-
The Journal of Foot and Ankle Surgery :... 2016From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment...
From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 ± 1.6 years; mean body mass index, 30.6 ± 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA.
Topics: Ablation Techniques; Chronic Disease; Female; Heel; Humans; Male; Middle Aged; Pain; Patient Satisfaction; Tibial Nerve; Visual Analog Scale
PubMed: 27073185
DOI: 10.1053/j.jfas.2016.03.009 -
Journal of Plastic, Reconstructive &... Nov 2011Nerve reconstruction following lower-extremity nerve injuries usually leads to worse outcomes in comparison with upper-extremity injuries due to the long distances of...
BACKGROUND
Nerve reconstruction following lower-extremity nerve injuries usually leads to worse outcomes in comparison with upper-extremity injuries due to the long distances of nerve regeneration. This study was performed to consider the clinical application of distal nerve transfer for the treatment of long gaps of the tibial nerve (TN) and in established compartment syndrome. It aimed to determine the anatomic suitability of transferring the sural nerve (SN) in combination with the superficial peroneal nerve (SPN) to the TN at the level of the tarsal tunnel for restoration of plantar sensation.
METHODS
Nine fresh above-knee amputated limbs were dissected with the aid of loupe magnification. We focussed on the detailed anatomy of the course of the SN and the SPN from its emergence proximally at the knee level to the foot. Two different regions, suprafascial and subfascial, were described for each nerve. The maximum length of dissection and the length of the nerves in each region were measured. In all dissections, we assessed the feasibility of directly transferring the SN and SPN to the TN at the level of the tarsal tunnel.
RESULTS
The average length of the course of the SN was 20.6 cm (SD ± 2.3 cm) subfascially and 16.4 cm (SD ± 0.9 cm) suprafascially. For the SPN, the average length was 19.4 cm (SD ± 1.9 cm) subfascially and 18 cm (SD ± 2.5 cm) suprafascially. The point of emergence of the nerve from the subfascial course to the suprafascial course was defined as the pivot point for its transfer to the TN. Both the SN and the SPN reached the TN comfortably at the level of the tarsal tunnel, allowing direct co-aptation.
CONCLUSION
Distal nerve transfer using the SN in combination with the SPN is an anatomically reliable procedure, being a potential alternative to the use of nerve grafts in reconstruction of long gaps of the TN. In addition, selected patients with compartment syndrome may also benefit from this transfer to restore plantar sensation.
Topics: Cadaver; Compartment Syndromes; Dissection; Feasibility Studies; Female; Foot; Humans; Leg; Male; Nerve Transfer; Peroneal Nerve; Sural Nerve; Tibial Nerve
PubMed: 21703955
DOI: 10.1016/j.bjps.2011.05.027 -
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 -
Archives of Physical Medicine and... Sep 1984A simple, reliable method of recording sensory nerve action potentials (SNAP) from the medial and lateral plantar nerves was established using 30 healthy adults as...
A simple, reliable method of recording sensory nerve action potentials (SNAP) from the medial and lateral plantar nerves was established using 30 healthy adults as subjects. Potentials were recorded with surface electrodes both antidromically and orthodromically. The mean latency and amplitude of the SNAP of the medial plantar nerve using antidromic stimulation were 2.5msec (+/- 0.32) and 16.3microV (+/- 6.5), respectively. Orthodromically, the latency was 2.5msec (+/- 0.35) and the amplitude 16.5microV (+/- 7.14). For the lateral plantar, antidromically the nerve latency was 2.5msec (+/- 0.35) and the amplitude 14.8microV (+/- 4.41). With the orthodromic procedure, the latency remained unchanged but the amplitude was 11.0microV (+/- 5.59). In the case of the lateral plantar nerve, the antidromic technique consistently resulted in higher amplitude responses.
Topics: Adolescent; Adult; Electrodes; Evoked Potentials; Female; Foot; Humans; Male; Middle Aged; Neural Conduction; Neurons, Afferent
PubMed: 6477086
DOI: No ID Found -
Journal of Applied Physiology... Nov 2020Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to... (Randomized Controlled Trial)
Randomized Controlled Trial
Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to long-term stretching is poorly understood. This randomized, single-blind, controlled study used ultrasonography and dynamometry to compare the effects of 12-wk nerve-directed and muscle-directed stretching programs versus control on maximal ankle dorsiflexion range of motion (ROM) and passive torque, shear wave velocity (SWV; an index of stiffness), and architecture of triceps surae and sciatic nerve. Sixty healthy adults were randomized to receive nerve-directed stretching, muscle-directed stretching, or no intervention (control). The muscle-directed protocol was designed to primarily stretch the plantar flexor muscle group, whereas the nerve-directed intervention targeted the sciatic nerve tract. Compared with the control group [mean; 95% confidence interval (CI)], muscle-directed intervention showed increased ROM (+7.3°; 95% CI: 4.1-10.5), decreased SWV of triceps surae (varied from -0.8 to -2.3 m/s across muscles), decreased passive torque (-6.8 N·m; 95% CI: -11.9 to -1.7), and greater gastrocnemius medialis fascicle length (+0.4 cm; 95% CI: 0.1-0.8). Muscle-directed intervention did not affect the SWV and size of sciatic nerve. Participants in the nerve-directed group showed a significant increase in ROM (+9.9°; 95% CI: 6.2-13.6) and a significant decrease in sciatic nerve SWV (> -1.8 m/s across nerve regions) compared with the control group. Nerve-directed intervention had no effect on the main outcomes at muscle and joint levels. These findings provide new insights into the long-term mechanical effects of stretching interventions and have relevance to clinical conditions where change in mechanical properties has occurred. This study demonstrates that the mechanical properties of plantar flexor muscles and sciatic nerve can adapt mechanically to long-term stretching programs. Although interventions targeting muscular or nonmuscular structures are both effective at increasing maximal range of motion, the changes in tissue mechanical properties (stiffness) are specific to the structure being preferentially stretched by each program. We provide the first in vivo evidence that stiffness of peripheral nerves adapts to long-term loading stimuli using appropriate nerve-directed stretching.
Topics: Adaptation, Physiological; Adult; Ankle Joint; Biomechanical Phenomena; Humans; Muscle Stretching Exercises; Muscle, Skeletal; Range of Motion, Articular; Single-Blind Method; Torque
PubMed: 32853116
DOI: 10.1152/japplphysiol.00239.2019 -
European Journal of Pharmacology Aug 2011Salvianolic acid A (SalA) is the main efficacious, water-soluble constituent of Salvia miltiorrhiza Bunge. This study evaluated the effects of SalA on plantar...
Salvianolic acid A (SalA) is the main efficacious, water-soluble constituent of Salvia miltiorrhiza Bunge. This study evaluated the effects of SalA on plantar microcirculation and peripheral nerve dysfunction in streptozotocin (STZ )-induced type 2 diabetic rats. The rats were given a high-fat and high-sucrose diet for a month followed by intraperitoneal injection of STZ (30 mg/kg). Oral administration of SalA (1 and 3mg/kg, respectively) was performed daily for 10 weeks after modeling. Diabetic rats were given a high-fat diet, while age-matched healthy rats were given a standard chow. Plantar microcirculation was measured by Laser Doppler flowmetry, and peripheral nerve function was measured with regard to pain withdrawal latency and motor nerve conduction velocity. The results show that the plantar blood perfusion and vasodilation reactivities decreased significantly, and latency of pain withdrawal and motor nerve conduction velocity rose in diabetic rats compared with the normal control group. SalA increased peripheral blood perfusion and vascular activities; improved peripheral nerve function; and decreased AGEs levels, vascular eNOS expression, and blood glucose, lipid, vWF and malondialdehyde levels in diabetic rats. The beneficial effects of SalA on plantar microcirculation and peripheral nerve function in diabetic rats might be attributed to improvements in lipid and glucose metabolism in diabetic rats, the inhibition of AGEs formation and the development of oxidative stress-related nervous and vascular damage. Based on these findings, we proposed that therapeutic use of SalA to prevent the development of diabetic foot problems.
Topics: Animals; Aorta; Blood Glucose; Body Weight; Caffeic Acids; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 2; Diabetic Foot; Foot; Glycation End Products, Advanced; Hyperemia; Lactates; Lipid Metabolism; Male; Malondialdehyde; Microcirculation; Motor Activity; Nitric Oxide Synthase Type III; Pain; Peripheral Nerves; Rats; Rats, Sprague-Dawley; Reaction Time; Survival Rate; von Willebrand Factor
PubMed: 21510928
DOI: 10.1016/j.ejphar.2011.03.054 -
Neurotoxicology Feb 2001To assess the relationship of nerve conduction and adenosine triphosphate (ATP) status in organophosphorus-induced delayed neuropathy (OPIDN), we evaluated both in adult...
To assess the relationship of nerve conduction and adenosine triphosphate (ATP) status in organophosphorus-induced delayed neuropathy (OPIDN), we evaluated both in adult hen peripheral nerves following exposure to a single 2.5 mg/kg dose of phenyl saligenin phosphate (PSP). ATP concentrations were determined at days 2, 4, 7, and 14 post-dosing, from five segments (n = 5 per group) representing the entire length of the sciatic-tibial and medial plantar nerve. Initial effects of PSP dosing were seen in the most distal segment at day 2, when a transient ATP concentration increase (388 +/- 79 pmol/ml/mg versus control value of 215 +/- 23, P < 0.05) was noted. Subsequently, ATP concentration in this distal segment returned to normal. In the most proximal nerve segment, ATP concentrations were decreased on day 7, and further decreased on day 14 post-dosing (P < 0.05). Changes in ATP concentration and nerve conduction velocity begin at post-dosing day 2, and were found prior to development of clinical neuropathy and axonopathic lesions. These results suggest that alterations in sciatic-tibial and medial plantar nerve conduction associated with sciatic-tibial and medial plantar nerve ATP concentration are early events in the development of OPIDN.
Topics: Action Potentials; Adenosine Triphosphate; Animals; Behavior, Animal; Chickens; Electrophysiology; Female; Foot; Insecticides; Neural Conduction; Neurotoxicity Syndromes; Organophosphorus Compounds; Sciatic Nerve; Tibial Nerve; Time Factors
PubMed: 11307855
DOI: 10.1016/s0161-813x(00)00004-8 -
Folia Morphologica 2021The aim of this study was to compare the histological structure (cross-sectional area [CSA] and number of nerve fascicles) of the distal part of the tibial nerve (TN)...
BACKGROUND
The aim of this study was to compare the histological structure (cross-sectional area [CSA] and number of nerve fascicles) of the distal part of the tibial nerve (TN) and its terminal branches (medial plantar nerve [MPN], lateral plantar nerve [LPN]) in the fresh and fresh-frozen cadavers using computer assisted image analysis.
MATERIALS AND METHODS
The TNs with terminal branches (MPN and LPN) were dissected from the fresh and fresh-frozen cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the TN bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 μm slices and stained with haematoxylin and eosin. Then the specimens were photographed and analysed using Olympus cellSens software.
RESULTS
The fresh cadavers' group comprised 60 feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve fascicles were respectively 15.25 ± 4.6 mm2, 30.35 ± 8.45 for the TN, 8.76 ± 1.93 mm2, 20.75 ± 7.04 for the MPN and 6.54 ± 2.02 mm2, 13.40 ± 5.22 for the LPN. The fresh-frozen cadavers' group comprised 21 feet (mean age 75.1 ± 9.0 years). The mean CSA and the number of nerve fascicles were respectively 13.71 ± 5.66 mm2, 28.57 ± 8.00 for the TN, 7.55 ± 3.25 mm2, 18.00 ± 6.72 for the MPN and 4.29 ± 1.93 mm2, 11.33 ± 1.93 for the LPN. Only LPNs showed statistical differences in the CSA and the number of nerve fascicles between examined groups (p = 0.000, p = 0.037, respectively). A positive correlation was found between donors age and tibial nerve CSA in the fresh cadavers group (r = 0.44, p = 0.000). A statistical difference was found between the MPN and LPN both in the CSA and the number of nerve fascicles (p < 0.001, p < 0.001, respectively).
CONCLUSIONS
The CSA and the number of nerve fascicles of the tibial and medial plantar nerves were similar in the fresh and fresh-frozen cadavers whilst different in the LPN. The TN showed increasing CSA with the advanced age in the fresh cadavers. The MPN had larger CSA and more nerve fascicles than the LPN.
Topics: Aged; Cadaver; Foot; Humans; Image Processing, Computer-Assisted; Tibial Nerve
PubMed: 32789845
DOI: 10.5603/FM.a2020.0088 -
Archives of Physical Medicine and... Jan 1992Tarsal tunnel syndrome is a commonly considered compression of the tibial nerve and its plantar divisions as the nerve curves behind the medial malleolus underneath the...
Tarsal tunnel syndrome is a commonly considered compression of the tibial nerve and its plantar divisions as the nerve curves behind the medial malleolus underneath the flexor retinaculum. Motor, sensory, and/or mixed-nerve conduction studies are used to confirm or exclude the presence of compression of the posterior tibial nerve and its plantar divisions. In previous studies, stimulation has been done either proximal to the tunnel or distally in the sole of the feet or in the toes. Thus, differentiation between compression of the nerve within the proximal tarsal tunnel, as distinguished from compression of the plantar nerves in the distal tarsal tunnel or distal to the tunnel, has not been feasible. In addition, onset latency is frequently difficult to measure, and peak latencies have not been reported for the motor-evoked action potential. This study reports across-tarsal-tunnel latencies and amplitude decrements for both the medial and the lateral plantar nerves. For the medial plantar nerve with active electrodes placed over the medial head of the flexor pollicis brevis, the calculated mean + 2SD across tunnel onset latency is 3.2msec, peak latency is 2.9msec, and amplitude decrement is 29.3%. For the lateral plantar division, the calculated across-tunnel onset latency is 3.2msec, peak latency is 2.9msec, and amplitude decrement is 27.2%. Medial plantar nerve latency distal to the tarsal tunnel for the mean + 2SD is 5.9msec to onset and 9.5msec to peak, and the lateral plantar nerve latency is onset 5.9msec and peak 9.7msec.
Topics: Adult; Electrodes; Electromyography; Female; Foot; Humans; Male; Middle Aged; Neural Conduction; Tarsal Tunnel Syndrome
PubMed: 1729977
DOI: No ID Found -
Clinical Neurophysiology : Official... Sep 2017The electrodiagnosis of polyneuropathy (PNP) may benefit from examination using near-nerve needle technique (NNT) and from inclusion of distal nerves. This study...
OBJECTIVE
The electrodiagnosis of polyneuropathy (PNP) may benefit from examination using near-nerve needle technique (NNT) and from inclusion of distal nerves. This study compared the diagnostic utility of distal nerve conduction studies (NCS) and NNT recording.
METHODS
Bilateral NNT and surface recording of the sural nerve and surface recording of the dorsal sural and medial plantar nerves were prospectively done in 91 patients with clinically suspected PNP. Distal NCS were additionally done in 37 healthy controls. Diagnostic reference standard was the final clinical diagnosis retrieved from the patients medical records after 1-4years.
RESULTS
The clinical follow-up diagnosis confirmed PNP in 68 patients. Equally high sensitivities of the dorsal sural (72%), medial plantar (75%), and sural nerve with NNT recording (77%) were seen, while the sensitivity of conventional surface recording of the sural nerve was lower (60%). Sural NCS with both NNT and surface recording and dorsal sural NCS showed high specificities (85-95%) and positive predictive values (94-98%), while a lower specificity was seen for the medial plantar nerve (68%).
CONCLUSION
NCS of distal nerves, especially the dorsal sural nerve, have high diagnostic power equalling sural NNT recording.
SIGNIFICANCE
The electrodiagnostic evaluation of patients with suspected PNP benefits from NCS of distal nerves.
Topics: Action Potentials; Adult; Aged; Electrodiagnosis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Needles; Neural Conduction; Polyneuropathies; Prospective Studies; Sural Nerve; Tibial Nerve
PubMed: 28710923
DOI: 10.1016/j.clinph.2017.06.031