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The first branch of the lateral plantar nerve and heel pain
Abstract
The course and ramification pattern of the lateral plantar nerve was studied in serial sections from 4 fetal feet and in dissections from 34 adult feet with special reference to the so called first branch. This branch was found in all of the observed fetal and adult specimen. From its originating point the nerve runs immediately distally to the medial process of the calcaneal tuberosity in a lateral direction to the proximal part of the abductor digiti minimi muscle. During its course the FB gives two branches. One of them penetrates sometimes the insertion of the quadratus plantae muscle, whereas in adult feet it always sends fibres to the periosteum around the medial process of the calcaneal tuberosity and the long plantar ligament. The other innervates the flexor digitorum brevis muscle. The site of a possible entrapment is located between the abductor hallucis muscle and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the long plantar ligament as well as motor fibres for the quadratus plantae, flexor digitorum brevis and abductor digiti minimi muscles, which may explain the characteristic pain complaints of the heel pain syndrome. The occurrence of a stiff fascia perforated by the nerve branch or a bursa around the insertion of the plantar aponeurosis as has been described by several authors and which was put forward as a possible aetiological factor could not be confirmed in our material.
... The range of X-coordinate was 39% to 57% and of Y-coordinate was from -45% to 36% in males; while the range in females was 29% to 65% in X-coordinate and -10% to 39% in Y-coordinate. The nerve branching patterns of the medial calcaneal branch were slightly different among the studies (Table 7) [9,14,[17][18][19][20]. Previous and this studies reported that multiple branches were most common. ...
... Previous and this studies reported that multiple branches were most common. Rondhuis and Huson [20] described all samples with one medial calcaneal branch, and Andreasen Struijk et al. [18] reported that half of the samples had one branch while the other half had several branches. Govsa et al. [17] and this studies mentioned and counted the 'multiple' origin. ...
... Thus, the medial calcaneal branch originated from the tibial nerve and the lateral or medial plantar nerves simultaneously [17]. Rondhuis and Huson [20] described the origin of the medial calcaneal branch from the tibial nerve, in all samples. Whereas five others studies reported that the origin of the medial calcaneal branch in most samples was from the tibial nerve [9,14,[18][19][20]. ...
Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain.
... The nerve bundle innervating the ADMM (i.e., ADMM nerve) has been referred to by several names, including the inferior calcaneal nerve, deep calcaneal nerve, and Baxter's nerve [4,5]. The ADMM nerve arises either as the first branch of the lateral plantar nerve or directly from the posterior tibial nerve, and runs in the medial-tolateral direction between the abductor hallucis muscle and the medial calcaneal tuberosity [6][7][8][9]. The ADMM nerve is a mixed sensory and motor nerve that supplies motor branches to the ADMM and, occasionally, supplied the flexor digitorum brevis and quadratus plantae muscles and sensory branches to the calcaneal periosteum and the long plantar ligament [8]. ...
... The ADMM nerve arises either as the first branch of the lateral plantar nerve or directly from the posterior tibial nerve, and runs in the medial-tolateral direction between the abductor hallucis muscle and the medial calcaneal tuberosity [6][7][8][9]. The ADMM nerve is a mixed sensory and motor nerve that supplies motor branches to the ADMM and, occasionally, supplied the flexor digitorum brevis and quadratus plantae muscles and sensory branches to the calcaneal periosteum and the long plantar ligament [8]. The ADMM nerve runs plantar from its origin, at a significant depth in relation to the abductor halluces muscle. ...
... Damage to the ADMM nerve was first reported in 1940 by Roegholt 18 and has subsequently been confirmed by numerous authors [1,4,8,[11][12][13][14][15][16][17][18]. The damage has been postulated to occur in one of two locations: either at the point where the nerve changes direction at the inferior margin of the abductor halluces, where it is compressed between the abductor hallucis and the medial side of the quadratus plantae, or slightly more distal, where the nerve passes anterior to the medial process of the calcaneal tuberosity [4,14]. ...
The nerve to the abductor digiti minimi muscle (ADMM nerve) is the first branch of the lateral plantar nerve or originates directly from the posterior tibial nerve. Damage to the ADMM nerve is a cause of heel pain and eventually results in ADMM atrophy. It is known that ADMM atrophy occurs more often in females than in males, and the reason remains unclear. This study aimed to explore sex differences in the branching pattern, position, and angle of the ADMM nerve.
Forty-two cadavers (20 males, 22 females) were dissected at Aichi Medical University between 2011 and 2015. Cases of foot deformity or atrophy were excluded and 67 ft (30 male, 37 female) were examined to assess the branching pattern, position, and angle of the ADMM nerve.
The branching positions of the ADMM nerve were superior to the malleolar-calcaneal axis (MCA) in 37 ft (55 %), on the MCA in 10 ft (15 %), and inferior to the MCA in 20 ft (30 %). There was no case among male feet in which the ADMM nerve branched inferior to the MCA, whereas this pattern was observed in 19 of 37 female feet (51 %). The branching position of the ADMM nerve was significantly closer to the MCA in female feet than in male feet. There were no significant sex differences in the branching pattern and angle of the ADMM nerve.
The ADMM nerve sometimes branches off inferior to the MCA in females, but not in males. This difference may be the reason for the more frequent occurrence of ADMM atrophy in females than in males.
... 2,3 The FBLPN is a small (≈2 mm) mixed motor and sensory nerve typically arising from the lateral plantar nerve (LPN) just distal to its origin from the tibial nerve (TN; Figure 1). [4][5][6] It provides motor innervation to the quadratus plantae (QP), flexor digitorum brevis (FDB), and abductor digiti minimi (ADM) muscles and sensory innervation to the calcaneal periosteum and long plantar ligament. 4 The FBLPN traverses the medial and plantar aspects of the heel region, where it may be injured or entrapped at two well-described locations ( Figure 2). ...
... [4][5][6] It provides motor innervation to the quadratus plantae (QP), flexor digitorum brevis (FDB), and abductor digiti minimi (ADM) muscles and sensory innervation to the calcaneal periosteum and long plantar ligament. 4 The FBLPN traverses the medial and plantar aspects of the heel region, where it may be injured or entrapped at two well-described locations ( Figure 2). More proximally, the FBPLN may be entrapped between the deep, taut fascia of the abductor hallucis (AH) muscle and the medial aspect of the QP, where the nerve changes course from vertical to horizontal as it travels toward the lateral foot. ...
... As expected based on prior anatomic descriptions, the FBLPN arose from the LPN just distal to the TN bifurcation, was approximately 2 mm in maximal diameter, and demonstrated a relatively vertical course as it passed caudally within the plane between the AH and QP (ie, AH-QP interval). [4][5][6][7][8][9] The nerve then assumed a more horizontal oblique orientation as it coursed laterally toward the ADM, bordered dorsally by the QP and on its plantar surface by the FDB. As the nerve continued laterally toward the ADM, it passed beyond the lateral margin of the QP, where it was bordered dorsally by the plantar calcaneal surface and the long plantar ligament. ...
Objectives:
The primary purpose of this investigation was to document the ability of high-resolution sonography to accurately identify the first branch of the lateral plantar nerve (FBLPN) using sonographically guided perineural injections in an unembalmed cadaveric model.
Methods:
single experienced operator completed sonographically guided perineural FBLPN injections in 12 unembalmed cadaveric specimens (6 right and 6 left) obtained from 10 donors (5 male and 5 female) aged 47 to 95 years (mean, 71 years) with an average body mass index of 24.2 kg/m(2) (range, 17.2-31.6 kg/m(2)). All injections were completed using 22-gauge, 38-mm stainless steel needles to deliver 1 mL of 50% diluted colored latex adjacent to the FBLPN in the abductor hallucis-quadratus plantae (AH-QP) interval. Six injections were completed using a cart-based ultrasound (US) machine and a 17-5-MHz transducer, and 6 were completed using a portable US machine and a 12-3-MHz transducer. Nerve conspicuity was graded on a 4-point scale (1, poor; 4, excellent). After a minimum of 24 hours, study coinvestigators dissected each specimen to assess injectate placement.
Results:
All 12 injections accurately placed latex onto the FBLPN within the AH-QP interval, with 11 of 12 (91%) resulting in complete nerve coverage. Proximal latex overflow to the lateral plantar nerve occurred in 82% of cases (10 of 12). The average distance between the plantar fascia and injected latex was 1.2 cm (range, 1.0-1.75 cm). No vascular injury was seen in any specimen. The average nerve conspicuities were 3.7 (range, 3-4) using the cart-based US machine and 1.8 (range, 1-4) using the portable US machine.
Conclusions:
Sonographic visualization of the FBLPN in the AH-QP interval is feasible and should be considered for diagnostic and therapeutic purposes in patients presenting with chronic or atypical heel pain syndromes. Further clinical experience should refine the role of FBLPN sonography and explore the utility of sonographically guided diagnostic and therapeutic FBLPN perineural injections.
... Available literature underlines the variability in the origin of MCN. Rondhuis and Huson (1986) observed that the nerve arose from the tibial nerve in 100% cases. Louisia and Masquelet (1999) noted that the nerve arose from tibial nerve and LPN. ...
... lateral to the inferior border of abductor hallucis muscle ( Fig. 3A and Table 1) thereby being at risk of compression at this particular site (Table 4). Similar findings were also reported by Rondhuis and Huson (1986). The compression of this nerve (also known as Baxter's Neuropathy) can produce chronic heel pain, as the nerve gives sensory branches to the anterior tubercle of the calcaneum (Baxter and Pfeffer, 1992;Chundru et al., 2008). ...
... Foot deformities which include varus deformity of the heel with pronated forefoot and valgus heel with abducted forefoot in flat foot deformities may lead to compression neuropathy by the overlying abductor hallucis muscle (Lau and Daniels, 1999). Baxter's neuropathy which involves the ICN, may occur in patients with altered biomechanics, such as excessive pronation or flat foot deformity (Rondhuis and Huson, 1986). Running with excessive pronation or a high medial arch can predispose to the injury of MCN (Rask, 1978;Murphy and Baxter, 1985). ...
Hypertrophy of abductor hallucis muscle is one of the reported causes of compression of tibial nerve branches in foot, resulting in tarsal tunnel syndrome. In this study, we dissected the foot (including the sole) of 120 lower limbs in 60 human cadavers (45 males and 15 females), aged between 45 and 70 years to analyze the possible impact of abductor hallucis muscle in compression neuropathy of tibial nerve branches. We identified five areas in foot, where tibial nerve branches could be compressed by abductor hallucis. Our findings regarding three of these areas were substantiated by clinical evidence from ultrasonography of ankle and sole region, conducted in the affected foot of 120 patients (82 males and 38 females), aged between 42 and 75 years, who were referred for evaluation of pain and/or swelling in medial side of ankle joint with or without associated heel and/or sole pain. We also assessed whether estimation of parameters for the muscle size could identify patients at risk of having nerve compression due to abductor hallucis muscle hypertrophy. The interclass correlation coefficient for dorso-planter thickness of abductor hallucis muscle was 0.84 (95% CI, 0.63-0.92) and that of medio-lateral width was 0.78 (95% CI, 0.62-0.88) in the imaging study, suggesting both are reliable parameters of the muscle size. Receiver operating characteristic curve analysis showed, if ultrasonographic estimation of dorso-plantar thickness is >12.8 mm and medio-lateral width > 30.66 mm in patients with symptoms of nerve compression in foot, abductor hallucis muscle hypertrophy associated compression neuropathy may be suspected. Clin. Anat., 2012. © 2012 Wiley Periodicals, Inc.
... The nerve consists of sensory fibers for the calcaneal periosteum and the long plantar ligament as well as motor fibers for the quadratus plantae, flexor digitorum brevis, and abductor digiti quinti muscles. 2 Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but it may play a role in the early phases of painful heel syndrome. 3 Diagnosis of the nerve entrapment is made on clinical grounds. ...
... The nerve can be entrapped between the deep fascia of the abductor hallucis and the medial caudal margin of the medial head of quadratus plantae. 2 Another potential site of entrapment is where the nerve passes through the deep fascia of the abductor hallucis. 22,23 A complete decompression of the nerve must include both of these sites. ...
Entrapment of the first branch of the lateral plantar nerve is a commonly missed cause of recalcitrant plantar heel pain. The diagnosis is made on a clinical ground with maximal tenderness at the site of nerve entrapment. Treatment of the nerve entrapment is similar to that for plantar fasciitis, with rest, activity modification, nonsteroidal anti-inflammatory drugs, stretching exercise, and local steroid injection. Surgical release of the deep abductor hallucis fascia is indicated when conservative treatment failed. Endoscopic release of the nerve through the dorsal and plantar portals, as well as endoscopic plantar aponeurosis release, is a feasible approach.
... The nerve to the ADQ is mixed and originates motor nerves to the ADQ and, occasionally, to the short flexor of the digits and plantar square muscle, as well as sensory branches to the calcaneal periosteum, long plantar ligament and adjacent skin (24) . Any situation determining increased volume in the region of the nerve might cause a focal compressive effect with consequential neuropathy. ...
... The literature suggests two possible sites of nerve entrapment which could result in Baxter's neuropathy, as follows: the first one, in patients with altered biomechanics, such as excessive pronation, since the nerve may be compressed in the movement of lateral rotation between the plantar square and abductor hallucis muscles (24) ; and second, either the nerve may be compressed as it passes anteriorly to the medial calcaneal tuberosity, or interfere mechanically with the plantar calcaneal spur (17,25,27,28) (Figure 2). ...
Objective:
To assess the prevalence of isolated findings of abnormalities leading to entrapment of the lateral plantar nerve and respective branches in patients complaining of chronic heel pain, whose magnetic resonance imaging exams have showed complete selective fatty atrophy of the abductor digiti quinti muscle.
Materials and methods:
Retrospective, analytical, and cross-sectional study. The authors selected magnetic resonance imaging of hindfoot of 90 patients with grade IV abductor digiti quinti muscle atrophy according to Goutallier and Bernageau classification. Patients presenting with minor degrees of fatty muscle degeneration (below grade IV) and those who had been operated on for nerve decompression were excluded.
Results:
A female prevalence (78.8%) was observed, and a strong correlation was found between fatty muscle atrophy and plantar fasciitis in 21.2%, and ankle varices, in 16.8% of the patients.
Conclusion:
Fatty atrophy of the abductor digiti quinti muscle is strongly associated with neuropathic alterations of the first branch of the lateral plantar nerve. The present study showed a significant association between plantar fasciitis and ankle varices with grade IV atrophy of the abductor digiti quinti muscle.
... Compression of the FBLPN typically occurs in two locations. The first is between the abductor hallucis and quadratus plantae muscles where the nerve changes from a vertical to a horizontal position [30]. More distally, where the FBLPN passes anterior to the medial calcaneal tubercle, entrapment can occur as a result of a calcaneal enthesophyte or plantar fascia [31][32][33][34]. ...
... Heel pain due to entrapment of the FBLPN can be difficult to establish since it can occur in isolation or coexist with plantar fasciopathy [35][36][37][38]. Furthermore, atrophy of the abductor digiti minimi muscle can be an asymptomatic finding [30,[38][39][40]. Recently, Presley et al., [35] demonstrated that the FBLPN can be reliably visualized at the proximal abductor hallucis-quadratus plantae interval and a sonographically guided diagnostic injection at that site may help to establish the diagnosis of FBLPN entrapment (Fig. 8c). ...
Foot pain is a common orthopedic condition that can have an impact on health-related quality of life. The evaluation of plantar hindfoot pain begins with history and physical examination. Imaging modalities, standard radiographs, sonography, MR, CT are often utilized to clarify the diagnosis. The article is a detailed description of the sonographic evaluation of the plantar fascia and its disorders as well as the common etiologies in the differential diagnosis of plantar fasciopathy. © 2014 Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).
... Anatomically, Rondhuis and Huson provided strong evidence that this nerve also supplies sensation to the periosteum of the medial calcaneal tubercle. It was believed that the site of entrapment is between the deep fascia of abductor hallucis muscle and the mediocaudal margin of the medial head of the quadratus plantae muscle [5]. ...
... The incisional approach was modified by Baxter and Pfeffer to an oblique vertical incision over the medial heel, this incision parallels the course of the nerve and is less likely to injure the medial calcaneal nerve [5]. The authors, similar to Sammarco and Helfery [27] did adopt this oblique incision successfully. ...
This is a case series study that was conducted to report the outcome of surgical release of the first branch of the lateral
plantar nerve in patients with chronic heel pain. Thirty-one patients with chronic heel pain underwent release of the first
branch of the lateral plantar nerve. The setting was a public university hospital and a public university-affiliated hospital
in the north of Jordan. Six patients were lost to follow-up. The average age of the remaining 25 patients was 43.8years.
The average duration of symptoms prior to surgery was 15months. Radiography showed spur in 14 cases. All patients had conservative
treatment for a minimum of 6months before surgery, and all had one or two local cortisone injection. The average length for
recovery was 3months. All patients, except for 2, reported fair to excellent results. Level of post-operative satisfaction
between fair and excellent was reported by 75% at 3months, 96% at 6months and 80% at 3–11years (average 8years). The diagnosis
of entrapment of the first branch of the lateral plantar nerve can be clinical and could be confirmed by nerve block. Heel
spurs should be removed when in very close proximity relation to the first branch of the lateral plantar nerve.
KeywordsHeel pain-Lateral plantar nerve
... The medial septae, a dorsal expansion of the medial border of the plantar fascia that separates the AH from the flexor digitorum brevis and quadratus plantae (flexor accessorius) (Fig.1), was considered the most important cause of entrapment neuropathy, beside the FR, in heel pain syndrome [5,8]. This was also the site described for a potential compression of the first branch of the LPN, the Baxter's Nerve (BN) [10]. ...
Background
The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle’s medial side and if so, do they have a regular path after emerging from TN.
Methods
The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon–McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT).
Results
The TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter’s nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p < 0.001).
Conclusions
In our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.
... (5,8) This was also the site described for a potential compression of the rst branch of the LPN, the Baxter's Nerve (BN). (10) Surgical treatment for TTS is reserved to whom does not respond to conservative measures.(2) However, the decision of how to operate is controversial. ...
Background
The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle’s medial side and if so, do they have a regular path after emerging from TN.
Methods
The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the (TN) was registered and the measurements were performed according to the Dellon–McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT).
Results
The TN divided proximal to DML in 87.5% and distal in none of the feet. The Baxter’s nerve (BN) originated proximally in 50% and distally in 12.5% of the cases. The correlation between specimens’ height and DML’s length was weak (ρ: 0.336). There was a significant correlation between the length of DML and the distance from the center of the medial malleolus to the lateral plantar (LPN) and medial plantar (MPN) nerves (ρ: 0.910 and 0.866, respectively, p < 0.01) but not to BN (ρ: 0.083; p value: 0.70).
Conclusions
In our sample the TN divides distal to DML in none of the cases. Therefore, a compression of the TN itself can be a more uncommon cause of heel pain. We also report a strong association between ankle size and the distribution of the MPN and LPN but not for BN.
... Baxter's neuropathy results from the entrapment of the inferior calcaneal nerve (first branch of the lateral plantar nerve). The nerve supplies the abductor digiti minimi muscle, calcaneal periosteum, long plantar ligament, and adjacent skin of the heel [80]. The nerve traverses between the abductor hallucis and quadratus plantae before taking an abrupt turn from medial to lateral direction under the medial calcaneal tuberosity (Fig. 14). ...
Purpose
This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies.
Methods
The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb
Results
The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. This leads to diverse clinical manifestations making them difficult to diagnose with traditional methods such as clinical examination and electrodiagnostic studies. Moreover, some of these may mimic other common conditions such as disc pain or fibromyalgia leading to delay in diagnosis and increasing morbidity. Addition of imaging improves the diagnostic accuracy and also help in correct treatment of these entities. Magnetic resonance imaging is very useful for deeply situated nerves in pelvis and thigh while ultrasound is well validated for superficial entrapment neuropathies.
Conclusion
The rapidly changing concepts in these conditions accompanied by the advances in imaging has made it essential for a clinical radiologist to be well-informed with the current best practices.
... As for other ramification models, the lateral plantar nerve gives off medial calcaneal branch(es) in 25% of cases followed by medial plantar nerve present in 8% of cases. Some authors finds medial calcaneal branch(es) originating only from the tibial nerve [35], others claim it goes off only form the tibial or lateral plantar nerve [14,17,21,23], yet another reports it originates only from the tibial or medial plantar nerve [4]. ...
BACKGROUND: The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment. MATERIALS AND METHODS: Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analysed in reference to the amount and their respective nerves of origin. RESULTS: In 77% of cases, tibial nerve bifurcation occurred below the tip of the medial malleolus with the average distance of 5.9 mm and in 48% of cases above the posterior superior tip of the calcaneal tuberosity with the average distance of 2.7 mm. In 73% of cases medial calcaneal branches occurred as a single branch originating from the tibial nerve (60%). The average distance of the first, second and third medial calcaneal branch was accordingly 9.3 mm above, 9.5 mm below and 11.6 mm below the tip of the medial malleolus and 17.7 mm above, 1.6 mm below and 4 mm below the posterior superior tip of the calcaneal tuberosity. CONCLUSIONS: As the tibial nerve and its branches present a huge variability in the medial ankle area, in order to prevent the iatrogenic injuries, the preoperative or intraoperative ultrasound assessment (sonosurgery) of its localisation should be introduced into the clinic.
... All of those structures were embedded in a variable echoic fatty tissue. Plantarly to the MIS, one can recognize the most dorsal structure, the lateral plantar nerve in the short axis also as an honey-hive echoic structure with a mean width of 0.3 cm (± 0.04 cm); the lateral plantar vascular bundle as hypoechoic circular structures and the "Baxter nerve" (in literature also known as the first branch of the lateral plantar nerve, anterior branch of the calcaneal nerve or the inferior calcaneal nerve [4,16,35]) in the short axis as an hypoechoic, "monofascicular" nerve with a mean width of 0.15 cm (± 0.05 cm) (Fig. 4). ...
Background
The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments.
Methods and results
The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet.
Conclusion
The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.
... According to other studies, the entrapment site of the BN, its motor branch for the abductor digiti minimi muscle and its sensitive branch (the latter is also known as the calcaneal branch of the inferior calcaneal nerve) for the periosteum of the medial calcaneal tuberosity can be found in two welldefined sites bounded by osteofibrous structures [2,24,38]. The proximal site at the lower calcaneal tube in the distal tarsal tunnel [16], where the nerve runs in between the abductor hallucis fascia and the quadratus plantae muscle [14,20,28] and the distal site at the medial calcaneal tuberosity (e.g. ...
Purpose
Neuropathy of the Baxter nerve (BN) seems to be the first cause of the heel pain syndrome (HPS) of neurological origin.
Methods
41 alcohol–glycerol embalmed feet were dissected. We documented the pattern of the branches of the tibial nerve (TN) and describe all relevant osteofibrous structures. Measurements for the TN branches were related to the Dellon–McKinnon malleolar-calcaneal line also called DM line (DML) for the proximal TT and the Heimkes Triangle for the distal TT. Additionally, we performed an ultrasound-guided injection procedure of the BN and provide an algorithm for clinical usage.
Results
The division of the TN was 16.4 mm proximal to the DML. The BN branches off 20 mm above the DML center or 30 mm distally to it. In most of the cases, the medial calcaneal branch (MCB) originated from the TN proximal to the bifurcation. Possible entrapment spots for the medial and lateral plantar nerve (MPN, LPN), the BN and the MCB are found within a circle of 5 mm radius with a probability of 80%, 83%, and 84%, respectively. In ten out of ten feet, the US-guided injection was precisely allocated around the BN.
Conclusions
Our detailed mapping of the TN branches and their osteofibrous tubes at the TT might be of importance for foot and ankle surgeons during minimally invasive procedures in HPS such as ultrasound-guided ankle and foot decompression surgery (UGAFDS).
... 11 Baxter's nerve is a mixed nerve that originates from lateral plantar nerve beneath the deep fascia of abductor hallucis muscle, carrying sensation from the calcaneal periosteum and supplying the abductor digiti mini muscle. 12,13 Baxter's nerve has two sites where it can become entrapped; the first is between the deep fascia beneath abductor hallucis muscle and the medial border of quadratus plantae; the second is anterior to the medial calcaneal tuberosity where it can be compressed by a calcaneal spur or thickened plantar fascia. 13 Nerve entrapment produces symptoms that are indistin- guishable from the symptoms of plantar fascitis and often is overlooked from other causes of heel pain, and weakness of abductor digiti minimi is difficult to detect clinically and electrodiagnostic studies are inconclusive in heel pain. ...
... 11 Baxter's nerve is a mixed nerve that originates from lateral plantar nerve beneath the deep fascia of abductor hallucis muscle, carrying sensation from the calcaneal periosteum and supplying the abductor digiti mini muscle. 12,13 Baxter's nerve has two sites where it can become entrapped; the first is between the deep fascia beneath abductor hallucis muscle and the medial border of quadratus plantae; the second is anterior to the medial calcaneal tuberosity where it can be compressed by a calcaneal spur or thickened plantar fascia. 13 Nerve entrapment produces symptoms that are indistinguishable from the symptoms of plantar fascitis and often is overlooked from other causes of heel pain, and weakness of abductor digiti minimi is difficult to detect clinically and electrodiagnostic studies are inconclusive in heel pain. ...
Background
Chronic recalcitrant heel pain is a commonly observed painful condition that often frustrates both the patient and the treating physician.
Methods
Twenty-four patients (14 men and 10 women) with chronic resistant heel pain were included in this study. All patients were locally injected by platelet rich plasma (PRP), and according to the results of injection, patients were divided into two groups: group A patients had significant improvement and group B had no specific progress. Group B patients underwent surgical decompression of the first branch of lateral planter nerve “Baxter’s nerve” with release of medial planter fascia and calcaneal drilling.
Results
PRP injection showed 58.3% satisfactory results with improvement of the Plantar Fasciitis Pain/Disability Scale (PFPS) from 79.15 (range, 71.8 to 83.8) to 22.3 (range, 15.4 to 25.5) and improvement of the Foot Function Index (FFI) from 160.42 (range, 155 to 166) to 30.4 (range, 23 to 38). PRP injection failed to provide satisfactory results in 10 patients (41.7%). This group of patients showed 90% satisfactory outcome after surgical interference with improvement of the PFPS from 60.8 (range, 55.4 to 63.8) to 21.8 (range, 16.4 to 25.6) and improvement of the FFI from 143.4 (range, 122 to 155) to 38 (range, 31 to 52).
Conclusions
Conservative methods can provide satisfactory outcome in up to 90% in the treatment of chronic heel pain. Resistant cases can be managed by a local injection of PRP; surgical management should be reserved for patients who do not respond to PRP injection. Surgical management requires release of Baxter’s nerve and medial planter fascia, and calcaneal drilling.
... There is a significant association between ADM atrophy and calcaneal spurs, with an odds ratio of 3.6 after multivariate logistic regression (Chundru et al. 2008). Branchinng off from the inferior calcaneal nerve there is also a calcaneal branch which supplies the calcaneal tuberosity and this has also been shown to be susceptible to PCS compression and may result in heel pain (Rondhuis & Huson, 1986;Louisia & Masquelet, 1999). Inflammation in the soft tissue surrounding the spur may be important in determining whether the spur is painful or not (Li & Muehleman, 2007). ...
The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.
... Despite the wide range of reported functions, no consensus has been reached on the significance of this muscle. Clinically, the quadratus plantae has been implicated in heel pain [8], and may contribute to pathologies that feature weakening of the intrinsic foot muscles, such as in Charcot-Marie-Tooth disease [9]. ...
Background
The human quadratus plantae muscle has been attributed a variety of functions, however no consensus has been reached on its significance to foot functioning. The architecture of the human quadratus plantae consists of an evolutionarily conserved lateral head, and a medial head thought to be unique to Man. Surveys of human anatomy have demonstrated the absence of either the medial or lateral head in 20% of the population, which may have implications for foot functioning if each muscle head performs a discrete function.
Methods
We investigated the quadratus plantae from eleven formalin-embalmed specimens with a mean age of 84 ± 9 years. Immunohistochemical methods were used to determine the percentage of Type I and Type II muscle fibers in the medial and lateral heads of the quadratus plantae from these specimens.
Results
Results showed striking homogeneity in fiber type composition within an individual, with an average difference in Type I fiber content of 4.1% between lateral and medial heads. Between individuals, however, the ratio of fiber types within the quadratus plantae was highly variable, with Type I fiber percentages ranging from 19.1% to 91.6% in the lateral head, and 20.4% to 97.0% within the medial head.
Conclusions
Our finding of similar fiber type composition of lateral and medial heads within an individual supports the hypothesis that the two heads have a singular function.
Keywords
Muscle fiber Myosin heavy chain Foot Intrinsic foot muscle Elderly Quadratus plantae
... 73) and peroneal (fibular, see Chap. 67) nerves, and the tibial nerve (TN) continues down through the deep posterior compartment of the leg The TN divides within or occasionally near the tarsal tunnel (TT) into the lateral plantar (LPN), medial plantar (MPN), and medial calcaneal (MCN) nerves The MCN runs postero-inferiorly, often through the flexor retinaculum, to end in the skin of the heel and the fat pad over the calcaneus [22], with an overall direction from deep to superficial [5, 9] The MCN and its branches are usually superficial to the abductor hallucis muscle (AbH) [5], and it does not enter the plantar vault or the deep structures of the foot [22, 23]; compared to the ICN, the MCN is posterior, more superficial, and thicker [22] The MCN usually divides into 2 major branches, an anterior one to the proximal abductor hallucis and a posterior one to the superficial soft tissues [3, 5] A relatively constant (15/15) terminal branch innervates the superficial inferior heel and is often called the cutaneous plantar nerve [5] Sensory distribution Medial aspect of the Achilles tendon, flexor retinaculum, medial heel, medial sole, and plantar fat pad [22] Motor innervation Abductor hallucis muscle (AbH) [5, 22]: from the distal flexor retinaculum, medial calcaneal tubercle, and the plantar aponeurosis to the base of the great toe; it flexes and abducts the great toe; the AbH is also innervated by the MPN and sometimes by a branch of the ICN [2, 24] Anatomic variability MCN nerve of origin: from the PTN in 100 % [25], 81 % (13/16) [22], 73 % (88/120) [9], 73 % (8/11) [26] From the LPN in 27 % (32/120) [9], 27 % (3/11) [26], 20 % (3/15) [5], 19 % (3/16) [22], 10 % (2/20) [24]; when the MCN is a branch of the LPN, it crosses deep to the AbH to appear from its inferior border distal to the flexor retinaculum [9] From the MPN in 46 % (39/85 operative notes) [27], 15 % (3/20) [24] MCN level of origin: proximal to the TT in 40 % (8/20), one of two branches proximal to the TT in 25 % (5/20), within the TT in 35 % (7/20) [28]; up to 5 cm [22] or 10 cm [5, 24] proximal to the PTN bifurcation Number of MCN terminal branches: one in 13 % (2/15) [5] – 36 % (31/85) [27], two in 41 % (35–85) [27] – 60 % (9/15) [5], three in 13 % (2/15) [5] – 19 % (16/85) [27], and four in 4 % (3/85) [27] – 13 % (2/15) [5] Relationship to the AbH: superficial to the AbH when MCN is a branch of the PTN; deep to the AbH when MCN is a branch of the LPN (Ghosh, 2013). Potential sites of compression of tibial nerve branches in foot: a cadaveric and imaging study} Other relevant structures ...
Heel pain is common in clinical practice. Medial calcaneal nerve entrapment in the superficial posterior foot can mimic more common conditions such as plantar fasciitis or pain referred from the back or proximal leg, which can present with similar pain but are treated differently. A patient with a previous diagnosis of “plantar fasciitis” who has failed all conservative management may have an entrapment neuropathy of the medial calcaneal nerve and may respond to nerve injections and neurolytic techniques.
... Despite the wide range of reported functions, no consensus has been reached on the significance of this muscle. Clinically, the quadratus plantae has been implicated in heel pain [8], and may contribute to pathologies that feature weakening of the intrinsic foot muscles, such as in Charcot-Marie-Tooth disease [9]. ...
The human quadratus plantae muscle has been attributed a variety of functions, however no consensus has been reached on its significance to foot functioning. The architecture of the human quadratus plantae consists of an evolutionarily conserved lateral head, and a medial head thought to be unique to Man. Surveys of human anatomy have demonstrated the absence of either the medial or lateral head in 20% of the population, which may have implications for foot functioning if each muscle head performs a discrete function.
We investigated the quadratus plantae from eleven formalin-embalmed specimens with a mean age of 84 ± 9 years. Immunohistochemical methods were used to determine the percentage of Type I and Type II muscle fibers in the medial and lateral heads of the quadratus plantae from these specimens.
Results showed striking homogeneity in fiber type composition within an individual, with an average difference in Type I fiber content of 4.1% between lateral and medial heads. Between individuals, however, the ratio of fiber types within the quadratus plantae was highly variable, with Type I fiber percentages ranging from 19.1% to 91.6% in the lateral head, and 20.4% to 97.0% within the medial head.
Our finding of similar fiber type composition of lateral and medial heads within an individual supports the hypothesis that the two heads have a singular function.
... It travels superficial to the quadratus plantae (QP) muscle along the medial aspect of the calcaneus, providing motor function to the QP, FDB, and abductor digiti quinti (ADQ) muscles, as well as sensation to the lateral plantar skin, calcaneal periosteum, and long plantar ligament. 48 The two potential points of compression are the deep margin of the abductor hallucis muscle and the point at which the nerve passes anterior to the medial calcaneal tuberosity 49 (Figure 2). Pain is felt approximately 4 to 5 cm anterior to the posterior aspect of the heel or just distal to the medial calcaneal tuberosity at the junction of the glabrous and nonglabrous skin. ...
Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution.
... In 1986, Rondhuis and Huson31
demonstrated, with strong evidence, that this branch was not purely motor, but rather,
mixed, with a sensory component to innervate the periosteum of the medial portion of the
calcaneus. The constancy of this sensory ramification to the periosteum was proven both by
Davis et al.21 and
Louisia et al.22 and by
Govsa et al.27 ...
Determine, through dissection in fresh cadavers, the topographic anatomy of the tibial nerve and its branches at the ankle, in relation to the tarsal tunnel.
Bilateral dissections were performed on 26 fresh cadavers and the locations of the tibial nerve bifurcation and its branches were measured in millimeters. For the calcaneal branches, the amount and their respective nerves of origin were also analyzed.
The tibial nerve bifurcation occurred under the tunnel in 88% of the cases and proximally in 12%. As for the calcaneal branches, the medial presented with one (58%), two (34%) and three (8%) branches, with the most common source occurring in the tibial nerve (90%) and the lower with a single branch per leg and lateral plantar nerve as the most common origin (70%). Level of Evidence, V Expert opinion .
... Rondhuis and Huson described the sensory fibers of the ICN especially in its branch to the periosteum of the anterior tubercle of the calcaneus and related the heel pain to entrapment of these fibers. 11 We recommended the RFNA procedure to the patients only if they benefited from the trial injection. We believe that the trial injection increases the success rate of the procedure and helps the physician better understand who will respond to RFNA. ...
Chronic plantar heel pain is one of the most painful foot conditions and is generally associated with plantar fasciitis. This study reports 2-year follow-up results of radiofrequency nerve ablation (RFNA) of the calcaneal branches of the inferior calcaneal nerve in patients with chronic heel pain associated with plantar fasciitis.
After receiving approval from the institutional review board, we prospectively evaluated the results of the RFNA of the calcaneal branches of the inferior calcaneal nerve on 35 feet in 29 patients with plantar heel pain between 2008 and 2011. All of the patients who were treated had been complaining of heel pain for more than 6 months and had failed conservative treatment. All of the patients were evaluated (quantitatively) using the average 10-point Visual Analog Scale (VAS) before treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. We also evaluated 26 feet in 20 patients with American Orthopaedic Foot and Ankle Society scale (AOFAS) scores before the treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure.
The average VAS score of the feet was 9.2 ± 1.9 before treatment, 0.5 ± 1.3 at 1 month after the procedure, 1.5 ± 2.1 at 1-year follow-up, and 1.3 ± 1.8 at 2-year follow-up (P < .001). The average AOFAS scores of the patients were 66.9 ± 8.1 (range, 44-80) before treatment, 95.2 ± 6.1 (range, 77-100) at 1 month after the procedure, 93 ± 7.5 (range, 71-100) at the 1-year follow-up, and 93.3 ± 7.9 (range, 69-100) at the 2-year follow-up. At the 1- and 2-year follow-up, 85.7% of the patients rated their treatment as very successful or successful.
These findings suggest that RFNA of the calcaneal branches of the inferior calcaneal nerve was an effective pain treatment option for chronic heel pain associated with plantar fasciitis that did not respond to other conservative treatment options.
Level IV, retrospective case series.
... This mixed nerve innervates the quadratus plantae, FDB, and abductor digiti quinti (ADQ); it also supplies sensation to the calcaneal periosteum, the long plantar ligament, and the lateral plantar skin. 17 Compression occurs deep to the abductor hallucis where the nerve turns and courses laterally. Patients complain of medial heel pain four to five cm anterior to the posterior aspect of the heel, or just distal to the medial calcaneal tuberosity. ...
Entrapment neuropathies of the foot and ankle are common clinical disorders that develop when the nerves around the foot and ankle are compressed due to a variety of causes like edema, inflammation of the surrounding tissues, bony prominences, space-occupying lesions, trauma, etc. Diabetes mellitus is also responsible for the etiology. The common sides for compression are the posterior tarsal tunnel for the tibial nerve, distal tarsal tunnel for the inferior calcaneal nerve, medial plantar tunnel and the knot of Henry for the medial plantar nerve, lateral plantar tunnel for the lateral plantar nerve, abductor hallucis muscle’s fascia and the calcaneus for the medial calcaneal nerve, anterior tarsal tunnel for the deep peroneal nerve, deep crural fascia between the peroneal muscles for the superficial peroneal nerve, intermetatarsal area of the third and the fourth metatarsals for the interdigital nerve, superficial sural aponeurosis for the sural nerve, and the biceps femoris muscle’s tendon for the lateral sural cutaneous nerve. For the clinical examination, applying gentle pressure over the nerve’s course and the common entrapped sides is essential apart from the special provocative tests. Injecting local anesthetics to the determined entrapped side will also be helpful in the clinical diagnosis. Ultrasound will show the nerve’s course and will determine the edema and the entrapment. For the space-occupying soft tissue lesions, magnetic resonance imaging will be helpful.
In this chapter, the author offers an in-depth analysis of the innervation of the skeleton. Basic information is provided on the importance of the peripheral nervous system (NS) (PNS) vis-a-vis the innervation of the appendicular bony structures. The somatic and autonomic innervations of the skeleton are reviewed. The regulation of bone homeostasis by the PNS is revisited. There is a deep analysis of the bone marrow infrastructure, including the “bone marrow niche.” The diabetic autonomic neuropathy and the impact on the bone marrow are reviewed. The role of the PNS on bone growth, fracture healing, and alterations of bone metabolism is also discussed. The last section of the chapter offers description of the common peripheral neuropathies encountered in patients with Charcot neuroarthropathies. MR images of some pathologies are provided.
Considerable variations have been reported regarding the branching pattern of tibial nerve (TN) close to its termination in foot. In order to comprehend the clinical anatomy of heel pain awareness of all the possible variations in relation to terminal branching pattern of TN (close to the tarsal tunnel) is essential. The present study was conducted to undertake a comprehensive review of the variations in TN branches in foot with particular emphasis on the implications for sensory distribution of these branches. Articles were searched in major online indexed databases using relevant key words. The pattern of termination of TN was noted as either trifurcation or bifurcation. Bifurcation pattern was more commonly observed and is associated with the medial calcaneal nerve (MCN) either arising high or low relative to the tarsal tunnel. The most commonly noted type of bifurcation was proximal to malleolar-calcaneal axis but within the tarsal tunnel. Across all five types of bifurcation reported in literature, the termination points of TN ranged from 3 cm proximal to 3 cm distal to malleolar-calcaneal axis and, therefore, the area beyond this region can be considered as safe zone for performing invasive procedures. MCN showed considerable variations in its origin both in trifurcation and bifurcation pattern pertaining to number of branches (one/two/three) at the point of origin. The origin of inferior calcaneal nerve was observed to be relativelyless variable as it mostly arose as a branch of lateral plantar nerve and sometimes as a direct branch from TN before termination. The frequent variation of MCN in the tarsal tunnel should be kept in mind while undertaking decompression measures in medial ankle region.
Significant volumes of literature are devoted to both acute and chronic overuse injuries common to track and field athletes. There is, however, a paucity of information regarding nerve injuries despite their high prevalence. Injuries are often thought to be a result of the athlete’s anatomy, the sport-specific biomechanics, and the training surface. This chapter is devoted to discussing the clinical presentation, diagnostic techniques, nonoperative, and operative managements for the following nerve injuries: Morton’s neuroma, superficial peroneal nerve entrapment, sural nerve entrapment, tarsal tunnel syndrome, and Baxter’s Neuropathy.
Muscle injuries are the most common injuries in professional athletes forced to high-intensity sprinting efforts. Due to a high recurrence rate and possible consequences for elite athletes, it is one of the most challenging tasks for a sports medicine team to prepare a professional athlete to return to performance. This results in an ongoing search for new treatments to improve and accelerate muscle healing. In this chapter, we describe the principle of muscle healing and discuss the contemporary biological therapies with the available scientific evidence on their efficacy and safety.
Acute and chronic hamstring injuries are common in athletics. Acute injuries account for 17.1% of all injuries. Chronic injuries (proximal hamstring tendinopathy) are seen less frequently, however, but true incidences are unknown. Acute injuries occur at the (from most frequent to less frequent) musculotendinous junction (MTJ), the intramuscular tendon and the free tendons (partial- or full-thickness injury). Proximal hamstring tendinopathy occurs in the proximal hamstring free tendons. Diagnosis of these injuries is mostly clinical but can be supported by imaging such as magnetic resonance imaging or ultrasound. Treatment for partial-thickness MTJ acute hamstring injuries is informed by 14 RCTs. For proximal hamstring tendinopathy and partial- or full-thickness free tendon injuries, there is little evidence to guide treatment. Cornerstone of treatment is physiotherapy-based interventions with progressive (eccentric) loading and activity modification, combined with expectation management. Surgery is usually reserved for full-thickness free tendon injuries. Other treatments such as platelet-rich plasma injections, corticosteroid injections and non-steroidal anti-inflammatory medication have little supportive evidence and should be avoided.
Stress fractures of the foot and ankle in athletes represent a challenging problem for the orthopedic surgeon, as they are associated with high rates of reoccurrence and long-lasting absence from daily sport activities. In elite sports, stress fractures most commonly occur in the lower extremity.
Ankle sprains and instability are among the most common musculoskeletal disorders in track and field athletes. They are associated with pain, loss of function, inability to sport, and loss of performance. Adequate diagnosis and treatment of ankle sprains will minimize the risk of long-term consequences including chronic instability and cartilage degeneration. The current chapter serves as a comprehensive overview of the most important aspects of diagnosis and treatment of lateral ankle sprains and instability with a special consideration for this type of injury in track and field athletes.
Flexor digitorum accessorius (quadratus plantae) is a muscle of second layer of the sole of the foot. Though it is not a very important muscle in terms of movements or stability of foot, it could pose problems when it presents variations. We observed a novel, accessory slip of flexor digitorum accessorius. The slip arose from the fascia covering abductor digiti minimi muscle and got inserted into the tendon of the flexor digitorum longus muscle. It was supplied by a branch from lateral plantar nerve. The proximal part of this accessory slip surrounded the lateral plantar nerve and vessels. Compression of lateral plantar nerve by this accessory slip might produce symptoms similar to that of tarsal tunnel syndrome and lead to misdiagnosis. The case could be of importance to foot and ankle surgeons and radiologists.
Plantar heel pain is a common disorder of the foot which involves multiple anatomic structures.
The anatomy of the innervation of the foot joints is described. Nerve blocks of the appropriate nerves are described. Heel pain, plantar fasciitis, is distinguished from foot joint pain. Baxter’s nerve and Joplin’s neuroma are discussed, and distinguished from foot joint pain. The technical approaches to partial denervation of the foot joints are described and illustrated. The results of foot denervation are presented.
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The lateral plantar nerve is a terminal branch of the tibial nerve, which innervates most of the foot's musculature, and also provides sensory innervation to the sole of the foot. In this present review we address various aspects of the lateral plantar nerve from its origin to its division, emphasizing those branches that, as a result of their anatomical disposition have been identified as causing compression syndrome. Furthermore, thorough knowledge and experience of anatomical variations are essential in procedures of the plantar region. Numerous studies have been carried out to accurately describe the path and relationship of the first branches of the lateral plantar nerve. Branches originating directly from the lateral plantar nerve are for the abductor digiti minimi and quadratus plantae muscles, in addition to a lateral cutaneous branch.Among these anatomical variations it is possible to find medial calcaneal branches, common trunk for medial calcaneal branches and abductor digiti minimi muscle, vascular branches for the plantar vessels, 2 or 3 branches for the quadrate plantae muscle, common trunk for the abductor digiti minimi muscle an quadratus plantae muscle,branch for the flexor digiti minimi brevis muscle, "anastomotic" branch for the medial plantar nerve and branch for long plantar ligament. Updated and absolute knowledge of the anatomy of the foot are necessary, particularly during those surgical procedures that require precision, with fewer invasive approaches and positive results.
Heel pain is a common reason for patients to visit a primary care provider, pain specialist, or podiatrist. Inferior calcaneal nerve entrapments in the deep posterior foot can mimic more common conditions such as plantar fasciitis or pain referred from the back or proximal leg, which present with similar pain but are treated differently. Understanding the presentation, anatomy, perpetuating factors, and treatment options is necessary for effective resolution of the pain.
Foot and Ankle Injection Therapies provides the student and practising podiatrist with all they need to understand when, how and what to inject. To support the clinician and student, the text covers: Changes in legislation The full range of injectable drugs available to the practitioner Essential information on nerve physiology, drug action, equipment, patient selection, injection techniques and many other topics. A Step-by-step guide to injection techniques Useful background information in introductory chapters DVD with video clips to supplement the text Foot and Ankle Injection Therapies is designed with a lie-flat binding for ease of reference in the clinic. It contains many photographs and clear colour line illustrations of the techniques and underlying anatomy. Introductory chapters give useful background information, and the accompanying CD contains video clips to supplement the text. Edited by two highly respected podiatric surgeons and with contributions from other experts, Foot and Ankle Injection Therapies is a book no student or practitioner will want to be without.
Nerve entrapment and resultant dysfunction in the foot may involve the posterior tibial nerve in the tarsal tunnel or any of its four branches. An understanding of the effect of other coexisting disease as well as the location and function of nerves about the foot and ankle is necessary for successful diagnosis and treatment. Clinical experience has demonstrated specific characteristics of the nerve entrapment syndromes of the foot and ankle and the loci of likely entrapment.
Shoulder replacement surgery is a reliable procedure that provides predictable results in patients with all types of glenohumeral arthritis. When performed by an experienced surgeon for the right indications, and with appropriate physical therapy, dramatic improvements in pain and function are seen in the majority of patients. With the recent availability of the reverse prosthesis, even patients with rotator cuff deficiency may have pain relief and restoration of shoulder function after reverse shoulder arthroplasty.
Rare distal compressions of lower limb nerves include tarsal tunnel syndrome, entrapment of the first branch of the lateral plantar and medial calcaneal nerves, interdigital neuroma, compression of the deep peroneal nerve on the dorsum of the foot, entrapment of the superficial peroneal and sural nerves. Nerve conduction and electromyographic studies are essential to evaluate these peripheral nerve injuries in order to differentiate focal lower extremity nerve entrapments from ischemic mononeuropathies, lumbar radiculopathies or plexopathies, and generalized peripheral neuropathies. This review summarizes the clinical and electrophysiological findings for each of these rare entrapment syndromes and provides the necessary clues to obtain a correct differential diagnosis with other more common causes of foot and ankle pain and paresthesias.
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