.4uv. The amplitude difference between the groups b & c, c & d and e and f using analysis of variance with Bonferroni correction and Tukey post-hoc test was not significant, but the other groups showed statistically significant variance. The equation of regression for the predicted amplitude value with age was defined as Y^ = {3.5 + age (-.0233) - 2 (0.389)}.
CONCLUSION
This study provides age stratified reference data for MP SNAP. There is evidence to suggest that MP SNAP amplitude varies with age hence age stratified data should be used to define abnormality.
PubMed: 35936599
DOI: 10.4103/aian.aian_53_22 -
Molecular Neurobiology Dec 2023Paclitaxel-induced peripheral neuropathy (PIPN) is a neurological disorder resulting from paclitaxel (PTX) treatment for cancer patients. There are currently no drugs...
Paclitaxel-induced peripheral neuropathy (PIPN) is a neurological disorder resulting from paclitaxel (PTX) treatment for cancer patients. There are currently no drugs available that can definitively prevent or treat PIPN. Exosomes are cell-secreted nanoscale vesicles that mediate communication between neurons and glial cells. We found that Schwann cell-derived exosomes (SC-EXOs) robustly improved PIPN both in vitro and in vivo. In vivo studies showed that SC-EXOs were able to alleviate PTX-induced mechanical nociceptive sensitization in rats. Pathomorphological analysis showed that SC-EXOs ameliorated PTX-induced plantar intraepidermal nerve fiber loss and dorsal root ganglion (DRG) injury. Additionally, the results of in vitro studies showed that SC-EXOs had significant protective effects on the DRG cells damaged by PTX, and did not affect the antitumor effect of PTX against Hela cells. Further, mechanism research revealed that SC-EXOs promoted axonal regeneration and protected damaged neurons by upregulating miR-21 to repress the phosphatase and tensin homolog (PTEN) pathway, which could improve PIPN. Taken together, these findings suggest that SC-EXOs ameliorate PTX-induced peripheral neuropathy via the miR-21-mediated PTEN signaling pathway, which provides a novel strategy for the treatment of PIPN.
Topics: Humans; Animals; Rats; Exosomes; HeLa Cells; Peripheral Nervous System Diseases; Schwann Cells; Signal Transduction; Paclitaxel; MicroRNAs; PTEN Phosphohydrolase
PubMed: 37498480
DOI: 10.1007/s12035-023-03488-4 -
The Journal of Foot and Ankle Surgery :... 2023The contents of the plantar intermetatarsal tunnel (PIMT) and the relationship between the common plantar interdigital nerve (CPIN) and the PIMT were recorded. The width...
The contents of the plantar intermetatarsal tunnel (PIMT) and the relationship between the common plantar interdigital nerve (CPIN) and the PIMT were recorded. The width of the PIMT was measured at the metatarsal neck (MTN), metatarsophalangeal (MTP) joint and the base of the proximal phalanx (BPP). The length of the deep transverse metatarsal ligament (DTML), the PIMT and the intracapsular ligament (ICL) were also measured. The PIMT was revealed to be a narrow osseofibrous tunnel divided into 3 segments by the DTML: the distal section, the area under the DTML (middle) and the proximal section. The length of the middle section was 12.77 mm in the second intermetatarsal (IM) space and 10.18 mm in the third IM space. The lengths of the distal sections were 15.52 and 14.95 mm in the second and third IM spaces, respectively. There was some soft tissue between the CPIN and PIMT, and the CPIN was observed not to glide freely within the tunnel. The widths of the PIMT at the MTN, MTP joint and BPP were respectively 2.87, 2.56, and 3.42 mm in the second IM space and 3.10, 2.68 and 3.61 mm in the third IM space. The ICL lies between the capsules of the MTP joint, and the length of the ICL was 2.76 and 3.03 mm in the second and third IM spaces, respectively. The PIMT was found to be a complex spatial structure, and the ICL might prevent the CPIN from being squeezed into the IM space.
Topics: Humans; Ligaments, Articular; Foot Diseases; Metatarsal Bones; Metatarsophalangeal Joint; Cadaver; Neuroma
PubMed: 36137897
DOI: 10.1053/j.jfas.2022.08.009 -
Journal of Plastic, Reconstructive &... Aug 2021The role of the plantar nerve in the pathogenesis of macrodactyly of the foot is unknown. We investigated the distribution of affected toes and forefoot in 27 feet of 26...
The role of the plantar nerve in the pathogenesis of macrodactyly of the foot is unknown. We investigated the distribution of affected toes and forefoot in 27 feet of 26 patients with pedal macrodactyly, and how this relates to innervation of the affected plantar nerve. A preoperative ultrasound examination was performed to determine the diameter and structure of the plantar nerve. Histologic findings were recorded during surgery. The microstructure of affected plantar nerves was evaluated by hematoxylin-eosin staining, while S100 expression was assessed by immunofluorescence analysis. Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene mutation in the affected nerve tissue was detected by Sanger DNA sequencing. The affected toes and forefoot involved innervation of the medial plantar nerve in 25/27 feet, the lateral plantar nerve in one foot, and both medial and lateral plantar nerves in one foot. All affected plantar nerves, which were accompanied by a fatty strip, were surrounded by or infiltrated with fat. The affected plantar nerves showed enlargement, a tortuous course, fatty infiltration, or a combination of these. Pathologic changes in affected plantar nerves involved only the epineurium and not the perineurium or endoneurium. Expression of the Schwann cell marker S100 was absent in some areas of affected nerves. Sequencing of PIK3CA exons identified a gain-of-function mutation (p.His1047Arg) in affected plantar nerves. These results indicate that pathologic impairment of the plantar nerve can lead to macrodactyly of the foot, which may be considered as a nerve trunk disease.
Topics: Child; Child, Preschool; Class I Phosphatidylinositol 3-Kinases; Female; Foot; Foot Deformities, Congenital; Humans; Infant; Male; Mutation; Tibial Nerve; Ultrasonography
PubMed: 33384233
DOI: 10.1016/j.bjps.2020.11.032 -
Archives of Rheumatology Sep 2023The aim of this study was to evaluate possible peripheral and autonomic nerve involvement in familial Mediterranean fever (FMF) patients with nerve conduction studies,...
OBJECTIVES
The aim of this study was to evaluate possible peripheral and autonomic nerve involvement in familial Mediterranean fever (FMF) patients with nerve conduction studies, sympathetic skin response (SSR) and RR interval variability (RRIV).
PATIENTS AND METHODS
The comparative case series was conducted with 76 participants between November 2017 and December 2018. Forty-six FMF patients, [12 with amyloidosis (5 males, 7 females; mean age: 44.7±13.9 years) and 34 without amyloidosis (14 males, 20 females; mean age: 35.9±8.7 years)], and 30 healthy volunteers (11 males, 19 females; mean age: 38.4±10 years) were included in this study. Nerve conduction parameters, SSR latency and amplitude from palmar and plantar responses, and RRIV at rest and deep breathing were studied in all the subjects. Neuropathic symptoms of the patient group were evaluated using the survey of autonomic symptoms scale and the neuropathy disability score.
RESULTS
Nerve conduction studies of the patient group revealed polyneuropathy in seven (15.21%) patients and carpal tunnel syndrome in six (13.04%) patients. The mean amplitudes of SSR measured from the soles were significantly lower than the control group (p=0.041). The mean values of RRIV during rest and hyperventilation were lower in the patient group compared to the control group, but no statistically significant difference was found (p=0.484, p=0.341).
CONCLUSION
We detected that the prevalence of carpal tunnel syndrome in our patient population (13.04%) was higher than in the general population. Most of the changes in the range of parameters of SSR and RRIV determined in the patient group did not reach statistical significance, suggesting subclinical dysautonomia in FMF patients.
PubMed: 38046242
DOI: 10.46497/ArchRheumatol.2023.9695 -
Seminars in Musculoskeletal Radiology Dec 2022Magnetic resonance imaging (MRI) is a robust method used for both preoperative and postoperative evaluation of Morton's neuroma and other neural lesions. MRI is used to...
Magnetic resonance imaging (MRI) is a robust method used for both preoperative and postoperative evaluation of Morton's neuroma and other neural lesions. MRI is used to confirm the diagnosis and for precise localization, estimation of outcome, and differential diagnoses. The differential diagnoses include mechanically induced plantar plate ruptures with associated Morton's neuroma-like tumors in the intermetatarsal/interdigital spaces; mechanical fibrosis cushion formations and pseudo bursae in the plantar foot adipose tissue; rheumatologic affections, such as rheumatoid nodules, gouty nodules, and intermetatarsal bursitis; and lastly the tenosynovial giant cell tumor (formerly called pigmented villonodular synovitis). In the postoperative evaluation after resection of Morton's neuroma, the same differential diagnoses must be considered as in the preoperative evaluation. Similarly, a high prevalence (up to 25%) of asymptomatic Morton's neuroma-like findings in the intermetatarsal and interdigital spaces should be kept in mind when interpreting postoperative recurrent forefoot pain after Morton's neuroma resection.
Topics: Humans; Morton Neuroma; Neuroma; Foot; Foot Diseases; Peripheral Nervous System Neoplasms
PubMed: 36791739
DOI: 10.1055/s-0042-1760212