Posterior Tibial Nerve Research Articles

Utility of Bilateral Posterior Tibial Nerve Electrostimulation in the Treatment of Idiopathic Constipation in the Mexican Population

Background: Constipation has a prevalence in the Mexican population of up to 14.4% (Remes-Troche 2018). Posterior tibial electrostimulation from L4 to S3 modulates sacral roots through multiple afferent pathways in the spinal cord via a spinal and supraspinal somatovisceral reflex that activates sympathetic nerve flow, increasing rectal distensibility, improving rectal sensory thresholds and favoring anterograde and retrograde colonic propagation sequences through stimulation of S2 and S3 thus improving the defecation mechanism. Objective: To describe the usefulness of bilateral posterior tibial nerve electrostimulation in the treatment of idiopathic constipation in the Mexican population. Materials and Methods: Prospective, longitudinal analytical study including 49 patients with idiopathic constipation from the coloproctology and gastroenterology outpatient department of Hospital General Regional no. 1, Orizaba, Veracruz. Two non-randomized groups were formed: group 1 received bilateral posterior tibial stimulation via transcutaneous electrodes 3 times a week for 6 weeks; group 2 was treated with fecal bolus modifiers and dietary habit changes. Constipation status was evaluated at the beginning and end of treatment using a custom survey where higher scores indicated greater symptoms and scores closer to zero indicated fewer symptoms. Descriptive statistics, frequencies, percentages, and central tendency measures were applied. The study took place from September 2023 to February 2024. Results: A total of 49 patients were selected; group 1 consisted of 15 patients (31%) who underwent bilateral posterior tibial nerve electrostimulation and were compared with 34 participants (69%) in group 2 who were treated with fecal bolus modifiers and changes in dietary habits. The mean age of the bilateral posterior tibial nerve electrostimulation group was 45 ± 18 and 55 ± 14 for the fecal bolus modifiers. The female sex predominated in both groups; group 1 with 12 participants (80%) and the second group with 28 (82%) female participants. Of all the patients in group 1, the mean improvement of symptoms was 16% at 6 weeks with bilateral posterior tibial electrostimulation as a treatment for idiopathic constipation, compared to the mean of 33% reported with the use of fecal bolus modifiers and changes in dietary habits; the use of laxatives was also evidenced, in group 1 only 2 participants (13%) continued with their use and in group 2, 22 participants (65%) continued with their use at the end of 6 weeks. Conclusion: Bilateral posterior tibial electrostimulation treatment for idiopathic constipation reduced symptom perception and laxative use compared to fecal bolus modifiers and dietary habit changes.

The Procedural Lifelines Video Blog: Ultrasound-Guided Posterior Tibial Nerve Block in the ED

The Procedural Lifelines Video Blog: Ultrasound-Guided Posterior Tibial Nerve Block in the ED

Methods for tissue perfusion assessment after Dellon decompression of tarsal tunnels in diabetic neuropathy: key to effective management-a narrative review.

Diabetic neuropathy significantly elevates the risk of foot ulceration and lower-limb amputation, underscoring the need for precise assessment of tissue perfusion to optimize management. This narrative review explores the intricate relationship between sympathetic nerves and tissue perfusion in diabetic neuropathy, highlighting the important role of autonomic neuropathy in blood flow dynamics and subsequent compromises in tissue perfusion. The consequences extend to the development of diabetic peripheral neuropathy and related foot complications. By analyzing both non-invasive diagnostic methods and surgical interventions, such as tarsal tunnel decompression, the paper seeks to highlight their effectiveness in improving tissue perfusion, preventing ulcers, and reducing the risk of amputations in patients with diabetic peripheral neuropathy. We reviewed current literature on both non-invasive diagnostic tools and surgical techniques for assessing and improving tissue perfusion in diabetic neuropathy. Methods discussed include transcutaneous oxygen pressure (TcPO2), Doppler ultrasound, Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI, and the SPY Laser Angiographic System. Emphasizing the critical importance of surgical interventions, such as tarsal tunnel decompression and neurolysis of the posterior tibial nerve, the article underscores their efficacy in enhancing tissue perfusion and preventing ulcers and amputations. Additionally, it addresses the significance of precise blood flow measurement and timely intervention in the management of diabetic neuropathy and foot ulcers. The non-invasive techniques for assessing tissue perfusion and blood flow in diabetic neuropathy such as TcPO2, Doppler ultrasound and Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI are explained. Also, this review introduces the SPY Laser Angiographic System, which employs near-infrared fluorescence imaging to assess blood flow and perfusion in tissues. This advanced tool generates real-time microvascular blood flow images and proves instrumental in diagnosing and monitoring diabetic foot ulcers. In conclusion, surgical interventions, both vascular and peripheral nerve are pivotal for optimizing patient care. Early identification of foot ulcers and peripheral arterial disease is imperative, and an understanding of blood flow dynamics, combined with effective surgical techniques, constitutes key elements in managing diabetic neuropathy, healing and preventing ulcers, and limb salvage.

Focused Anatomic Review: Ultrasound-Guided Peripheral Nerve Stimulation of the Sciatic, Posterior Tibial, and Obturator Nerves.

Abstract Ultrasound-guided percutaneous peripheral nerve stimulation (PNS) is an emerging modality for managing pain by targeting specific nerves. This focused review examines the anatomy and ultrasound imaging techniques for the sciatic, posterior tibial, and obturator nerves. The current evidence is limited to proof-of-concept studies and case reports. Further research is needed to optimize technical approaches and address the unique challenges of peripheral nerve stimulation.

Impact of different muscle-lengthening amplitudes combined with electrical nerve stimulation on torque production.

This study investigated torque production resulting from the combined application of wide-pulse neuromuscular electrical stimulation (NMES), delivered over the posterior tibial nerve, and muscle lengthening at two distinct amplitudes. Wide-pulse NMES (pulse duration: 1 ms; stimulation intensity: 5-10% of maximal voluntary contraction) was delivered at both low- (20 Hz) and high- (100 Hz) stimulation frequencies, either alone (NMES condition) or combined with a muscle lengthening at two amplitudes (10 or 20° ankle joint rotation; NMES + LEN10 and NMES + LEN20 conditions, respectively). For each frequency, the torque-time integral (TTI) and the muscle activity following the cessation of stimulation trains (sustained EMG activity) were calculated. At 20 Hz, TTI was higher (P = 0.007) during NMES + LEN10 (233.2 ± 101.5 Nm·s) and NMES + LEN20 (229.2 ± 92.1 Nm·s) than during the NMES condition (187.5 ± 74.5 Nm·s), without any change in sustained EMG activity (P = 0.54). At 100 Hz, TTI was higher (P = 0.038) during NMES + LEN10 (226.6 ± 115.3 Nm·s) than during NMES + LEN20 (180.6 ± 84.0 Nm·s) and NMES (173.9 ± 94.9 Nm·s). This torque enhancement was accompanied by a higher sustained EMG activity (P = 0.045) in the NMES + LEN10 condition. These findings show that, for low-frequency NMES, significant torque increases were observed with both a 10- or a 20-degree lengthening amplitude, probably linked to increased afferents' activation. In contrast, with high-frequency NMES, a significant TTI enhancement was observed only with the 10-degree amplitude, accompanied by increased sustained EMG activity, suggesting neural mechanisms' involvement. When a greater lengthening amplitude was superimposed during high-frequency NMES, these mechanisms were probably inhibited, precluding torque enhancement.NEW & NOTEWORTHY This study demonstrates that combining wide-pulse low-frequency NMES and muscle lengthening can increase torque production compared with the sole application of NMES. Torque enhancement is most likely linked to the persistent firing of muscle afferents. Although muscle lengthening superimposition also permitted torque increases during wide-pulse high-frequency NMES, increasing the muscle lengthening amplitude did not allow further torque enhancements, probably due to presynaptic inhibitory mechanisms.

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.

Third-Line Therapeutic Interventions for Non-Neurogenic Bladder Dysfunction in Children.

The aim of this article is to review considerations and efficacy of third-line treatments for pediatric non-neurogenic bladder dysfunction, including Botulinum toxin A (BoTNA), Posterior Tibial Nerve Stimulation (PTNS), and Sacral Neuromodulation (SNM). Federal Drug Administration approval for use of beta-3-agonists in overactive detrusor activity in pediatric patients may provide an additional step prior to third-line therapies. New long-term data on pediatric SNM efficacy, complications, and revision rates will provide valuable information for counseling families. BoTNA offers a safe and efficacious treatment to decrease detrusor contractility and improve bladder capacity but is limited by the half-life of BoNTA agent. Percutaneous or transcutaneous PTNS offers improved voided volumes or cure in some patients but is time-intensive. SNM can be utilized in a variety of LUTD pathology with high success rate and cure but should consider cumulative anesthetic and fluoroscopic exposures for battery replacements and re-positioning for patient growth.

Posterior Tibial Nerve Stimulation Effect on Treatment of Overactive Bladder: A Systematic Review and Meta-analysis

Context: Overactive bladder (OAB) is a symptomatic syndrome indicative of lower urinary tract dysfunction. Current treatments for OAB syndrome include behavioral therapy, pharmacotherapy, minimally invasive procedures like sacral nerve stimulation and tibial nerve stimulation, as well as surgical options. Objectives: This systematic review aimed to evaluate the effectiveness of posterior tibial nerve stimulation (PTNS) as a treatment for OAB syndrome and to identify potentially effective stimulation methods. Evidence Acquisition: A systematic search was conducted using PubMed, Scopus, ProQuest, Web of Science, Google Scholar, and The Cochrane Library databases for predefined keywords. Two independent reviewers screened the studies’ titles, abstracts, and full texts. The quality of the studies was assessed using the JBI risk of bias (RoB) checklists. Studies meeting the inclusion criteria were summarized in an extraction table. Meta-analysis was performed using Review Manager Software. Results: Out of 2,282 studies identified, 63 were included in the data extraction table, and 19 of these were included in the meta-analysis to compare the effect of PTNS based on the number of treatment sessions (less than 12 sessions vs. 12 - 24 sessions). Despite heterogeneity among the studies, results showed a significant reduction in voiding frequency post-intervention (95% confidence interval, -4.25 to -1.48, P < 0.0001, Z = 4.06), with a greater reduction in the 12 - 24 sessions group (chi2 = 8.40, df = 1 (P < 0.004); I2 = 88.1%). Additionally, specific electrode placement methods further reduced voiding frequency after PTNS. Conclusions: Posterior tibial nerve stimulation can reduce voiding frequency in patients with OAB and painful bladder syndrome. However, establishing a standard PTNS method remains challenging due to variations among studies and the absence of control groups in many cases. Based on the results, PTNS with a frequency of 20 Hz, pulse duration of 200 µs, and stimulation intensity at the pain threshold appears effective for both transcutaneous and percutaneous techniques over 12 - 24 sessions. The percutaneous method may be more effective than the transcutaneous method.

Anatomical Analysis of the Traditional Postero-Medial Approach to the Ankle and Evaluation of Structures at Risk

IntroductionThe presence of a fracture of the posterior malleolus gives a poor prognosis for ankle fractures. This study aimed to analyze the anatomical structures at risk in the traditional postero-medial (TPM) approach. MethodsOf a total of 21 cadaveric pieces, 11 were female and 10 were male; 9 ankles/right foot and 11 ankles/left foot. The age of the specimens ranged between 66 and 98 years. The following statistical tests were performed: Median, Mean, SD and Mann Whitney non-parametric test. ResultsThe p values associated with the statistical tests were calculated, obtaining all p values lower than the level of significance. Therefore, there is statistically significant evidence to reject the null hypothesis, that is, there is a difference in the medians of men and women, with respect to the 3 measurements. The evaluation of the anatomical structures at risk allowed us to measure the distance of the Posterior Tibial nerve, thus demonstrating that the approach was 20mm above could cause injury. The difference in the measurements obtained between men and women had statistical significance. ConclusionUsing the TPM (traditional postero-medial) approach it is possible to identify a large portion of the posterior malleolus both laterally and medially. The evaluation of the anatomical structures at risk allowed us to measure the distance of the Posterior Tibial nerve, thus demonstrating that the approach was 20mm. above could cause injury. The difference in the measurements obtained between men and women had statistical significance. We intend to quantify visualization percentages using computed tomography in our next study.

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.

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.

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.

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