Branches Of Tibial Nerve Research Articles

PREVALENCE OF MEDIAL CALCANEAL NEUROPATHY,CAUSE HEEL PAIN IN GIRLS WHO WEARS HIGH HEELS

BACKGROUND :In this topic there is prevalence of calcanealneuropathy which causesPain in the plantar heel is a frequent issue that can be very uncomfortable chronic plantar heel pain has been linked to a number of neurological Etiology including entrapment neuropathy of the medial calcaneal nerve a branch of the posterior tibial nerve. One kind of tarsal tunnel syndrome is through to be medial calcaneal neuropathy.OBJECTIVE :The study was done to determine the prevalence of medial calcaneal neuropathy which causes heel pain.METHODS:The study was an observational study which include 357 girls in Karad which includes rural and urban area. Consent forms was explained and signed by the participants. The test performed was specific to neuropathy Tinel’s sign. RESULT :on the basis of the study 84.5 girls has pain and 15.5 girls is not having pain in both urban and rural area .CONCLUSION :The study concluded that there is a significant portion of individuals with persistent plantar heel pain have medial calcaneal neuropathy.

Is the Silfverskiöld Test a valid tool for evaluating calf muscles spastic overactivity in patients with stroke? A retrospective observational study.

Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity. The aim of this study was to investigate the Silfverskiöld Test validity for evaluating spastic equinus (plantar flexed) foot (i.e., differentiation between gastrocnemius and soleus muscle overactivity) by checking its outcome against those of selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. The design of the study was retrospective observational. The study was set in a university hospital. Sixty-seven adult stroke patients with spastic equinus (plantar flexed) foot. Each patient underwent selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. All patients were evaluated before diagnostic nerve block by means of the Silfverskiöld Test which was considered positive when ankle joint passive dorsiflexion was greater with the knee flexed than extended. Furthermore, they were assessed before and after nerve block by means of the modified Ashworth Scale and the Tardieu Scale. Our sample included 41 males and 26 females (mean age 57.6 years) suffering from spastic equinus (plantar flexed) foot due to chronic stroke (mean time from onset 2.4 years). Forty-eight patients out of 67 presented with positive Silfverskiöld Test. The χ2 test showed no association between the Silfverskiöld Test and spastic overactivity of the gastrocnemius (P=0.253), soleus (P=0.605) and tibialis posterior (P=0.462) muscles as evaluated by serial selective diagnostic block of the tibial nerve motor branches. Our findings do not support the Silfverskiöld Test as a valid tool for evaluating spastic equinus (plantar flexed) foot to differentiate between gastrocnemius, soleus and tibialis posterior spastic muscle overactivity in adult patients with stroke. The choice for an appropriate management of spastic equinus (plantar flexed) foot in adults with stroke should not be mainly defined on the base of Silfverskiöld Test.

The Effectiveness of Neural Mobilization in Patients with Tarsal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Background: Tarsal Tunnel Syndrome (TTS) is a compression neuropathy, occurring when the distal branches of the posterior tibial nerve become entrapped within the tarsal tunnel, with no definitive evidence for its conservative management. Neural mobilization, a therapeutic approach involving joint and peripheral nerve movement, seeks to restore the nervous system’s homeostasis. There is currently insufficient evidence to determine the efficacy of neural mobilization. Objectives: Analysis of data from randomized controlled trials (RCTs) examining the efficacy of neural mobilization techniques (NMT) in TTS patients. Methods: A thorough search was carried out from inception until September 2024 utilizing four scientific databases (PubMed, Scopus, EMBASE, and Physiotherapy Evidence Database-PEDro) and the Google Scholar search engine. Relevant English-language research was retrieved, assessed, and given an independent methodological quality rating (PEDro scale). Meta-analyses were conducted for select outcomes, where possible. Results: 745 studies were eliminated from the total of 748 because they were duplicates or did not fit the inclusion criteria. Three RCTs were finally included, rated on average with 6.67/10 for methodological quality (PEDro scale). NMT led to a highly significant improvement of the nerve’s physiological sensitivity (p0.001), measured with the Tinel’s sign, based on evidence of high methodological quality (7.5/10) and no heterogeneity. NMT did not lead to a significant diminution of pain intensity (p=0.21) based on evidence of moderate methodological quality (6.67/10). Significant improvements in favour of NMT, however measured in one out of three studies, were identified for 2-point discrimination and light touch, the Neuropathic Pain Questionnaire, and the Functional Foot Index (p0.05). No adverse events were reported. All studies measured change immediately post-treatment. Conclusion: NMT significantly improved the tibial nerve’s mechanosensitivity. Moreover, as part of the treatment of patients with TTS, high-quality RCTs are necessary to examine the short and longer-term effects of NMT.

Efficacy of distal peripheral nerve blocks in lumbar radicular pain: A randomized placebo-controlled triple-blinded study

Context: Inflamed nerve root leads to mechano-sensitization and upregulation of sodium channels in nerve endings far distal to the site of inflammation, leading to tenderness of these nerve endings. Due to pseudounipolar nature, the blockade of sodium channels at peripheral nerve endings leads to relief in radicular pain. Aims: The aim of this study was to assess the efficacy of bupivacaine in improving pain and straight leg raising test (SLRT), 30 min after injection around tender nerves near the ankle, in patients with unilateral radicular pain. Design: This was a randomized placebo-controlled triple-blinded study. Methods: One hundred patients of single-level lumbar disc prolapse and unilateral radicular pain were randomized into two equal groups. Three nerves (sural nerve, lateral branch of deep peroneal nerve and posterior tibial nerve) were assessed for tenderness around the ankle. Bupivacaine (0.5%) was injected around each tender nerve in the case group whereas equal volume of normal saline was injected in the control group around each tender nerve. Pain Numerical Rating Scale (NRS) and SLRT were checked before and 30 min postinjection. A proportion of patients achieving minimum clinically important difference (MCID) of NRS ≤4 and MCID of SLRT ≥30° were compared. Results: A mean decrease in NRS among cases was from 8.06 ± 1.236 to 3.90 ± 2.013 (P < 0.001) with 78% achieving MCID. A mean decrease in NRS in the control group was from 7.88 ± 1.023 to 7.66 ± 1.171 (P = 0.084), and only 2% of patients achieved MCID. There was a statistically significant improvement in SLR in the case group (40.90°–60.90°, P < 0.001), and 54% showed a clinically significant improvement by crossing MCID threshold. The control group showed nonsignificant improvement in SLRT (38.10°–39.10°, P = 0.351), and only 2% achieved MCID. Conclusions: In single-level lumbar disc prolapse with unilateral radicular pain, injection of bupivacaine 0.5% (a sodium channel blocker) around tender nerves near the ankle provides clinically significant relief in pain and SLRT at 30 min when compared to placebo.

Anatomical study of the motor branches of the tibial nerve and incision design for hyperselective neurectomy.

Selective tibial neurotomy (STN) is a surgical procedure for treating spastic equinovarus foot. Hyperselective neurectomy (HSN) of tibial nerve is a modified STN procedure, which was rarely discussed. This study aimed to describe the branching patterns of the tibial nerve and propose an optimal surgical incision of HSN for treatment of spastic equinovarus foot. Sixteen lower limbs were dissected to determine the various branching patterns of the tibial nerve and categorized according to these branching patterns. The mean distances from the nerve entry points to the tip of femur's medial epicondyle were measured, as well as their percentage to the overall length of the leg. The surgical incision was designed according to the range of these nerve entry points. The tibial nerve sent out proximal and distal motor branches based on their position relative to the soleus muscle's tendinous arch. For proximal motor branches, the branches innervating the medial gastrocnemius, lateral gastrocnemius and proximal soleus were categorized into types I (9/16), II (5/16) and III (2/16). Measurements from the medial epicondyle to the nerve entry points into the medial gastrocnemius, lateral gastrocnemius and proximal soleus ranged from 14 to 33mm (4-9% of leg length), 22-45mm (6-12%) and 35-81mm (10-22%), respectively. Distal motor branches including the distal soleus, posterior tibialis, flexor digitorum longus and flexor hallucis longus, were classified as types A (8/14), B (4/14) and C (2/14), with the distances from their respective terminal points to the medial epicondyle were 67-137mm (19-39%), 74-125mm (20-35%), 116-243mm (33-69%) and 125-272mm (35-77%). The motor branches of tibial nerve were classified into two groups and each subdivided into three types. Detailed location parameters may serve as an anatomical basis for designing incision of HSN.

Morphometric assessment of tibial nerve and its branches around the ankle.

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.

Management Of Spastic Equinovarus Foot in Children with Cerebral Palsy: An Evaluation of Anatomical Landmarks for Selective Nerve Blocks of the Tibial Nerve Motor Branches

To define the anatomical landmarks of tibial motor nerve branches for selective motor nerve blocks of the gastrocnemii, soleus and tibialis posterior muscles in the management of spastic equinovarus foot. Observational study. Twenty-four children with cerebral palsy with spastic equinovarus foot. Considering the affected leg length, motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles were tracked using ultrasonography, and located in the space (vertical, horizontal, deep) according to the position of fibular head (proximal/distal) and a virtual line from the middle of popliteal fossa to the Achilles tendon insertion (medial/lateral). Location of motor branches was defined as percentage of the affected leg length. Mean coordinates were: for the gastrocnemius medialis 2.5 ± 1.2% vertical (proximal), 1.0 ± 0.7% horizontal (medial), 1.5 ± 0.4% deep; for the gastrocnemius lateralis 2.3 ± 1.4% vertical (proximal), 1.1 ± 0.9% horizontal (lateral), 1.6 ± 0.4% deep; for the soleus 2.1 ± 0.9% vertical (distal), 0.9 ± 0.7% horizontal (lateral), 2.2 ± 0.6% deep; for the tibialis posterior 2.6 ± 1.2% vertical (distal), 1.3 ± 1.1% horizontal (lateral), 3.0 ± 0.7% deep. These findings may help the identification of tibial motor nerve branches to perform selective nerve blocks in patients with cerebral palsy with spastic equinovarus foot.

Correlation between nerve conduction changes and BETA-2 microglobulin concentration in chronic kidney disease patients on hemodialysis combined with hemodiafiltration online.

This study aimed to investigate the correlation between beta-2 microglobulin (B2M) concentration and some nerve conduction indices and evaluate the changes in some nerve conduction indices after treatment with hemodialysis (HD) combined with hemodiafiltration online in end-stage renal disease patients. From July 2021 to July 2022, a cross-sectional study was conducted on 80 end-stage renal disease patients on HD at Can Tho General Hospital, Viet Nam. All the patients had B2M testing and nerve conduction measurements. Patients with nerve conduction disorders were treated and remeasured after 6 months to evaluate the treatment results. At baseline, there was a moderate negative correlation between B2M and the tibial nerve and motor branch of the ulnar conduction velocity (V) (r = -0.305 and -0.315, P < .05). There was a moderate positive correlation between B2M and motor latency of the tibial and peroneal nerve (r = 0.434 and 0.440, P < .05). After 6 months of using the combination of HD and hemodiafiltration online, the V (31.3 ± 7.96 up to 44.88 ± 9.67 m/s) and the amplitude (A) (1.71 ± 1.16 up to 2.61 ± 1.51 mV) of the peroneal nerve increased, the motor latency decreased (8.21 ± 2.65 down to 5.23 ± 3.58 ms). With the tibial nerve, motor conduction V increased from 30.53 ± 8.05 m/s to 43.56 ± 8.99 m/s and the A increased from 5.04 ± 3.16 mV to 7.75 ± 4.45 mV. With the ulnar nerve, the A increased, and motor latency decreased after 6 months. The nerve conduction indices also improved significantly in the median nerve.

Comparative Neuroanatomy of the Mechanosensory Subgenual Organ Complex in the Peruvian Stick Insect, Oreophoetes peruana

The subgenual organ complex in the leg of Polyneoptera (Insecta) consists of several chordotonal organs specialized to detect mechanical stimuli from substrate vibrations and airborne sound. In stick insects (Phasmatodea), the subgenual organ complex contains the subgenual organ and the distal organ located distally to the subgenual organ. The subgenual organ is a highly sensitive detector for substrate vibrations. The distal organ has a characteristic linear organization of sensilla and likely also responds to substrate vibrations. Despite its unique combination of sensory organs, the neuroanatomy of the subgenual organ complex of stick insects has been investigated for only very few species so far. Phylogenomic analysis has established for Phasmatodea the early branching of the sister groups Oriophasmata, the Old World phasmids, and Occidophasmata, the New World phasmids. The species studied for the sensory neuroanatomy, including the Indian stick insect Carausius morosus, belong to the Old World stick insects. Here, the neuroanatomy of the subgenual organ complex is presented for a first species of the New World stick insects, the Peruvian stick insect Oreophoetes peruana. To document the sensory organs in the subgenual organ complex and their innervation pattern, and to compare these between females and males of this species and also to the Old World stick insects, axonal tracing is used. This study documents the same sensory organs for O. peruana, subgenual organ and distal organ, as in other stick insects. Between the sexes of this species, there are no notable differences in the neuroanatomy of their sensory organs. The innervation pattern of tibial nerve branches in O. peruana is identical to other stick insect species, although the innervation pattern of the subgenual organ by a single tibial nerve branch is simpler. The shared organization of the organs in the subgenual organ complex in both groups of Neophasmatodea (Old World and New World stick insects) indicates the sensory importance of the subgenual organ but also of the distal organ. Some variation exists in the innervation of the chordotonal organs in O. peruana though a common innervation pattern can be identified. The findings raise the question for the ancestral neuroanatomical organization and innervation in stick insects.

Prevalence for Plantar Fasciitis of Neural Origin in Community-Dwelling Adults

Introduction: Plantar fasciitis (PF) is one of the most common causes of heel pain in adults. Common causes of PF include prolonged standing, obesity, flat foot, and nerve entrapment. PF caused due to nerve entrapment is often left unnoticed when making a diagnosis or management for PF. Lateral and medial plantar nerves are the common nerves to get entrapped causing pain and tingling in the foot ultimately leading to PF. Aims: This study aimed to come up with the prevalence of PF of neural origin in community-dwelling adults. Settings and Design: A cross-sectional study was conducted on fifty patients with PF attending Department of Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune, over a 6 months period. Subjects and Methods: Patients were assessed based on their symptoms and whether they meet the criteria for diagnosing the condition as PF. Assessment for classifying PF of neural origin was done using Standard Neurodynamic Testing for Plantar nerves branch of tibial nerve. Statistical Analysis Used: Descriptive statistics was presented as frequency percentage. Results: The prevalence of neural origin PF among fifty patients was 54%. Forty-eight percent of them were females and 6% were males. Conclusion: This study concludes that the burden of PF of Neural Origin is more in Community Dwelling Adults yet goes undiagnosed due to the tendency of following a set battery of physical examination by physiotherapists which does not include neurodynamic tests.

Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study.

ObjectiveCommon peroneal nerve (CPN) injury that leads to foot drop is difficult to manage and treat. We present a new strategy for management of foot drop after CPN injury. The soleus muscular branch of the tibial nerve is directly transferred to the deep fibular nerve, providing partial restoration of motor function.MethodsWe retrospectively reviewed eight patients treated for CPN injury between 2017 and 2019. The soleus muscular branch of the tibial nerve was transferred to the deep fibular nerve to repair foot drop. Electrophysiology was conducted, and motor function was assessed. Motor function was evaluated by measuring leg muscle strength during ankle dorsiflexion using the British Medical Research Council (BMRC) grading system and electromyography (EMG).ResultsIn 10–15 months postoperatively, EMG revealed newly appearing electrical potentials in the tibialis anterior, extensor hallucis longus, and extensor toe longus muscle (N = 7). Two patients achieved BMRC grade of M4 for ankle dorsiflexion, 2 patients achieved M3, 1 patient achieved M2, and 2 patients achieved M1. Four patients showed good functional recovery after surgery and could walk and participate in activities without ankle-foot orthotics.ConclusionSurgical transfer of the soleus muscular branch of the tibial nerve to the deep fibular nerve after CPN injury provides variable improvements in ankle dorsiflexion strength. Despite variable strength gains, 50% of patients achieved BMRC M3 or greater motor recovery, which enabled them to walk without assistive devices.

Potential association between serum 25-hydroxy vitamin D levels and symptomatic neuropathic pain in rheumatoid arthritis patients

Aim of the workTo study the effect of vitamin D levels on clinical and laboratory characteristics of rheumatoid arthritis (RA), and to evaluate a possible relationship with neuropathic pain (NP). Patients and methodsSixty RA patients with neuropathic pain symptoms and 60 healthy controls were included. All patients were assessed by Leeds assessment of neuropathic symptoms and signs (LANSS) to confirm the presence of NP, modified health assessment questionnaire (MHAQ), disease activity score (DAS-28) and visual analogue scale (VAS). Anti-cyclic citrullinated peptide (anti-CCP), glycolysated hemoglobin (HbA1C) and 25-hydroxy vitamin D levels were assessed. Nerve conduction velocity study (NCVS) was performed in those with confirmed NP. ResultsMean age of patients was 42.4 ± 10.9 years, disease duration 5.3 ± 4.2 years and 91.7% were females. RA patients showed significant lower vitamin D levels than controls (23.5 ± 14.03 ng/ml vs 37.8 ± 13.8 ng/ml; p < 0.001). There was a significant difference between RA patients with NP (n = 30; 18.3 ± 5.5 ng/ml), and patients without (n = 30; 28.8 ± 17.7 ng/ml) regarding 25-hydroxyvitamin D (p = 0.003), LANSS, VAS, MHAQ (all p < 0.001), DAS-28 and TJC (p = 0.04). Carpal tunnel syndrome (CTS) was found in 46.7%; 42.3% of the females and 75% of males, mononeuritis multiplex (MM) in 23.3%; 25% males and 23.1% females. Patients, with deficient vitamin D had either CTS or MM (85.7% each). RA patients with NP had significant delayed latency and reduction of conduction velocity of motor and sensory branches of median, ulnar and tibial nerves. ConclusionVitamin D deficiency could be a plausible cause for neuropathic pain in RA patients.

Foot Reanimation Using Double Nerve Transfer to Deep Peroneal Nerve: A Novel Technique for Treatment of Neurologic Foot Drop.

Our primary objective was to assess the efficacy of a new technique for foot reanimation in patients with neurologic foot drop using double nerve transfer from the tibial to the deep peroneal nerve. Our secondary objective was to document the technical nuances of our technique. Thirty-one patients with common peroneal nerve injury between October 2015 and March 2019 were prospectively enrolled in the study. Patients underwent a transfer of the tibial nerve branches to flexor digitorum longus and lateral head of gastrocnemius to the deep peroneal nerve. Motor recovery, range of ankle dorsiflexion, pain, leg girth, and complications were examined as outcome measures. The modified Medical Research Council (MRC) scale was adopted to assess the motor power recovery. All patients were followed up for a minimum of 1 year. Motor recovery of M3 or M4 grade of tibialis anterior, extensor hallucis longus, and extensor digitorum longus was achieved in 15 of 31, 13 of 31, and 12 of 31 patients, respectively. Those patients could discontinue use of orthosis. Most patients with high-energy traumas or knee-level injuries failed to recover antigravity function. Only 2 patients reported weak postoperative toe plantarflexion. Our patients achieved significant improvement of the pain perception and range of active ankle motion at the final follow-up. The double nerve transfer technique represented a feasible and safe surgical option. It has been shown to improve function in some patients with neurologic foot drop resulting from a less than 12-month injury of the deep peroneal nerve. Level IV, therapeutic.

Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation.

To analyze the safety and efficacy of image-guided genicular nerve cooled radiofrequency ablation (C-RFA) for the treatment of pain in non-surgical candidates with moderate to severe knee osteoarthritis (OA) and to compare three- vs four-needle technique. This retrospective study included 50 consecutive patients with pain from moderate to severe knee OA refractory to anti-inflammatory analgesia that failed multiple intra-articular lidocaine-steroid injections and who were non-surgical total knee arthroplasty candidates because of comorbidities. Patients initially underwent anesthetic blocks of the superior medial/lateral femoral and inferior medial tibial genicular nerve branches and in some cases the suprapatellar genicular nerve branch. Radiofrequency ablations of the same nerve branches were performed 1-2weeks after the nerve blocks. Follow-up outcome was collected at approximately 2weeks, 1, 3, and 6months after the C-RFA procedure utilizing VAS and clinically validated questionnaires. A total of 77 knees were treated. The mean total KOOS score improved significantly from baseline at 24.7 ± 14.1 to 59.4 ± 26.5 at 6months after treatment (p < 0.0001), with significant improvement in mean pain score from 25.5 ± 15.2 to 64.5 ± 25.2 (p < 0.0001) and mean stiffness score from 35.1 ± 21.9 to 65.8 ± 24.9 (p < 0.0001). At 6months, 65% of all patients demonstrated decreased opiate medication usage, 79% of patients in the four-needle, and 45% of patients in the three-needle arms (p = 0.03). No complications were reported. The four-needle treatment approach offers an advantage in the overall efficacy in treating stiffness and pain in patients with moderate-to-severe OA refractory to conservative treatments leading to decreased opiate usage without complications.

Conditioning Electrical Stimulation Accelerates Regeneration in Nerve Transfers.

Compared to the upper limb, lower limb distal nerve transfer (DNT) outcomes are poor, likely due to the longer length of regeneration required. DNT surgery to treat foot drop entails rerouting a tibial nerve branch to the denervated common fibular nerve stump to reinnervate the tibialis anterior muscle for ankle dorsiflexion. Conditioning electrical stimulation (CES) prior to nerve repair surgery accelerates nerve regeneration and promotes sensorimotor recovery. We hypothesize that CES prior to DNT will promote nerve regeneration to restore ankle dorsiflexion. One week following common fibular nerve crush, CES was delivered to the tibial nerve in half the animals, and at 2 weeks, all animals received a DNT. To investigate the effects of CES on nerve regeneration, a series of kinetic, kinematic, skilled locomotion, electrophysiologic, and immunohistochemical outcomes were assessed. The effects of CES on the nerve were investigated. CES-treated animals had significantly accelerated nerve regeneration (p < 0.001), increased walking speed, and improved skilled locomotion. The injured limb had greater vertical peak forces, with improved duty factor, near-complete recovery of braking, propulsive forces, and dorsiflexion (p < 0.01). Reinnervation of the tibialis anterior muscle was confirmed with nerve conduction studies and immunohistochemical analysis of the neuromuscular junction. Immunohistochemistry demonstrated that CES does not induce Wallerian degeneration, nor does it cause macrophage infiltration of the distal tibial nerve. Tibial nerve CES prior to DNT significantly improved functional recovery of the common fibular nerve and its muscle targets without inducing injury to the donor nerve. ANN NEUROL 2020;88:363-374.

Soleus nerve transfer to deep peroneal nerve for treatment of foot drop

Different mechanisms including knee dislocation, replacement surgery, nerve tumor, lumbar disc herniation, sharp injury, and gunshot wound lead to foot drop. Several surgical techniques have been used for treatment of foot drop, however, they have had sub-optimal outcomes. Soleus branch of tibial nerve is a good donor for nerve transfer for treatment of foot drop. In this is retrospective study, we reviewed medical records of 6 consecutive patients with sustained foot drop following injury to lumbar root or peroneal nerve, who underwent transfer of the soleus branch of tibial nerve to deep peroneal nerve during 2014–2016. The mean age of the patients was 44.8 years and duration of injury to surgery and follow-up was 8.3 and 14.6 months, respectively. At the end of the follow-up, ankle dorsiflexion force was M4 in two patients (with traumatic peroneal nerve injury with M3 toe extension) and was M2 in one patient. There were three patients with lumbar degenerative disease. Of these patients, two showed M0 and one patient experienced M1 ankle dorsiflexion. We recommend that transfer of soleus nerve to deep peroneal nerve is used as an alternative technique for treatment of foot drop.

Post-burn tarsal tunnel syndrome response to extracorporeal shock wave therapy

IntroductionTo evaluate the effect of extracorporeal shock wave therapy (ESWT) on electrophysiological responses in patients suffering from tarsal tunnel syndrome after burnMethodsOverall, 40 male and female individuals with tarsal tunnel syndrome after a burn injury were equally divided into 2 groups. Group 1 received ESWT in addition to a routine physical therapy program, which consisted of stretching of calf muscles followed by pulsed ultrasound, ice massage, and ankle pump exercise. Group 2 received the routine physical therapy program only. The area of popliteal fossa (slightly laterally) was outlined and 100 impulses per cm2 and another 100 impulses per cm2 were administered over the area behind and above the medial malleolus. The 2 areas were administered every 2 weeks for 3 months as a total period of treatment. Sensory and motor nerve conduction velocities of the lateral and medial plantar branches of the tibial nerve were measured before the treatment and after 3 months.ResultsThere was an improvement and a significant decrease in the prolonged motor and distal latencies of the 2 branches of the posterior tibial nerve in the ESWT group compared with group 2 (&lt;i&gt;p&lt;/i&gt; &lt; 0.05).ConclusionsESWT is effective in treating patients suffering from tarsal tunnel syndrome after burn as evidenced by decreasing the prolonged motor and sensory distal latencies of the 2 branches of the posterior tibial nerve

Branching Pattern of the Medial Calcaneal Neurovascular Bundle in Porta Pedis of the Human Foot

The medial calcaneal nerve (MCN) is the first branch of the posterior tibial nerve (PTN) in the porta pedis, enervates the skin of the heel and medial side of the foot. Heel pain is a common condition encountered by physicians, and this may have a significant clinical association with the MCN’s branching pattern. This study was to identify branching pattern variations in the medial calcaneal neurovascular bundle. This study was carried out using 60lower limbs of formalin-embalmed cadavers, using the tarsal tunnel dissection method for 30right and 30 left lower limbs. The medial calcaneal neurovascular bundle course was identified by exposing the PTN and its branches from the distal end of the leg toward the plantar surface beyond its bifurcation and resecting the skin and flexor retinaculum. Many MCN branching pattern variations (specifically concerning origins, numbers, and levels of branching) were observed. In the right foot a single branch was present in 21 specimens (70%), while two branches were observed in nine specimens (30%). In the left foot, a single branch was present in 22 specimens (73.3%) and two branches were present in 8 specimens (26.7%). In this study, two branches originate from lateral planter artery is the most common observation. This study concludes that a single MCN originating from the TN is the most common variant. Two medial calcaneal arteries (MCAs) originating from the LPA is also common.

Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study

Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose. We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained. The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose. The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.

Paralysis of the gastrocnemius medial head differentially affects gait patterns and muscle activity during level and stair ascent locomotion

BackgroundPrior studies have analyzed the activity of the gastrocnemius (GCM) medial and lateral heads as a single unit because it is technically challenging to separately analyze the function of each component in vivo. However, functional variation between the medial and lateral heads is expected due to their anatomical differences. Research questionWhat is the independent function of the medial GCM? How does paralysis of the GCM medial head affect gait kinematics?. MethodsTwelve healthy adults (two males and ten females; age: 28.2 [±7.72] years) that were scheduled to undergo neurolysis of the tibial nerve branch supplying the medial head of the GCM for aesthetic calf reduction participated in the study. Gait analysis was performed using a computerized opto-electric gait analysis system to measure kinematic data. Surface electromyography (EMG) was recorded simultaneously during the gait analysis. Surface electrodes were placed on seven muscles. Pre-procedure and 1-week and 3-month post-procedure data were compared using a linear mixed model. ResultsDuring level walking, decreased activity of the GCM medial head did not significantly change gait kinematics. However, a significant increase in GCM lateral head and hamstring activities occurred after a branch nerve block to the GCM medial head. During stair ascent, in contrast to level walking, changes in EMG activity only occurred in the GCM medial head, and post-procedure ankle dorsiflexion angles at the end of the terminal-stance phase significantly increased. Ankle plantarflexion angles during the push-off phase were also decreased when compared with pre-procedure values. SignificanceThe human body response to dysfunction of the GCM medial head depended on the type of locomotion.