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Inferior heel pain
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Dishan Singh, Shelain Patel, Karan Malhotra
Tarsal tunnel syndrome is a condition where the posterior tibial nerve or its branches become compressed. The tarsal tunnel contains the tibialis posterior, flexor digitorum longus, posterior tibial artery and veins, tibial nerve, and flexor hallucis longus. These structures run in a fibro-osseous tunnel from the medial malleolus to the midfoot. From proximal to distal the ‘floor’ of the tunnel is formed by the posterior aspect of the medial malleolus, the talus, the sustentaculum tali and the calcaneal body. Proximally, the ‘roof’ of the tunnel is formed by the flexor retinaculum. At its termination the tarsal tunnel narrows and merges with the fascia of the abductor hallucis muscle. The tibial nerve lies posterior to the artery and branches into the medial and lateral plantar nerves and the medial calcaneal nerve. This trifurcation has a variable location, but usually occurs proximal to or within the tarsal tunnel. The medial and lateral plantar branches enter the foot deep to the abductor hallucis (Figure 10.6).
Spinal Cord and Reflexes
Published in Nassir H. Sabah, Neuromuscular Fundamentals, 2020
The largest and longest peripheral nerve, that is, a nerve outside the central nervous system, is the sciatic nerve. In humans, it is a flat thick band, about 2 cm wide, formed by the grouping of spinal nerves L4 to S3. It originates in the lower back, runs through the buttock and thigh, and divides, usually at the back of the knee joint, into the tibial nerve and the common fibular (or peroneal) nerve. The sciatic nerve directly controls the muscles of the posterior thigh and the hamstring portion of the adductor magnus muscle. Its branches control the muscles of the leg and foot. These branches also convey signals from the skin of the lateral leg and the foot.
Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The tibial nerve is the larger of the two branches and normally arises from the apex of the popliteal space and traverses the posterior aspect of the knee joint. It gives off branches to muscles in the superficial posterior compartment of the lower leg and here, it gives rise to the sural nerve. The tibial nerve continues its descent down the tibia alongside the posterior tibial vessels supplying the deeper muscles of the posterior leg. At the foot, the nerve passes posteroinferior to the medial malleolus through the tarsal tunnel and distal to this, the tibial nerve terminates by dividing into its sensory branches innervating the sole of the foot.
The Adipo-Fascial ALT Flap in Lower Extremities Reconstruction Gustillo IIIC-B Fractures. An Osteogenic Inducer?
Published in Journal of Investigative Surgery, 2021
Mario Cherubino, Martina Corno, Mario Ronga, Giacomo Riva, Pietro G. di Summa, Davide Sallam, Federico Tamborini, Francesca Maggiulli, Michele Surace, Luigi Valdatta
All the flaps survived without any re-exploration (The results are summarized in Table 1). There were none vascular compromised. All patients were men. The mean time from injury to flap coverage was 72 hours (22 h–56h). The mechanisms of injury were motorbike accidents in all patients except for one case, who was involved in a job accident. At the time of injury, tibial nerve palsy was observed in one case. The mean size of the soft tissue defects before the operation was 50 cm2. The receiving vessels were the anterior tibial artery (end-to-end anastomosis) and posterior tibial artery (end-to-side anastomosis). None of the patients required vein grafting because of short pedicle length. In two patients the external fixator was kept the same kind till the end because were hybrid circular type. In other 3 cases, after the damage control period, internal fixation was used to allow a better quality of life of the patients. Solid bone union was reached, and full weight bearing present at 11 weeks (range 4–20) after the injury. All wounds healed without evidence of infection. An efficient bone union was reached at a mean of 6 months (range 2–10) after the injury and the lower limb was saved in 100% of the cases (Figure 8).
Exercise induced neuropathic lower leg pain due to a tibial bone exostosis
Published in The Physician and Sportsmedicine, 2021
Loreen van den Hurk, Marijn van den Besselaar, Marc Scheltinga
The differential diagnosis of exercise induced lower leg pain (ELP) in runners is extensive and includes tendinopathies, chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS) and stress fractures [1]. The standard work up of ELP includes an X-ray, or a CT or an MRI scan of the lower leg and foot. However, even extensive imaging and functional studies may not always lead to a correct diagnosis. The present patient is a marathon runner who reported leg pain and tingling sensations toward the foot, during the day as well as at night. Physical examination revealed diminished skin sensation (hypo-esthesia) of the foot sole. Imaging revealed a calcified lesion in continuity to the proximal tibial bone. He underwent surgical removal of the lesion and neurolysis of the tibial nerve. Histology demonstrated an osteocartilaginous exostosis. The aim of this contribution is to increase the awareness of sports physicians regarding ELP of a neuropathic origin.
Percutaneous tibial nerve stimulation for idiopathic and neurogenic overactive bladder dysfunction: a four-year follow-up single-centre experience
Published in Scandinavian Journal of Urology, 2021
K. Andersen, H. Kobberø, T. B. Pedersen, M. H. Poulsen
PTNS was applied according to Govier et al. [13]. The tibial nerve is located just anterior to the Achilles tendon cephalad to the medial malleolus [14]. PTNS is performed by placing a 34-G needle 3–5 cm cephalad to the medial malleolus and posterior to the tibia, at 60° [15]. A grounding pad is placed on the bottom of the foot, after which a low-voltage stimulator is attached to the needle. Correct needle placement is confirmed by observing dorsiflexion of the big toe or fanning of the toes, as well as a patient-reported sensation on the bottom of the foot. Stimulation is performed at 0.5–9.0 mA amplitude at a fixed frequency of 20 Hz and a set pulse width of 200 µs, based on patient sensation, motor response, and comfort [7,15]. The induction treatment course consists of 12 consecutive weekly sessions, for 30 minutes per session.