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Foot and ankle examination
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Nikhil Nanavati, Nicholas Eastley, Maneesh Bhatia
Sensation: To perform a complete assessment of sensation, the saphenous nerve (medial border of the foot), deep peroneal nerve (1st web space), superficial peroneal nerve (dorsum of the foot), sural nerve (lateral border of hindfoot) and tibial nerve (plantar aspect of heel and foot) should all be tested (Figure 1.7). Medial plantar nerve is the main sensory nerve of the plantar aspect of the foot. Lateral plantar nerve supplies sensation to plantar surface of 5th toe, plantar lateral half of 4th toe and strip of skin on lateral plantar area of the foot.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Tarsal tunnel syndrome: Usually unilateral, burning pain in sole of foot.Symptoms may only be present at night or while exercising.May have atrophy of intrinsic foot muscles.Sensory loss in the sole of the foot and toes in the distribution of the medial plantar nerve (most commonly), lateral plantar nerve, or both.Often, idiopathic tarsal tunnel syndrome occurs in the setting of polyneuropathy.
Lower limb
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
A 23-year-old woman injures her ankle after tripping on an uneven surface. Radiographs reveal no broken bones in her foot. Physical examination reveals a severe inversion sprain of her ankle. Which of the following structures has most likely been injured in this patient?Anterior talofibular ligament.Posterior talofibular ligament.Medial plantar nerve.Lateral plantar nerve.Deltoid ligament.
Free neurosensory flap based on the accompanying vessels of lateral sural cutaneous nerve: anatomic study and preliminary clinical applications
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Weichao Yang, Gen Wen, Feng Zhang, William C. Lineaweaver, Chunyang Wang, Kyler Jones, Yimin Chai
The size of the flaps ranged from 12 × 6 cm to 25 × 8 cm, and the length of the pedicle was 5.5 cm on average. All six flaps survived completely without complications. In three patients, the superficial lateral sural vessels were anastomosed to medial plantar vessels, and the LSCN was coapted to the medial plantar nerve in an end-to-end fashion. In two patients, the pedicle vessels were anastomosed end-to-end to a branch of radial vessels, and the LSCN was coapted to the superficial branch of the radial nerve. In one patient, the vessels of the flap were anastomosed end-to-end to a branch of ulnar vessels, and the LSCN was coapted to the medial cutaneous nerve. Follow-up ranged from 6 to 18 months with 11 months in average. No additional debulking was necessary, and the overall contour after resurfacing was satisfactory. No epithelial breakdown occurred in patients with sole injuries. The donor sites healed without complications and the skin grafts healed uneventfully. The main donor site morbidity was the scar after grafting over the posterolateral leg, which can be concealed by pants. No painful neuroma of LSCN recorded.
Presynaptic inhibition in restless legs syndrome
Published in International Journal of Neuroscience, 2021
Şule Aydin Türkoglu, Elif Sultan Bolac, Serpil Yildiz, Oya Kalaycioglu, Nebil Yildiz
Heide et al demonstrated decreased Hc/Ht ratios for ISI of 200–300 us with anodal TsDCS (transcutaneous spinal direct stimulation) in RLS patient which can be commented indirectly for supportive evidence of spinal cord hyperexcitability. The uniformly pattern of muscular recruitment in spinal up or down segments and the greater spatial spread/the lower threshold of flexor responses with medial plantar nerve stimulation has been evaluated in favor of spinal cord hyperexcitability in RLS patients [12,17]. The spinal motor excitability increases possibly due to decreased spinal inhibitory reflexes can partly contribute -in addition to the central disinhibition- to the periodic leg movements which is seen often in RLS patients. Diminished 1a, 1 b inhibitions can also be related with sensory symptoms, because of unlimited sensory entries/sensory overloading. But all these assumptions need further studies.
Reconstruction of the distal lower leg and foot sole with medial plantar flap: a retrospective study in one center
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Zheng-Qiang Cang, Xiao-Dong Ni, Yuan Xu, Min Wang, Qian Wang, Si-Ming Yuan
The pedicle is constituted by the medial plantar artery and its venae comitantes and the cutaneous branch of the medial plantar nerve [23–25]. The medial plantar artery is not the dominant blood supply source of the plantar, and it plays a relatively minor role in the blood flow of the foot because the blood flow of the deep plantar arch mainly comes from the lateral plantar artery and branches of the dorsalis pedis artery [20]. This artery’s sacrifice will not affect the prognosis of the plantar. On the other hand, the medial plantar artery has sufficient diameter to ensure good blood supply of the flap [23]. Thus, we removed the superfluous soft tissue and got a slender vascular pedicle that had a high flexibility to rotate the flap. No flap had difficulty in rotation during the operation, even though some of the patients had the distal lower leg defect. No patient complained of bloated pedicle after operation. This advantage is particularly evident in the repair of distal lower leg defect when compared with sural flaps. Herlin, in his study of patients who underwent ankle defect reconstruction using the sural flap, reported a major ankle bulking [11].