-
Clinics in Plastic Surgery Oct 1986Foot injuries constitute a spectrum of problems that can be classified by severity. The development of successful techniques for the treatment of lower leg injuries has... (Review)
Review
Foot injuries constitute a spectrum of problems that can be classified by severity. The development of successful techniques for the treatment of lower leg injuries has made the severity of a concomitant foot injury a key factor in determining the overall salvageability of the leg. A more complete classification of foot injuries is therefore needed and has been proposed. Preoperative assessment of foot injuries differs in the acute versus the delayed presentation. The acute case requires evaluation of wound conditions, exposed structures, and associated proximal injuries. The chronic injury requires gait analysis, study of weight-bearing patterns by Harris mat prints, skeletal evaluation, mapping of plantar sensation, and, in some cases, angiography. Thorough knowledge of foot anatomy is essential for developing a rational plan for treatment. The significance and course of the medial calcaneal nerve and the anatomy of the plantar nerves have not been fully appreciated in most reports on the treatment of foot injuries. The recognition of the proximal plantar subcutaneous plexus blood supply has modified the understanding of plantar flap design. It has simplified and improved the safety of dissection of sensate plantar flaps. A plethora of both local and distant flap options exist for the treatment of foot injuries. The foot is divided into four major areas based on different requirements for reconstruction and the types of flaps available. These areas are the proximal plantar area; the malleoli, Achilles tendon, and posterior (non-weight-bearing) heel area; the distal plantar area; and the dorsum. The options for coverage have been discussed in detail, and a summary of the reconstructive strategy by area has been presented in Table 3. Complex (type III) injuries are special injuries owing to their severity and multiple components. They require a careful initial evaluation for both feasibility and advisability of extremity salvage. Treatment of these injuries consists of bony stabilization and soft-tissue debridement followed by flap coverage.
Topics: Debridement; Foot; Foot Injuries; Humans; Microsurgery; Skin Transplantation; Surgery, Plastic; Surgical Flaps
PubMed: 2876797
DOI: No ID Found -
The British Journal of Dermatology Jul 2010
Topics: Anesthetics, Local; Biopsy; Foot; Humans; Keratoderma, Palmoplantar; Lidocaine; Mepivacaine; Nerve Block; Peripheral Nerves; Skin; Tibial Nerve
PubMed: 20346024
DOI: 10.1111/j.1365-2133.2010.09780.x -
Anatomia, Histologia, Embryologia Mar 2022The neurovascular bundle of the equine distal cannon can dynamically vary with limb position, and this can affect the performance of low 4- or 6-point block. This study...
The neurovascular bundle of the equine distal cannon can dynamically vary with limb position, and this can affect the performance of low 4- or 6-point block. This study aims to identify and describe the anatomical position and variations of the lateral and medial palmar/plantar nerve at the metacarpal/metatarsal distal level in horses by ultrasonography. Eight mares underwent ultrasound examination on the lateral and medial palmar/plantar sides of the metacarpus/metatarsus. Images were obtained for measurements of the cross-sectional area of the nerve, distances between the nerve and the skin surface, branch of the suspensory ligament (SL), deep digital flexor tendon (DDFT) and superficial digital flexor tendon (SDFT) with limbs supported and elevated. The distance to the skin for forelimbs was higher on the lateral side when the limb was elevated (p < 0.001). The comparisons between supported and elevated limbs on the same side showed longer distances to the skin with the limb supported on the medial side (p < 0.001). Hindlimbs showed longer distances to the skin with the limb supported on the medial face (p = 0.027). The anatomical position of palmar/plantar nerves was similar between the lateral and medial sides of the limb, generally being in contact with the dorsal edge of DDFT. The strategy of elevating the limb during the injection of the low 4- or 6-point block can lead to a higher risk of puncture of the digital sheath.
Topics: Animals; Female; Forelimb; Horse Diseases; Horses; Metacarpal Bones; Metatarsal Bones; Metatarsus; Ultrasonography
PubMed: 35000219
DOI: 10.1111/ahe.12782 -
The Journal of Physiology Jun 19801. Certain muscles in the hind foot of rats were partially paralysed by applying tetrodotoxin to part of their motor innervation. In these muscles motor nerve sprouting...
1. Certain muscles in the hind foot of rats were partially paralysed by applying tetrodotoxin to part of their motor innervation. In these muscles motor nerve sprouting occurred from the terminals of the unblocked axons. The extent of sprouting was compared with that seen in totally paralysed and in partially denervated muscles. 2. Action potentials were blocked in the medial and lateral plantar nerves of adult rats for 5-13 days by continuous superfusion with a solution containing tetrodotoxin. The drug was delivered through a tube and nerve cuff from an osmotic pump placed intraperitoneally. Control experiments showed that nerve block was complete and that signs of nerve damage were absent in the animals included in the study. 3. Two muscles (the second lumbrical and flexor digitorum brevis), which received innervation only from the medial plantar nerve, were totally paralysed by the nerve block. Two different muscles (the fourth lumbrical and flexor digitorum quinti brevis) were only partially paralysed, since they received their innervation from the lateral plantar nerve and, in addition, from the sural nerve which was not blocked. One day before the final experiment, the lateral plantar nerve was cut, and its terminals degenerated. Thus in the partially paralysed muscles only the unblocked terminals from the sural nerve remained. These terminals were observed after staining with zinc iodide and osmium tetroxide. Similarly, terminals from the medial plantar nerve were examined in the totally blocked muscles from the same animal. 4. In other experiments, muscles were partially denervated by cutting the lateral plantar nerve in order to compare effects of nerve block and nerve section. 5. Sprouting occurred under all three conditions. Active terminals in the muscles partially paralysed for 5-7 days sprouted to the same extent as terminals in muscles totally blocked during the same period: about 35% of the terminals had sprouts, and their average length was about 13 micron. Sprouting was more pronounced in partially denervated muscles: about 65% of the terminals had sprouts and they averaged 24 micron in length. Collateral (preterminal) sprouts were seen only after partial denervation. 6. Physiological and histological observations suggested that sprouts in paralysed muscles, unlike those in partially denervated muscles, seldom if ever made new synapses on neighbouring muscle fibres, even after 12-13 days of nerve block. 7. The results show that inactive muscle fibres cause active nerve terminals on neighbouring fibres to sprout, perhaps by releasing a diffusible, sprout-promoting factor, which is part of the stimulus for motor nerve sprouting in partially denervated muscles.
Topics: Action Potentials; Animals; Axons; Female; Hindlimb; Male; Motor Neurons; Muscle Contraction; Muscle Denervation; Muscles; Nerve Block; Nerve Endings; Nerve Regeneration; Rats
PubMed: 7431235
DOI: 10.1113/jphysiol.1980.sp013285 -
Veterinary Sciences Apr 2023This study aimed to describe the anatomy of the nerve supply of the hindlimb's distal portion in a dromedary camel's foot. In our study, we used ten adult slaughtered...
This study aimed to describe the anatomy of the nerve supply of the hindlimb's distal portion in a dromedary camel's foot. In our study, we used ten adult slaughtered dromedary camels (twenty distal hindlimbs) of different sexes and ages (4-6 years). The hindlimbs were preserved using 10% formalin for about one week. The distal part of the hindlimb of the camels was dissected with extreme precision to show the group of nerves responsible for the nervous supply to the distal part of the hindlimb in dromedary camels. This study shows the numerous branches of the superficial fibular nerve along its extension to the dorsal surface metatarsus and the abaxial aspect of the third digit. The results show that the tibial nerve possesses many branches along its extension to the plantar surface skin of the metatarsus. Additionally, it provides the axial and abaxial plantar surfaces of the fourth digit and the interdigital surfaces as well as its branches to supply the plantar-abaxial and plantar-axial of the third digit. The present study shows the anatomical nerve supply of the hindlimb's distal portion that is essential for anesthesia and surgery in this region.
PubMed: 37104460
DOI: 10.3390/vetsci10040305 -
American Journal of Physical Medicine &... Feb 2022The aim of the study was to demonstrate abnormalities of motor conduction of the tibial nerve across the tarsal tunnel in type 2 diabetes.
OBJECTIVE
The aim of the study was to demonstrate abnormalities of motor conduction of the tibial nerve across the tarsal tunnel in type 2 diabetes.
DESIGN
One hundred twenty-four consecutive patients (mean age = 66.6 yrs, 62.1% male) with distal symmetric diabetic polyneuropathy clinically diagnosed were prospectively enrolled. Nerve conduction studies of deep peroneal, tibial, superficial peroneal, medial plantar, and sural nerves and standard needle electromyography in the lower limbs were performed. Demographic, anthropometric, and clinical findings were collected.
RESULTS
Motor conduction velocity of the tibial nerve across tarsal tunnel was slowed in 60.5% of patients; another 4% showed conduction block across tarsal tunnel without reduction of motor conduction velocity. Overall percentage of abnormalities across tarsal tunnel (64.5%) exceeds that of the sensory conduction velocities of proximal sural and superficial peroneal nerves. Abnormal tibial motor conduction velocity across tarsal tunnel represents the most common abnormality among all motor nerve conduction study parameters and significantly correlates with hemoglobin level, diabetic neuropathic index score, and diabetic complications frequency.
CONCLUSIONS
Tibial conduction abnormalities across tarsal tunnel are the most sensitive motor parameter in distal symmetric diabetic polyneuropathy, second only to conduction abnormalities of sensory/mixed distal nerves of the feet. The use of nerve conduction studies across tarsal tunnel of the tibial nerve may be useful in the electrophysiological protocol to confirm the diagnosis of distal symmetric diabetic polyneuropathy.
Topics: Aged; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Electromyography; Female; Humans; Male; Neural Conduction; Prospective Studies; Tarsal Tunnel Syndrome; Tibial Nerve
PubMed: 33901043
DOI: 10.1097/PHM.0000000000001769 -
Medicine Apr 2024It is essential to understand the considerable variations in bifurcation patterns of the tibial nerve (TN) and its peripheral nerves at the level of the tarsal tunnel to...
It is essential to understand the considerable variations in bifurcation patterns of the tibial nerve (TN) and its peripheral nerves at the level of the tarsal tunnel to prevent iatrogenic nerve injury during surgical nerve release or nerve block. A total of 16 ankles of 8 human cadavers were dissected to investigate the branching patterns of the TN, using 2 imaginary lines passing through the tip of the medial malleolus (MM) as reference lines. Bifurcation patterns and detailed information on the relative locations of the medial plantar, lateral plantar, medial calcaneal, and inferior calcaneal nerves to the reference lines were recorded. The most common bifurcation pattern was Type 1 in 12 ankles (75%), followed by Type 2 in 2 ankles (13%). One medial calcaneal nerve (MCN) was seen in 11 (69%) specimens and 2 MCN branches were seen in 5 (31%) specimen. 88% of the MCN branches bifurcated from the TN, whereas 6% originated from both TN and lateral plantar nerve (LPN). At the level of the tip of the MM, 2 of 7 parameters showed statistically significant difference between both sexes (P < .05). There was a statistically significant difference between left and right ankles in 2 of 7 measurements (P < .05). Further morphometric analysis of the width, distance, and angle between the TN branches and the tip of MM showed a highly variable nature of the location of the peripheral nerve branches.
Topics: Female; Male; Humans; Ankle; Ankle Joint; Tibial Nerve; Tibia; Leg
PubMed: 38608103
DOI: 10.1097/MD.0000000000037745 -
Compound nerve action potentials of the medial and lateral plantar nerves through the tarsal tunnel.Archives of Physical Medicine and... Jul 1982The purpose of this study was to determine and standardize an easy and convenient method of studying the orthodromic latencies of the medial and lateral plantar nerves...
The purpose of this study was to determine and standardize an easy and convenient method of studying the orthodromic latencies of the medial and lateral plantar nerves for clinical purposes using conventional equipment. Forty-one able-bodied adult subjects ranging in age from 20 to 76 years were tested orthodromically to establish normal values over fixed distances. The temperatures of the feet ranged from 26C to 32C. A standard TECA bipolar surface electrode fixed in a plastic mount was placed on the posterior tibial nerve proximal to the flexor retinaculum. The medial plantar nerve was stimulated with a bipolar surface stimulator at a distance of 10, 14, and 18cm, and at the great toe. The lateral plantar nerve was stimulated at a distance of 14 and 18cm, and at the little toe. Orthodromic latencies for the medial plantar nerve for distances of 10, 14 and 18cm, and the great toe were 2.4 +/- SD 0.15msec, 3.2 +/- SD 0.26msec, 4.0 +/- SD 0.22msec, and 5.0 +/- SD 0.38msec, respectively. Lateral plantar nerve latencies for 14 and 18cm segments were 3.2 +/- SD 0.25msec and 4.0 +/- SD 0.27msec, respectively. These standard values should allow more accurate assessment of tarsal tunnel syndrome (TTS) and peripheral neuropathies because the orthodromic method involves a mixed motor and sensory nerve action potential and should be more sensitive to early changes than a pure motor nerve action potential.
Topics: Action Potentials; Adult; Aged; Female; Humans; Middle Aged; Reference Values; Tarsal Tunnel Syndrome; Tibial Nerve
PubMed: 7092529
DOI: No ID Found -
Veterinary and Comparative Orthopaedics... Jul 2020This article evaluates and compares the diffusion pattern of radiopaque contrast medium following perineural analgesia of the deep branch of the lateral plantar nerve...
Diffusion of Radiodense Contrast Medium Following Perineural Injection of the Deep Branch of the Lateral Plantar Nerve Using Two Different Techniques in Horses: an In Vivo Study.
OBJECTIVES
This article evaluates and compares the diffusion pattern of radiopaque contrast medium following perineural analgesia of the deep branch of the lateral plantar nerve performed using two different techniques: weight-bearing or flexed.
STUDY DESIGN
This was an experimental study.
METHODS
Eight horses were enrolled. Perineural injection of the right and left deep branch lateral plantar nerves was performed with a weight-bearing or flexed technique, using radiopaque contrast medium (iohexol). Radiographic evaluation was performed after 5 (T5), 15 (T15) and 30 (T30) minutes. The diffusion of contrast medium was assessed independently by two blinded readers who analysed the extension of the main contrast medium bulk and the maximum diffusion of contrast medium in both proximal and distal directions. The effect of time and technique employed on contrast medium diffusion was assessed using two-way analysis of variance for repeated measures ( ≤ 0.05).
RESULTS
There was no significant difference in the diffusion of the contrast medium between the two techniques at T15. However, at T30 the weight-bearing technique resulted in a significantly increased diffusion in the proximal direction ( = 0.02). In one case, belonging to the weight-bearing group, contrast medium was identified within the tarsal sheath. There was no evidence of contrast medium in the tarsometatarsal joint of any horse, regardless of the technique used.
CONCLUSIONS
The two techniques resulted in a similar diffusion at T15. However, the use of a weight-bearing technique resulted in a significant increase in proximal contrast medium diffusion 30 minutes after injection.
Topics: Animals; Contrast Media; Diffusion; Female; Foot; Hindlimb; Horses; Injections; Iohexol; Male; Tibial Nerve
PubMed: 32283558
DOI: 10.1055/s-0040-1701655 -
Journal of Child Neurology Jul 2015The aim of the study was to investigate nerve conduction studies in terms of neuropathic characteristics in obese patients who were in prediabetes stage and also to...
The aim of the study was to investigate nerve conduction studies in terms of neuropathic characteristics in obese patients who were in prediabetes stage and also to determine the abnormal findings. The study included 69 obese adolescent patients between April 2009 and December 2010. All patients and control group underwent motor (median, ulnar, tibial, and peroneal) and sensory (median, ulnar, sural, and medial plantar) nerve conduction studies and sympathetic skin response test. Sensory response amplitude of the medial plantar nerve was significantly lower in the patients with impaired glucose tolerance and insulin resistance. To our knowledge, the present study is the first study demonstrating the development of sensory and autonomic neuropathy due to metabolic complications of obesity in adolescent children even in the period without development of diabetes mellitus. We recommend that routine electrophysiological examinations be performed, using medial plantar nerve conduction studies and sympathetic skin response test.
Topics: Adolescent; Blood Glucose; Cholesterol; Electric Stimulation; Female; Galvanic Skin Response; Glucose Tolerance Test; Humans; Insulin Resistance; Male; Neural Conduction; Neurologic Examination; Obesity; Peripheral Nerves; Reaction Time
PubMed: 25342307
DOI: 10.1177/0883073814550188