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Neurological Sciences : Official... Oct 2011Objective of this study was to determine which nerve conduction is more sensitive electrophysiologically in the diagnosis of polyneuropathy in diabetics by evaluating...
Objective of this study was to determine which nerve conduction is more sensitive electrophysiologically in the diagnosis of polyneuropathy in diabetics by evaluating the sensory conduction in medial plantar nerve and medial peroneal (dorsal) cutaneous nerves. Additionally to investigate the relation between Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) values used in the diagnosis of these conduction studies. Forty patients with diagnosis diabetic neuropathy were included into this study. In diabetic polyneuropathic patient group, both medial plantar and medial dorsal cutaneous nerve sensory action potential were not bilaterally obtained in 19 patients (47.5%). Sensitivity and specificity of medial dorsal cutaneous nerve and medial plantar nerve sensory conduction abnormalities in diagnosis of diabetic polyneuropathy were higher compared to sural nerve conduction abnormalities. This study showed that both medial plantar and medial dorsal cutaneous nerve conduction study performed bilaterally was a highly sensitive and specific method in diagnosis of diabetic neuropathy.
Topics: Action Potentials; Adult; Diabetic Neuropathies; Electrodiagnosis; Female; Foot; Humans; Male; Middle Aged; Neural Conduction; Neurologic Examination; Peroneal Nerve; Polyneuropathies; Tibial Nerve
PubMed: 21720897
DOI: 10.1007/s10072-011-0669-2 -
Foot and Ankle Clinics Sep 2014Recurrence of tarsal tunnel syndrome after surgery may be due to inadequate release, lack of understanding or appreciation of the actual anatomy involved, variations in... (Review)
Review
Recurrence of tarsal tunnel syndrome after surgery may be due to inadequate release, lack of understanding or appreciation of the actual anatomy involved, variations in the anatomy of the nerve(s), failure to execute the release properly, bleeding with subsequent scarring, damage to the nerve and branches, persistent hypersensitivity of the nerves, and preexisting intrinsic damage to the nerve. Approaches include more thorough release, use of barrier materials to decrease adherence of the nerve to surrounding tissues to avoid traction neuritis, excisions of neuromas using conduits, and consideration of nerve stimulators and systemic medications to deal with persistent neural pain.
Topics: Humans; Recurrence; Tarsal Tunnel Syndrome; Tibial Nerve
PubMed: 25129355
DOI: 10.1016/j.fcl.2014.06.015 -
Clinical Neurophysiology : Official... May 2007To collect a reference material of the medial plantar nerve action potential, to test intra/interobserver reliability in healthy controls and to apply the test to a...
OBJECTIVE
To collect a reference material of the medial plantar nerve action potential, to test intra/interobserver reliability in healthy controls and to apply the test to a group of patients with diabetes mellitus.
METHODS
98 healthy controls and 50 patients with diabetes mellitus were included. The medial plantar nerve was stimulated orthodromically and recorded with a surface electrode. In the patient group, NCS of motor and sensory nerves and quantitative sensory testing were also performed.
RESULTS
Responses of the medial plantar nerve were obtained from all controls except from one aged 72. Amplitude decreased with age (r=-0.68, p<0.0001). Intra/interobserver reliability was acceptable. 52% of the patients had abnormal overall NCS classification. Forty-eight percent had delayed tibial F-response latency. The medial plantar NCS were abnormal in 59% of the cases (47% abnormal NAP amplitude and 39% reduced CV), 59% of those with abnormal NCS had symptoms of sensory polyneuropathy. Only 24% had abnormal sural amplitude. Cold perception threshold was abnormal in more patients (30%) than warmth perception threshold (14%).
CONCLUSIONS
Responses were easily obtained in controls under 70 years. In diabetics the amplitudes of the medial plantar nerve were abnormal more often than in the sural nerve.
SIGNIFICANCE
The medial plantar nerve response is reliable in patients under 70 years, and intra/interobserver reliability is acceptable.
Topics: Action Potentials; Adolescent; Adult; Aged; Aging; Child; Cold Temperature; Diabetes Mellitus; Diabetic Neuropathies; Electric Stimulation; Evoked Potentials, Motor; Female; Foot; Hot Temperature; Humans; Male; Middle Aged; Motor Neurons; Neurons, Afferent; Observer Variation; Peripheral Nerves; Reproducibility of Results; Sensory Thresholds; Sural Nerve
PubMed: 17321794
DOI: 10.1016/j.clinph.2007.01.008 -
The Journal of Foot and Ankle Surgery :... 2001A neurilemoma is an uncommon, benign, encapsulated neoplasm whose origin is derived from the Schwann cells. Its incidence in the foot is uncommon. A review of the... (Review)
Review
A neurilemoma is an uncommon, benign, encapsulated neoplasm whose origin is derived from the Schwann cells. Its incidence in the foot is uncommon. A review of the literature, etiology, incidence, clinical presentation, histology, differential diagnosis, and treatment are discussed. The authors present a case of a neurilemoma of the medial plantar nerve of the foot.
Topics: Aged; Female; Foot; Foot Diseases; Humans; Magnetic Resonance Imaging; Neurilemmoma; Peripheral Nerves; Peripheral Nervous System Neoplasms; Soft Tissue Neoplasms
PubMed: 11324666
DOI: 10.1016/s1067-2516(01)80052-1 -
Multiple Sclerosis and Related Disorders Feb 2022Lower urinary tract symptoms (LUTSs) are common in patients with multiple sclerosis (MS). Percutaneous posterior tibial nerve stimulation (PTNS) is a minimally invasive... (Meta-Analysis)
Meta-Analysis Review
Percutaneous posterior tibial nerve stimulation (PTNS) for lower urinary tract symptoms (LUTSs) treatment in patients with multiple sclerosis (MS): A systematic review and meta-analysis.
BACKGROUND
Lower urinary tract symptoms (LUTSs) are common in patients with multiple sclerosis (MS). Percutaneous posterior tibial nerve stimulation (PTNS) is a minimally invasive treatment which is considered to be effective for patients who suffer from LUTS symptoms. In previous studies, the endpoints of treatment reported differently. So, we designed this systematic review and meta-analysis to estimate pooled efficacy of PTNS based on different assessment methods.
METHODS
We systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar. We also searched the gray literature including references of the included studies, and conference abstracts which were published up to May 2021. The search strategy included the MeSH and text words as (((Tibial Nerves) OR Posterior Tibial Nerve) OR (Posterior Tibial Nerves) OR (Medial Plantar Nerves) OR (Medial Plantar Nerve) OR (tibial Nerve Stimulation) OR (Trans-Cutaneous Tibial Nerve Stimulation) OR (Percutaneous Tibial Nerve Stimulation) OR (Cutaneous Tibial Nerve Stimulation) AND ((Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).Two independent researchers independently evaluated the articles.
RESULTS
We found 2430 articles by literature search, after deleting duplicates 2027 remained. Eight articles remained for meta-analysis The pooled SMD of post voiding residual (PVR) (post-treatment - pre-treatment) was -0.75 (95%CI:-0.93, -0.56)(I=0, p = 0.67). The pooled SMD of voiding volume (post-treatment - pre-treatment) was 1.21 (95% CI:0.94-1.49) (I:0%, p = 0.4). The pooled SMD of nocturia (post-treatment - pre-treatment) was -1.10 (95% CI:-1.33, -0.87) (I:86.4%, p<0.001). The pooled SMD of leakage per day (post-treatment - pre-treatment) was -0.69 (95% CI:-0.93, -0.45) (I:84.3%, p<0.001). The pooled frequency of responders was 66%(95% CI:59%-73%)(I:0).
CONCLUSION
The results of this systematic review and meta-analysis show that PTNS in effective in treating LUTS in patients with MS.
Topics: Disease Progression; Humans; Lower Urinary Tract Symptoms; Multiple Sclerosis; Tibial Nerve; Transcutaneous Electric Nerve Stimulation; Treatment Outcome
PubMed: 35216773
DOI: 10.1016/j.msard.2021.103392 -
Manual Therapy May 2008Plantar heel pain is a symptom commonly encountered by clinicians. Several conditions such as plantar fasciitis, calcaneal fracture, rupture of the plantar fascia and... (Review)
Review
Plantar heel pain is a symptom commonly encountered by clinicians. Several conditions such as plantar fasciitis, calcaneal fracture, rupture of the plantar fascia and atrophy of the heel fat pad may lead to plantar heel pain. Injury to the tibial nerve and its branches in the tarsal tunnel and in the foot is also a common cause. Entrapment of these nerves may play a role in both the early phases of plantar heel pain and recalcitrant cases. Although the contribution of nerve entrapment to plantar heel pain has been well documented in the literature, its pathophysiology, diagnosis and management are still controversial. Therefore, the purpose of this article was to critically review the available literature on plantar heel pain of neural origin. Possible sites of nerve entrapment, effectiveness of diagnostic clinical tests and electrodiagnostic tests, differential diagnoses for plantar heel pain, and conservative and surgical treatment will be discussed.
Topics: Diagnosis, Differential; Diagnostic Techniques, Neurological; Foot Diseases; Heel; Humans; Nervous System Diseases; Pain; Pain Management; Tarsal Tunnel Syndrome
PubMed: 17400020
DOI: 10.1016/j.math.2007.01.014 -
Operative Orthopadie Und Traumatologie Jul 2010Reduction of heel pain by neurolysis of the lateral plantar nerve. Indications Contraindications Surgical Technique Postoperative Management Results
OBJECTIVE
Reduction of heel pain by neurolysis of the lateral plantar nerve. Indications Contraindications Surgical Technique Postoperative Management Results
INDICATIONS
Heel pain due to an entrapment of the lateral plantar nerve.
CONTRAINDICATIONS
Acute inflammatory alterations in the foot. Skin laceration at the medial hindfoot. Relative: heel pain, which could not be assigned to a distinct diagnosis. Relative: flatfoot deformity with hindfoot valgus.
SURGICAL TECHNIQUE
Regional anesthesia. Supine position. Tourniquet. Curved skin incision behind the medial malleolus to the medioplantar aspect of the heel. Incision of the flexor retinaculum and careful dissection of the tibial nerve, until the medial and lateral plantar nerves can be clearly identified. Stepwise decompression of the lateral plantar nerve along its course to the medial aspect of the heel. Exposure of the first branch of the lateral plantar nerve (Baxter's nerve) by dissection of the fascia overlying the quadratus plantae muscle and the flexor digitorum brevis muscle. Release of the tourniquet and hemostasis. Wound closure in layers. Below-knee splint in neutral position of the ankle.
POSTOPERATIVE MANAGEMENT
Elevation of the concerned leg. Mobilization without weight bearing during the first 5 days. Stepwise increased weight bearing according to the pain level. Soft insoles for 12 weeks. No running or jumping for 12 weeks.
RESULTS
From 2006 to 2008, twelve patients (ten women, two men) were treated with a neurolysis of the lateral plantar nerve. In nine patients, the diagnosis was confirmed neurologically; in three patients, the authors decided to perform the nerve decompression due to clinical findings. The patients were followed up clinically (mean follow-up 15 months) and were asked to estimate their pain level with the visual analog scale (VAS). There were no postoperative complications. One patient developed a complex regional pain syndrome. Pain level decreased significantly within 6 weeks (VAS preoperatively 7.9; VAS postoperatively 3.8) and showed a further pain reduction to VAS 2.1 after 9 months. Two patients complained of recurrent symptoms after a mean of 11 months. In these patients, the initial diagnosis could not be confirmed by electrophysiological measurements.
Topics: Decompression, Surgical; Female; Humans; Male; Middle Aged; Nerve Compression Syndromes; Tibial Nerve; Tibial Neuropathy; Treatment Outcome
PubMed: 20676826
DOI: 10.1007/s00064-010-9022-9 -
Journal of the American Podiatric... Mar 2018Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous...
Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous hamartoma is associated with pain and sensory and/or motor deficits in the area of innervation of the affected nerve. This report describes a rare case of LFH of the plantar nerve. A 48-year-old woman presented to our outpatient orthopedic clinic with pain and a burning sensation on her left foot. The patient had a history of Morton's neuroma and had undergone a tarsal tunnel operation 2 years earlier at another center. None of her symptoms was alleviated by two previous operations. Magnetic resonance imaging with contrast revealed tenosynovitis of the flexor hallucis longus tendon and signal changes at deep tissue planes of the foot at the levels of the second and third toes, on the dorsal site and subcutaneous soft-tissue planes, suggesting edema and Morton's neuroma. The lesion was excised under spinal anesthesia, and histopathologic examination of the specimen revealed a diagnosis of LFH. The patient was discharged without any symptoms and her foot was normal at 8-month outpatient follow-up, with no indications of postoperative complications and/or recurrence.
Topics: Female; Foot; Hamartoma; Humans; Magnetic Resonance Imaging; Middle Aged; Morton Neuroma; Peripheral Nerves; Soft Tissue Neoplasms
PubMed: 29634300
DOI: 10.7547/16-168 -
Folia Morphologica 2021The aim of this study was to analyse the histological structure (cross-sectional area [CSA] and number of nerve bundles) of the distal part of the tibial nerve and its...
BACKGROUND
The aim of this study was to analyse the histological structure (cross-sectional area [CSA] and number of nerve bundles) of the distal part of the tibial nerve and its terminal branches (medial plantar nerve, lateral plantar nerve) using computer-assisted image analysis.
MATERIALS AND METHODS
The tibial nerve and its distal branches (medial and lateral plantar nerves) were dissected from the fresh cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the tibial nerve bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 μm slices and stained with haematoxylin and eosin. Then photographed and analysed using Olympus cellSens software.
RESULTS
The studied group comprised 28 female and 32 male feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve bundles were respectively 17.86 ± 4.57 mm2, 33.88 ± 6.31 for the tibial nerve, 9.58 ± 1.95 mm2, 23.41 ± 7.37 for the medial plantar nerve and 7.17 ± 2.36 mm2, 15.06 ± 5.81 for the lateral plantar nerve in males and 12.27 ± 2.45 mm2, 26.32 ± 8.87 for the tibial nerve, 7.81 ± 1.41 mm2, 17.71 ± 5.28 for the medial plantar nerve and 5.83 ± 1.25 mm2, 11.50 ± 3.72 for the lateral plantar nerve in females. Both CSA and number of nerve bundles of the tibial, medial plantar and lateral plantar nerves revealed no statistical differences when comparing foot side of the individual. The statistical difference was related to the gender, showing significantly bigger CSA and number of nerve bundles in males (CSA: p = 0.000, p = 0.000, p = 0.016; number of nerve bundles: p = 0.01, p = 0.003, p = 0.004, respectively). A positive correlation was found between the donor age and the tibial nerve CSA (r = 0.44, p = 0.000). A significant statistical difference was found between the medial and lateral plantar nerves both in CSA and number of nerve bundles (p < 0.001, p < 0.001, respectively).
CONCLUSIONS
The CSA and the number of nerve bundles in the distal part of the tibial nerve and its branches are significantly larger in males with no differences between right and left foot of the individual. The tibial nerve shows increasing CSA with advanced age. The medial plantar nerve has larger CSA and more nerve bundles than the lateral plantar nerve.
Topics: Aged; Cadaver; Computers; Female; Foot; Humans; Image Processing, Computer-Assisted; Male; Tibial Nerve
PubMed: 32639574
DOI: 10.5603/FM.a2020.0068