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Applied anatomy and surgical approaches
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Rajeev Vohra, Babaji Sitaram Thorat, Avtar Singh
In lower third of the leg TN it is located in the posterior compartment between flexor digitorum longus (FDL) and flexor hallucis longus (FHL) (Figure 2.3). In this region it can be easily confused with the FHL tendon during posteromedial and posterolateral approaches to the ankle (9). The nerve courses behind the medial malleolus (MM) and divides into its terminal branches, the medial and lateral plantar nerves before entering the tarsal tunnel. In the tarsal tunnel, it lies between FHL and FDL along with the posterior tibial artery (PTA), and both structures should be protected during tarsal tunnel release. The lateral plantar nerve supplies all but 4 intrinsic muscles of the foot and the medial plantar nerve is the main sensory nerve of the plantar aspect of the foot.
Neuroanatomy overview
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Lateral plantar nerve Crosses the sole obliquely deep to the first layer of musclesSupplies the flexor accessorius and the abductor digit minimiHas perforating branches through the plantar aponeurosis to the skin on the lateral side of the soleDivides into superficial and deep branches near Vth metatarsal baseHas superficial branch that supplies IVth cleft, and little toe, and supplies the flexor digiti minimi, and two interossei of IVthHas a deep branch that supplies the rest of the interossei and the transverse head of the adductor hallucis
The ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Nerve entrapment Entrapment of the first branch of the lateral plantar nerve has been reported as a cause of heel pain. The commonest complaint is pain after sporting activities. Characteristically, tenderness is maximal on the medial aspect of the heel, where the small nerve branch is compressed between the deep fascia of abductor hallucis and the edge of the quadratus plantae muscle. Diagnosis is not easy, because the symptoms and signs may mimic those of plantar fasciitis.
Venous malformation as source of a tarsal tunnel syndrome: treat the source or the cause of the complaints? A case report
Published in Acta Chirurgica Belgica, 2018
H. Mufty, G. A. Matricali, S. Thomis
Since a positive evolution was seen, a further conservative management was given. However, five months later, the patient presented at the emergency department with paresthesia of the right foot and difficulties in plantar flexion of the right foot since two days. Electromyography and nerve conduction study showed lowered compound muscle action potential of the abductor hallucis muscle without evidence for block of the peroneal nerve. Since the patient stopped wearing them, once again, compression stockings were advised with strict venous hygienic management. Nevertheless, 20 days later, an evolution towards unsustainable pain at the right foot was seen. New electromyography revealed a symptomatic TTS of the right site. A new MRI was planned and confirmed this finding in the tarsal tunnel area although difficulties in differentiation of the nerve structures were noticed. A combination of Contramal retard 100 mg (tramadol hydrochloride) and Neurontin 100 mg (gabapentine), both once daily, was associated to the anti-inflammatory drugs in an increasing dose. Eventually, 10 months after initial presentation, the increasing pain and the impossibility to treat the venous malformation as the external cause, obliged us to perform an open tarsal tunnel release through a retromalleolar incision. A tight retinaculum was identified and dissected (Figure 2). The abductor hallucis muscle was also identified and dissected for complete release of the lateral plantar nerve. A subcutaneous drain was left in situ and the skin was closed with nonabsorbable sutures. The procedure was uncomplicated. The drain could be removed on the first postoperative day. A visual analog scale (VAS) was performed preoperatively and on the first day postoperatively. This showed immediately excellent results with values of 9/10 and 2/10, respectively. Ten months postoperatively, the patient was still without any pain. Only a small area of hypoesthesia at the medial foot and toes remained.