Posterior Tibial Nerve Research Articles

Ultrasound-Guided Approach to the Distal Tarsal Tunnel: Implications for Healthcare Research on the Medial Plantar Nerve, Lateral Plantar Nerve and Inferior Calcaneal Nerve (Baxter's Nerve).

The tibial nerve, commonly misnamed the "posterior tibial nerve", branches into four key nerves: the medial plantar, lateral plantar, inferior calcaneal (Baxter's nerve), and medial calcaneal branches. These nerves are integral to both the sensory and motor functions of the foot. Approximately 15% of adults with foot issues experience heel pain, frequently stemming from neural origins, such as tarsal tunnel syndrome (TTS). TTS diagnosis remains challenging due to a high false negative rate in neurophysiological studies. This study aims to improve the understanding and diagnosis of distal tarsal tunnel pathology to enable more effective treatments, including platelet-rich plasma, hydrodissections, radiofrequencies, and prolotherapy. Ultrasound-guided techniques were employed to examine the distal tarsal tunnel using the Heimkes triangle for optimal probe placement. The results indicate that the tunnel consists of two chambers separated by the interfascicular septum, housing the medial, lateral plantar, and inferior calcaneal nerves. Successful interventions depend on precise visualization and patient positioning. This study emphasizes the importance of avoiding the calcaneus periosteum to reduce discomfort. Standardizing nerve involvement classification in TTS is difficult without robust neurophysiological studies. The accurate targeting of nerve branches is essential for effective treatment.

Promising predictors of diabetic peripheral neuropathy in children and adolescents with type 1 diabetes mellitus

BackgroundDiabetic peripheral neuropathy (DPN) in children and adolescents with type 1 diabetes mellitus (T1DM) is a growing issue, with controversial data in the terms of prevalence and evaluation timelines. Currently, there are no clear standards for its early detection. Therefore, our aim was to assess the contribution of the Michigan neuropathy screening instrument (MNSI), lipid profile, serum neuron specific enolase (NSE), and serum heat shock protein 27 (HSP 27) to the prediction of DPN in children and adolescents with T1DM.MethodsIn this case-control study, fifty children diagnosed with T1DM for at least five years were enrolled and evaluated through complete neurological examination, MNSI, and nerve conduction study (NCS). Additionally, HbA1c, lipid profile, serum NSE, and serum HSP 27 levels were measured for patients and controls.ResultsThe prevalence of DPN in our study was 24% by NCS, and electrophysiological changes showed a statistically significant lower conduction velocity for the posterior tibial and sural nerves, as well as a prolonged latency period for the common peroneal and sural nerves in neuropathic patients. In these patients, older age, earlier age of diabetes onset, longer disease duration, higher total cholesterol, triglycerides, low density lipoprotein cholesterol, HbA1c, serum NSE, and HSP27 levels were observed. The MNSI examination score ≥ 1.5 cutoff point had an area under the curve (AUC) of 0.955, with 75% sensitivity and 94.74% specificity, according to receiver operating characteristic curve analysis. However, the questionnaire’s cutoff point of ≥ 5 had an AUC of 0.720, 75% sensitivity, and 63% specificity, with improved overall instrument performance when combining both scores. Regarding blood biomarkers, serum NSE had greater sensitivity and specificity in discriminating neuropathic patients than HSP27 (92% and 74% versus 75% and 71%, respectively). Regression analysis revealed a substantial dependency for MNSI and serum NSE in predicting DPN in patients.ConclusionsDespite limited research in pediatrics, MNSI and serum NSE are promising predictive tools for DPN in children and adolescents with T1DM, even when they are asymptomatic. Poor glycemic control and lipid profile changes may play a critical role in the development of DPN in these patients, despite conflicting results in various studies.

Effects of neural mobilization of sciatic nerve and its branches in plantar foot pressures and stabilometry

Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900.

ID: 313567 PNS with HF-EMC at the Posterior Tibial and Common Peroneal Nerves: Case Report

ID: 313567 PNS with HF-EMC at the Posterior Tibial and Common Peroneal Nerves: Case Report

ID: 329569 Peripheral Nerve Stimulation of the Posterior Tibial Nerve for Chemotherapy Induced Neuropathy

ID: 329569 Peripheral Nerve Stimulation of the Posterior Tibial Nerve for Chemotherapy Induced Neuropathy

ID: 317851 PNS with HHF-EMC at the Sural and Posterior Tibial Nerves for the Treatment of CRPS

ID: 317851 PNS with HHF-EMC at the Sural and Posterior Tibial Nerves for the Treatment of CRPS

171 - Comparison of the Transcutaneous Posterior Tibial Nerve Stimulation and Solifenacin Treatments’ Effects in Women with Overactive Bladder

171 - Comparison of the Transcutaneous Posterior Tibial Nerve Stimulation and Solifenacin Treatments’ Effects in Women with Overactive Bladder

ID: 313494 PNS with a HF-EMC Powered Implanted Receiver at the Posterior Tibial Nerve for foot pain

ID: 313494 PNS with a HF-EMC Powered Implanted Receiver at the Posterior Tibial Nerve for foot pain

170 - Transcutaneous Posterior Tibial Nerve Stimulation on Demand During Multichannel Urodynamics: A New Approach in the Management of Overactive Bladder

170 - Transcutaneous Posterior Tibial Nerve Stimulation on Demand During Multichannel Urodynamics: A New Approach in the Management of Overactive Bladder

Updates on the use of neuromodulation in geriatric patients.

In light of the updated AUA/SUFU guidelines on the diagnosis and treatment of overactive bladder (OAB), increased utilization of advanced therapies is expected in the coming years. The primary aim of this review is to summarize existing outcome and safety data on the use of neuromodulation in geriatric patients, as well as highlight recent advances in neuromodulation that may be particularly advantageous in the geriatric population. There are mixed data demonstrating efficacy of sacral neuromodulation by decade of life, with older individuals most often demonstrating lower odds of progressing to stage 2 implantation. However, a large majority of patients still undergo stage 2 implantation with no significant increase in complications reported when compared to younger cohorts. Neuromodulation is broadening to have wider indications outside of OAB, which may be particularly beneficial in the elderly population (fecal incontinence, nonobstructive urinary retention, and constipation). Posterior tibial nerve stimulation remains a well tolerated and efficacious treatment for OAB, with new FDA-approved implantable devices joining the commercial market, which may expand access for elderly populations. The data are encouraging and support the use of neuromodulation in geriatric patients.

Posterior Tibial Nerve Stimulation With versus Without Mirabegron: A Randomized Controlled Trial.

To compare change in urgency urinary incontinence episodes (UUIEs) in women undergoing posterior tibial nerve stimulation (PTNS) plus mirabegron versus PTNS plus placebo for the treatment of refractory urgency urinary incontinence (UUI). The primary hypothesis was that combination therapy is superior to monotherapy. A randomized controlled trial was performed in individuals identifying as female aged ≥ 18 years with UUI symptoms refractory to second-line treatment or who could not tolerate antimuscarinic medications. Both participants and providers were blinded to medication treatment allocation. Participants were randomized (1:1) to PTNS plus mirabegron or PTNS plus placebo. Participants completed a 3-day bladder diary prior to and after 12-week treatment. Validated symptom distress and impact questionnaires were obtained pre- and post-treatment. The primary outcome was change in mean number of UUIEs on a 3-day bladder diary pre- versus post-treatment between arms. Primary and secondary outcomes were analyzed via sample t tests. Fifty-four subjects were randomized, mean ± SD baseline age 56.2±15.6 years and body mass index 35.0±9.4 (kg/m2); no differences were noted in any clinical-demographic characteristics. There was a significant difference between arms in mean pre- to post-treatment UUIEs, 9.4±3.9, mirabegron versus 5.3±5.5, placebo (p=0.007). Significant differences were found pre- compared with post-treatment in urinary frequency, Overactive Bladder Questionnaire Short Form Symptom Bother and Symptom Health-Related Quality of Life scores. In subjects undergoing PTNS treatment for refractory UUI and OAB-wet symptoms, the addition of a β-3 agonist produced significant improvement in both objective and subjective overactive bladder symptom outcomes compared with PTNS plus placebo.

Long term safety, continuation rates and subjective and objective success of Posterior Tibial Nerve Stimulation for Overactive Bladder

Introduction:Posterior tibial nerve stimulation (PTNS) is currently offered to patients with refractory overactive bladder (OAB). We aim to evaluate the efficacy, safety and long-term continuation of PTNS over 11 years. Methods:We conducted a retrospective cohort study on all patients who underwent PTNS from 2012 to 2023. The primary outcomes were change in urinary frequency over 24 hours, maximum voided volume (MVV), number of episodes of urgency urinary incontinence (UUI) and patient perception of intensity of urgency scale (PPIUS). Results:We identified 81 patients. 83% of patients completed 12 treatments of PTNS, and 54% of those that did not complete their full course of treatment stated that this was due to inefficacy. 33% of patients underwent PTNS ‘top ups’ as needed. Only 1 patient reported an adverse effect of musculoskeletal leg pain.28% of patients reported a subjective improvement of their symptoms by 50% or more. There was an average reduction in daytime frequency by 0.6 episodes (p = 0.033), an increase in MVV by 13mls (p = 0.927), a reduction in UUI episodes each day by 0.7 (p = 0.008) and a reduction in average PPIUS by 0.4 (p = 0.024). Conclusion:PTNS remains a safe treatment option for patients with refractory OAB with evidence of both subjective and objective improvement to most symptoms. The majority of our patients completed a 12-week cycle but only 1 in 3 chose to have further PTNS ‘top ups’ and only 1 in 5 are continuing with PTNS for long term management of their OAB.

A Wearable Dual-Mode Probe for Image-Guided Closed-Loop Ultrasound Neuromodulation.

Low-intensity focused ultrasound (FUS) is an emerging non-invasive and spatially/temporally precise method for modulating the firing rates and patterns of peripheral nerves. This paper describes an image-guided platform for chronic and patient-specific FUS neuromodulation. The system uses custom wearable probes containing separate ultrasound imaging and modulation transducer arrays realized using piezoelectric transducers assembled on a flexible printed circuit board (PCB). Dual-mode probes operating around 4 MHz (imaging) and 1.3 MHz (modulation) were fabricated and tested on tissue phantoms. The resulting B-mode images were analyzed using a template-matching algorithm to estimate the location of the target nerve and then direct the modulation beam toward the target. The ultrasound transmit voltage used to excite the modulation array was optimized in real-time by automatically regulating functional feedback signals (the average rates of emulated muscle twitches detected by an on-board motion sensor) through a proportional and integral (PI) controller, thus providing robustness to inter-subject variability and probe positioning errors. The proposed closed-loop neuromodulation paradigm was experimentally demonstrated in vitro using an active tissue phantom that integrates models of the posterior tibial nerve and nearby blood vessels together with embedded sensors and actuators.

Detection of Sub-Clinical Tarsal Tunnel Syndrome in Rheumatoid Arthritis Patients

Abstract Background Asymptomatic or subclinical entrapments are common and frequent specially in patients with rheumatoid arthritis. Objectives Detection of sub clinical tarsal tunnel syndrome in rheumatoid arthritis patients and detect its correlation with disease activity and severity. Patient and Methods This case control was carried out on 16 patients with rheumatoid arthritis (RA) diagnosed according to American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) criteria of 2010 and 16 healthy controls matched for age and sex. Assessment of disease activity was done by Disease Activity Score in 28 joints (DAS28) and Rheumatoid Arthritis Severity Scale (RASS). Electrophysiological studies were conducted on a two channel EMG machine, for each patient on both legs. Results No significant differences were noted between study groups regarding basal demographic and clinical manifestations. In rheumatoid patient, mean ± SD for disease activity score (DAS) was 4.11±0.51 versus 2.51 ± 0.66 in control patient with p < 0.0001. Regarding RASS, in rheumatoid patient, mean ± SD for disease activity was 28.94 ± 5.78; mean ± SD for functional impairment was 28.44 ± 5.46 and mean ± SD for physical damage was 31.75 ± 5.58 versus 11.44 ± 4.91, 13.88 ± 5.88 and 12.69 ± 4.24 in control group with statistically significant difference between both groups (p < 0.0001). In rheumatoid cases, all patients (100%) were affected on medial plantar nerve “sensory latency and amplitude” of right and left sides, also, all patients (100%) were affected on lateral plantar nerve “sensory latency” of right and left sides, while for amplitude right and left; 31.25% of patients were affected. Medial plantar nerves (motor latency) in both sides weren‟t affected in any patients, while for amplitude and nerve conduction velocity the percentage of patients in right and left was 100%. Lateral plantar nerve (motor latency and amplitude) weren‟t affected in any patients in both sides, while for nerve conduction velocity the percentage of patients in right and left was 100%. Posterior tibial nerves (motor latency and nerve conduction velocity) weren‟t affected in any patients in both sides, while for amplitude the percentage of patients in right and left was 6.25%. No correlation was detected between DAS and RASS as regard clinical, laboratory data and electrophysiological study in rheumatoid cases. This was clearly demonstrated by sensitivity and specificity test that medial and lateral plantar nerved (sensory and motor) were of highly significant value and posterior tibial nerve (motor) was of insignificant value in detection of sub clinical tarsal tunnel syndrome in rheumatoid arthritis patients. Conclusion Subclinical entrapments and sub clinical tarsal tunnel syndrome were detected in all rheumatoid arthritis patients using electrophysiological study and they were positively correlated with disease activity and severity. Also, most of joint complaints of rheumatoid arthritis patients as oedema and pain were due undiagnosed subclinical entrapments and sub clinical tarsal tunnel syndrome.

Update on Overactive Bladder Therapeutic Options.

Millions of Americans are burdened by overactive bladder (OAB) syndrome and the psychogenic and economic hardships that accompany it. Several theories attempt to explain OAB as a neurogenic dysfunction, myogenic dysfunction, urothelial dysfunction, or decreased expression of a channel protein secondary to bladder outlet obstruction. Given that the etiology of OAB is a working theory, the management of OAB is also an evolving subject matter in medicine. There are uncertainties surrounding the pathophysiology of OAB, the strength of a clinical diagnosis, and accurate reporting because of the disease's stigma and decreased use of health care. This is a narrative review that used PubMed, Google Scholar, Medline, and ScienceDirect to review literature on current and future OAB therapies. Currently, first-line treatment for OAB is behavioral therapy that uses lifestyle modifications, bladder-control techniques, and psychotherapy. Second-line therapy includes antimuscarinic agents or beta 3 adrenergic agonists, and studies have shown that combination therapy with antimuscarinics and beta 3 adrenergic agonists provides even greater efficacy than monotherapy. Third-line therapies discussed include onabotulinumtoxinA, posterior tibial nerve stimulation, and sacral neuromodulation. OnabotulinumtoxinA has been FDA-approved as a nonpharmaceutical treatment option for refractory OAB with minimal side effects restricted to the urinary tract. Posterior tibial nerve modulation and sacral neuromodulation are successful in treating refractory OAB, but the costs and complication rates make them high-risk procedures. Therefore, surgical intervention should be a last resort. Estrogen therapy is effective in alleviating urinary incontinence in postmenopausal women, consistent with the association between estrogen deficiency and genitourinary syndrome. Potassium channel activators, voltage-gated calcium channel blockers, and phosphodiesterase inhibitors look to be promising options for the future of OAB management. As new therapies are developed, individuals with OAB can better personalize their treatment to maximize their quality of life and cost-effective care.

Efficacy of Percutaneous vs Transcutaneous Posterior Tibial Nerve Stimulation in Overactive Bladder Syndrome: A Randomized Clinical Trial

Efficacy of Percutaneous vs Transcutaneous Posterior Tibial Nerve Stimulation in Overactive Bladder Syndrome: A Randomized Clinical Trial

Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus.

Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus.

Reply to Comments on Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus.

Reply to Comments on Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus.

Posterior tibial nerve stimulation versus desmopressin in treating children with primary mono-symptomatic nocturnal enuresis. A randomized clinical trial

ABSTRACT Objective Assessment of the efficacy of Posterior Tibial Nerve Stimulation (PTNS) versus Desmopressin in treating Primary Mono-symptomatic Nocturnal Enuresis (PMNE). Patients and methods This randomized clinical trial was conducted at the Urology department of Abo Elreesh pediatric hospital, Cairo University on 80 children, aged between 5 and 13 years old, diagnosed to have PMNE between June 2020 and November 2020. Children were divided into two equal groups; those who underwent PTNS (as one session per week for 12 weeks) (Group A) and those who received Desmopressin 0.2 mg. single evening dose for 12 weeks (Group B). Both groups were constructed to adhere to behavioral therapy and were statistically evaluated regarding the frequency of nocturnal enuresis (NE) before, after treatment, and after 1 month of follow-up. Results Both groups showed statistically significant improvement in the frequency of NE before and after treatment (p < 0.001), but there were no statistically significant differences between them (p = 0.763). There was a statistically significant relapse of NE frequency after 1 month of follow-up after completion of treatment in both groups (p < 0.001), with no statistically significant differences between the two groups (p = 0.075). Conclusion Posterior tibial nerve stimulation and Desmopressin are viable treatment options for children with primary mono-symptomatic nocturnal enuresis. However, relapse in some responders with time suggests the need for maintenance therapy.

Pediatric Intraoperative Electromyographic Responses at the Adductor Pollicis and Flexor Hallucis Brevis Muscles: A Prospective, Comparative Analysis.

Peripheral nerve stimulation with a train-of-four (TOF) pattern can be used intraoperatively to evaluate the depth of neuromuscular block and confirm recovery from neuromuscular blocking agents (NMBAs). Quantitative monitoring can be challenging in infants and children due to patient size, equipment technology, and limited access to monitoring sites. Although the adductor pollicis muscle is the preferred site of monitoring, the foot is an alternative when the hands are unavailable. However, there is little information on comparative evoked neuromuscular responses at those 2 sites. Pediatric patients undergoing inpatient surgery requiring NMBA administration were studied after informed consent. Electromyographic (EMG) monitoring was performed simultaneously in each participant at the hand (ulnar nerve, adductor pollicis muscle) and the foot (posterior tibial nerve, flexor hallucis brevis muscle). Fifty patients with a mean age of 3.0 ± standard deviation (SD) 2.9 years were studied. The baseline first twitch amplitude (T1) of TOF at the foot (12.46 mV) was 4.47 mV higher than at the hand (P <.0001). The baseline TOF ratio (TOFR) before NMBA administration and the maximum TOFR after antagonism with sugammadex were not different at the 2 sites. The onset time until the T1 decreased to 10% or 5% of the baseline value (T1) was delayed by approximately 90 seconds (both P =.014) at the foot compared with the hand. The TOFR at the foot recovered (TOFR ≥0.9) 191 seconds later than when this threshold was achieved at the hand (P =.017). After antagonism, T1 did not return to its baseline value, a typical finding with EMG monitoring, but the fractional recovery (maximum T1 at recovery divided by the baseline T1) at the hand and foot was not different, 0.81 and 0.77, respectively (P =.68). The final TOFR achieved at recovery was approximately 100% and was not different between the 2 sites. Although this study in young children demonstrated the feasibility of TOF monitoring, interpretation of the depth of neuromuscular block needs to consider the delayed onset and the delayed recovery of TOFR at the foot compared to the hand. The delay in achieving these end points when monitoring the foot may impact the timing of tracheal intubation and assessment of adequate recovery of neuromuscular block to allow tracheal extubation (ie, TOFR ≥0.9).