-
Seminars in Musculoskeletal Radiology Jul 2018Peripheral nerve entrapment of the ankle and foot is relatively uncommon and often underdiagnosed because electrophysiologic studies may not contribute to the diagnosis.... (Review)
Review
Peripheral nerve entrapment of the ankle and foot is relatively uncommon and often underdiagnosed because electrophysiologic studies may not contribute to the diagnosis. Anatomy of the peripheral nerves is variable and complex, and along with a comprehensive physical examination, a thorough understanding of the applied anatomy is essential. Several studies have helped identify specific areas in which nerves are commonly compressed. Identified secondary causes of nerve compression include previous trauma, osteophytes, ganglion cysts, edema, accessory muscles, tenosynovitis, vascular lesions, and a primary nerve tumor. Imaging plays a key role in identifying primary and secondary causes of nerve entrapment, specifically ultrasound (US) and magnetic resonance imaging. US is a dynamic imaging modality that is cost effective and offers excellent resolution. Symptoms of nerve entrapment may mimic other common foot and ankle conditions such as plantar fasciitis.
Topics: Ankle; Foot; Humans; Nerve Compression Syndromes; Ultrasonography
PubMed: 29791963
DOI: 10.1055/s-0038-1648252 -
Agri : Agri (Algoloji) Dernegi'nin... Aug 2020It is possible to observe the in-vivo movements of nerves using real-time ultrasound. In this study, we aimed to visualize the movements of the sciatic nerve as a guide... (Comparative Study)
Comparative Study
OBJECTIVES
It is possible to observe the in-vivo movements of nerves using real-time ultrasound. In this study, we aimed to visualize the movements of the sciatic nerve as a guide to identify the sciatic nerve to distinguish from surrounding tissue.
METHODS
This trial was a prospective, cross-over comparative study. We included 25 healthy volunteers in this study. The movements of the sciatic nerve were visualized in the transverse view at popliteal and midthigh levels using ultrasonography. Anterior-posterior movements were assessed by measuring skin-to-nerve distance. The distances were measured during maximum ankle dorsiflexion, maximum plantar flexion and neutral position and compared with each other. We also evaluated the quality of dynamic (real-time) rotation/lateral movements of the sciatic nerve by assigning a subjective observer score.
RESULTS
The movement of sciatic nerve was significant at popliteal region with active and passive ankle dorsiflexion which was 0.32 cm and 0.23 cm respectively (p=0.003). The movement of sciatic nerve was significant at midthigh region with active and passive ankle plantar flexion which was 0.11 cm and 0.01 cm respectively (p<0.001). Excellent rotation/lateral movement was observed in subjects at popliteal region and good rotation/lateral movement was observed at midthigh level.
CONCLUSION
Sciatic nerve movement can be observed with ankle dorsiflexion and plantar flexion in the transverse plane at popliteal and midthigh locations under real time ultrasound. This preliminary study suggest that observing the movements of sciatic nerve is potentially valuable in clinical sciatic nerve blocks for facilitating the localization of the sciatic nerve.
Topics: Adolescent; Adult; Ankle Joint; Cross-Over Studies; Female; Humans; Male; Movement; Nerve Block; Prospective Studies; Sciatic Nerve; Sciatica; Ultrasonography; Young Adult
PubMed: 32789828
DOI: 10.14744/agri.2019.65390 -
Journal of Orthopaedic Surgery (Hong... Aug 2015To compare the outcome following lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis. (Comparative Study)
Comparative Study Randomized Controlled Trial
PURPOSE
To compare the outcome following lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis.
METHODS
30 women and 3 men aged 30 to 60 (mean, 45) years with resistant plantar fasciitis were randomised to undergo release of the first branch of the lateral plantar nerve with (group 1, n=18) or without (group 2, n=15) calcaneal drilling.
RESULTS
Patients were followed up for a mean of 27 months. According to the modified Mayo scoring system for plantar fasciotomy, group 1 was superior to group 2 in terms of score (93.9±6.97 vs. 83±8.2, p<0.001) and grading (15 excellent, 2 good, and one fair vs. 6 excellent, 4 good, and 5 fair; p=0.031). Three patients in group one and one patient in group 2 (16.7% vs. 6.6%, p=0.381) developed complications of heel numbness, foot oedema, and 2 cases of superficial wound infection, respectively.
CONCLUSION
Adding calcaneal drilling to release of the first branch of the lateral plantar nerve achieves better outcome than release alone in patients with resistant plantar fasciitis.
Topics: Adult; Calcaneus; Fasciitis, Plantar; Fasciotomy; Female; Humans; Male; Middle Aged; Orthopedic Procedures; Peripheral Nerves
PubMed: 26321559
DOI: 10.1177/230949901502300226 -
The Journal of Bone and Joint Surgery.... Feb 2012Anterior tibial tendon transfer is a common procedure for treatment of clubfoot recurrence. Fixation of the tendon usually includes passing the tendon through the...
BACKGROUND
Anterior tibial tendon transfer is a common procedure for treatment of clubfoot recurrence. Fixation of the tendon usually includes passing the tendon through the lateral cuneiform. Drilling the bone and passing sutures through the plantar aspect of the foot may cause neurovascular damage.
METHODS
Anterior tibial tendon transfer was performed through the lateral cuneiform in twelve cadaveric limbs. Drill holes were made perpendicular to the lateral cuneiform surface (group A), made perpendicular to the weight-bearing surface (group B), inclined 15° in the frontal and sagittal planes (group C), or aimed at the middle of the plantar aspect of the foot (group D). Two unmodified Keith needles and two blunted Keith needles were each passed ten times per foot. A dissection was performed. The average distance from the drill hole to the nerve structures and the number of punctures of nerve structures were reported.
RESULTS
In group A, the drill hole was 1.7 mm from a medial plantar nerve branch and 5 mm from the nerve bifurcation. In group B, the hole was 0.3 mm from a branch of the lateral plantar nerve and 25.3 mm from the lateral plantar nerve bifurcation. The drill hole in group C was 1.7 mm from the lateral plantar nerve bifurcation. In group D, the drill direction resulted in an inclination of 22° in the frontal plane and 4° in the sagittal plane. The drill exited 7.7 mm from a medial plantar nerve branch and 4.3 mm from a lateral plantar nerve branch. The medial and lateral plantar nerve bifurcations were at a distance of 13 mm and 14.7 mm, respectively, from the drill hole in group D. Unmodified Keith needles punctured nerve structures twelve times in group A, twenty times in group B, six times in group C, and once in group D. Use of blunted Keith needles resulted in no nerve punctures.
CONCLUSIONS
When anchoring the transferred anterior tibial tendon in the lateral cuneiform for the treatment of clubfoot recurrence, the drill should be aimed at the middle of the plantar surface of the foot to minimize the risk of nerve damage. Passing the sutures with a blunt needle might prevent damage to nerves or vessels when anterior tibial tendon transfer to the lateral cuneiform is performed for the treatment of clubfoot recurrence.
Topics: Cadaver; Clubfoot; Female; Foot; Humans; Intraoperative Complications; Male; Peripheral Nerve Injuries; Risk; Tendon Transfer
PubMed: 22336974
DOI: 10.2106/JBJS.K.00004 -
Muscle & Nerve Dec 2008Many studies have used sural nerve action potential (NAP) as an electrophysiological marker for distal symmetrical polyneuropathy (DSP). We examined the role of medial...
Many studies have used sural nerve action potential (NAP) as an electrophysiological marker for distal symmetrical polyneuropathy (DSP). We examined the role of medial plantar nerve testing for identifying DSP by comparing amplitudes from sural, superficial peroneal, and medial plantar nerves in 85 participants with symptoms and clinical signs of DSP and 204 participants without DSP. Receiver-operating characteristic curves were used to determine the sensitivity of all three sensory conduction studies for the diagnosis of DSP. All three nerves could be used to discriminate between subjects with and without DSP with an area under the curve of more than 85% of cases. Sural and superficial peroneal nerve testing sensitivities were about 55%, whereas medial plantar nerve testing sensitivity was more than 90%. These findings suggest that testing the medial plantar nerve may increase the diagnostic yield of nerve conduction studies for DSP.
Topics: Action Potentials; Adult; Aged; Aged, 80 and over; Data Interpretation, Statistical; Electric Stimulation; Electrophysiology; Female; Foot; Humans; Male; Middle Aged; Peripheral Nerves; Peroneal Nerve; Polyneuropathies; ROC Curve; Sural Nerve; Young Adult
PubMed: 19016533
DOI: 10.1002/mus.21029 -
Clinical Neurophysiology : Official... Jul 2004In rats the available techniques for evaluation of sensory nerve conduction are limited. We report a new method of sensory nerve conduction of the plantar nerve using... (Comparative Study)
Comparative Study
OBJECTIVE
In rats the available techniques for evaluation of sensory nerve conduction are limited. We report a new method of sensory nerve conduction of the plantar nerve using needle electrodes as the recording electrodes behind the medial malleolus and ring electrodes as the stimulating electrodes around the three middle toes.
METHODS
We performed this sensory nerve conduction test in 25 rats during their growth over a 6 weeks' period and compared this method with the motor nerve conduction and H-reflex sensory nerve conduction of the tibial nerve in 10 rats, and with the motor and mixed nerve conductions of the tail nerve in 15 rats.
RESULTS
There was a highly or moderately significant correlation between the body weight and sensory nerve conduction velocity (NCV) of the plantar nerve, mixed NCV and motor NCV of the tail nerve, indicating a growth-related increase in the NCV. The growth-related increase in the NCV was not observed in the motor and H-reflex sensory nerve conductions of the tibial nerves.
CONCLUSIONS
This test is simple and reliable and can be used for the sensory nerve conduction test in rats.
Topics: Aging; Animals; Body Weight; Foot; H-Reflex; Male; Motor Neurons; Nervous System Physiological Phenomena; Neural Conduction; Neurons, Afferent; Rats; Rats, Wistar; Tail; Tibial Nerve; Time Factors
PubMed: 15203069
DOI: 10.1016/j.clinph.2004.02.007 -
Radiographics : a Review Publication of... 2015The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is... (Review)
Review
The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is essential for correct identification at imaging. Ultrasonography (US) and magnetic resonance (MR) imaging allow visualization of these nerves and may facilitate diagnosis of various compression syndromes, such as "jogger's heel," Baxter neuropathy, and Morton neuroma. It may be difficult to distinguish the nerves from adjacent vasculature at MR imaging, and US can help in differentiation. The authors review the normal anatomy and common variants of the nerves of the foot and ankle, with use of dissected specimens and correlative US and MR imaging findings. In addition, the authors illustrate proper probe positioning, which is essential for visualizing the nerves at US. The authors' discussion focuses on the superficial and deep peroneal, sural, saphenous, tibial, medial and lateral plantar, medial and inferior calcaneal, common digital, and medial proper plantar digital nerves.
Topics: Ankle; Artifacts; Foot; Humans; Magnetic Resonance Imaging; Nerve Compression Syndromes; Peroneal Nerve; Sural Nerve; Tibial Nerve; Ultrasonography
PubMed: 26284303
DOI: 10.1148/rg.2015150028 -
European Radiology Jan 2019To determine whether ultrasound allows precise assessment of the course and relations of the medial plantar proper digital nerve (MPPDN). (Comparative Study)
Comparative Study
PURPOSE
To determine whether ultrasound allows precise assessment of the course and relations of the medial plantar proper digital nerve (MPPDN).
MATERIALS AND METHODS
This work was initially undertaken in six cadaveric specimens and followed by a high-resolution ultrasound study in 17 healthy adult volunteers (34 nerves) by two musculoskeletal radiologists in consensus. Location and course of the MPPDN and its relationship to adjacent anatomical structures were analysed.
RESULTS
The MPPDN was consistently identified by ultrasound along its entire course. Mean cross-sectional area of the nerve was 0.8 mm (range 0.4-1.4). The MPPDN after it branches from the medial plantar nerve was located a mean of 22 mm (range 19-27) lateral to the medial border of the medial cuneiform. More distally, at the level of the first metatarsophalangeal joint, mean direct distances between the nerve and the first metatarsal head and the medial hallux sesamoid were respectively 3 mm (range 1-8) and 4 mm (range 2-9).
CONCLUSION
The MPPDN can be depicted by ultrasonography. Useful bony landmarks for its detection could be defined. Precise mapping of its anatomical course may have important clinical applications.
KEY POINTS
• The medial plantar proper digital nerve (MPPDN) rises from the medial plantar nerve to the medial side of the hallux. • Because of its particularly long course and superficial position, the MPPDN may be subject to trauma, resulting in a condition known as Joplin's neuroma. • The MPPDN can be clearly depicted by ultrasound along its entire course. Precise mapping of its anatomical course may have important clinical applications.
Topics: Adult; Aged, 80 and over; Cadaver; Female; Hallux; Healthy Volunteers; Humans; Male; Metatarsophalangeal Joint; Tibial Nerve; Ultrasonography; Young Adult
PubMed: 29922929
DOI: 10.1007/s00330-018-5536-6 -
American Journal of Physical Medicine &... Mar 2023
Topics: Humans; Foot; Peripheral Nerves; Tibial Nerve; Neuralgia; Ultrasonography, Interventional
PubMed: 36075877
DOI: 10.1097/PHM.0000000000002094