Tibial Nerve Research Articles

BEETter AGING: Short-Term Dietary Nitrate Supplementation Enhances Muscle Contractile Properties in Older But Not in Young Adults.

Dietary nitrate (NO3-) supplementation has been shown to improve skeletal muscle contractile function and reduce fatigue, potentially due to alterations in skeletal muscle Ca2+ handling/sensitivity. Since aging muscle can have impaired Ca2+ handling, the aim of the study was to evaluate the effects of dietary NO3- supplementation on muscle contractile properties in young and older adults. Eleven older (69 ± 4 yrs, O) and 11 young (26 ± 2 yrs, YG) adults consumed either NO3--rich beetroot juice (BR) or placebo (PLA), for 7 days. After supplementations, plantar flexors of dominant leg were evaluated as follow: a) maximal voluntary isometric contraction (MVIC); b) potentiated single twitches (Twpot) and double twitches electrical stimulations at the frequency of 100 Hz (Db100) on the tibial posterior nerve; c) a fatigue isometric (70% of MVIC) test until exhaustion. The force-frequency relationship was assessed with trains of electrical pulses across a wide range of frequencies on the muscle belly of the non-dominant leg. BR supplementation increased plasma [NO3-] and nitrite [NO2-] in both O and YG compared to PLA (more than 7-fold; all P ≤ 0.02). No changes were observed in MVC, Twpot, and Db100 force after BR compared to PLA in both YG and O. Only in O, Db100 area under the curve (-7 ± 6 N·s change from PLA) and half relaxation time (-0.05 ± 0.06 s change from PLA) were significantly reduced. and time to exhaustion (+32 ± 43 s change from PLA) was significantly longer (all P < 0.02) after BR. In O, BR also significantly increased submaximal force produced by trains of electrical pulses (P < 0.001). NO3- supplementation positively affects muscle contractile proprieties, submaximal electrically evoked force production and fatigue resistance in older adults while these positive results were not found in young.

Nerve Ultrasound Detects Nerve Atrophy in Patients With Ataxia-Telangiectasia: A Pilot Study.

Ataxia-telangiectasia (A-T) is a genetic multisystem neurodegenerative disorder characterized by cerebellar ataxia, oculocutaneous telangiectasia, extrapyramidal involvement, peripheral sensorimotor neuropathy, immunodeficiency, pulmonary disease, and an increased risk of malignancy that ultimately determines the shortened lifespan in many patients. A-T nerve ultrasonographic characteristics remain underexplored. This pilot study aimed to characterize the ultrasonographic morphology of peripheral nerves in patients with A-T. Ultrasound cross-sectional areas (CSAs) of the median, ulnar, sural, and tibial nerves were obtained from three A-T patients and were compared to reference values. Nerve conduction studies and electromyography were also performed. Given the small sample size and the exploratory nature of this study, formal statistical analyses were not performed, and descriptive statistics were presented for the data. Nerve CSAs in A-T patients were smaller than in healthy controls at all measurement sites. Nerve ultrasound revealed atrophy in the peripheral nerves of A-T patients. This reduction in nerve size may distinguish A-T and highlights the utility of nerve ultrasound as a non-invasive diagnostic tool for peripheral sensorimotor neuropathy. These findings may have important implications for early detection in clinical practice.

Management of Popliteal Artery Interposition Graft Infection by Extra-anatomic Bypass.

ObjectivesInfection of peripheral interposition grafts is a rare but devastating complication following aneurysm repair. Typically, graft infection necessitates explantation and, if possible, revascularization of the limb. However, treatment complexity varies substantially depending on the location and extent of infection. This case describes the management of a popliteal artery interposition graft infection.MethodsWe describe an 84 year old male with a history of left popliteal artery aneurysm repair with PTFE interposition graft (found on workup a year prior for a gangrenous great toe) who presented with four days of night sweats, chills, and a painful posterior left knee. Laboratory findings indicated leukocytosis, while ultrasound and CT imaging revealed complex fluid surrounding the graft without evidence of pseudo-aneurysm. Surgical management was conducted in two stages, the first with the patient supine for bypass from the superficial femoral artery to the posterior tibial artery using ipsilateral reversed great saphenous vein. The patient was then repositioned prone for the second stage of the procedure, and the infected popliteal fossa was entered posteriorly for debridement with caution to avoid injury to the tibial nerve and popliteal vein. The infected graft was removed, and antibiotic beads were placed in the infected region.ResultsFollowing this procedure and serial washouts one week later, the patient retained motor function, sensation, and palpable posterior tibial and dorsal pedal pulses. The patient was placed on IV cefazolin for 6 weeks following the procedure and discharged with 6 months of oral suppression to achieve long-term prevention of further infection.ConclusionsWhen managing popliteal artery graft infection, the presence of purulent material in the popliteal fossa can make anatomic bypasses high-risk for recurrent infection, and caution must be taken to avoid the nearby popliteal vein and tibial nerve during irrigation and debridement.

Cross-limb transfer during isometric plantar flexion familiarization

This study examined the number of contractions required for an isometric plantar flexion familiarization. Twenty-six males were separated into two independent Groups: Group A: where five contractions were initiated on the dominant limb (right) followed by the contralateral limb; and Group B, initiated by the non-dominant limb (left) followed by the dominant limb. Participants carried out a 5-s maximum voluntary contraction (MVC), with an interpolated twitch administered to the tibial nerve. In Group A, both the dominant and non-dominant limbs required two contractions for familiarization, whereas in Group B, the dominant limb required two contractions, and the non-dominant limb required three (p < 0.05). A strong relationship between MVC and voluntary activation (VA) was observed in Group A for the D (r = 0.91, p < 0.05) and in Group B for the ND limb (r = 0.99, p < 0.05). The results demonstrated evidence of cross-limb transfer from the dominant to the non-dominant limb (p < 0.05). This phenomenon implicates central involvement, substantiated by VA responses that mirror the changes in MVC. Practitioners and researchers should consider the impact of cross-limb transfer during a single familiarization session when assessing strength to avoid overestimation of the gains. Future cross-education/cross-limb transfer studies could investigate the central mechanisms involved during familiarization.

Fecal Incontinence in Adults: New Therapies.

Fecal incontinence (FI) is the involuntary and recurrent loss of stool. FI significantly affects both physical and social well-being, while imposing a substantial economic burden. The global prevalence of FI is approximately 8%. Risk factors include advanced age, diarrhea, anal sphincter damage from obstetric trauma or anorectal surgery, pelvic floor abnormalities (such as rectal prolapse), inflammatory bowel disease, and neurological conditions. Despite greater understanding of the impact of FI and advances in diagnostic techniques and treatment options, management remains inconsistent, likely due to limited awareness of available therapies. Patients often benefit from conservative treatments, including dietary modifications, fiber supplementation, antidiarrheal agents, and physical therapy, especially when these are tailored to specific symptoms and rigorously applied. Next level options include anorectal biofeedback therapy, the perianal injectable bulking agent dextranomer, or anal/vaginal barrier devices, which can be effective for patients if tolerated. Transanal irrigation may be considered for patients with neurogenic bowel and fecal retention to aid in rectal cleansing and prevent FI. Sacral neuromodulation is the preferred surgical treatment for FI. Noninvasive anal electrical and percutaneous tibial nerve stimulation are not superior to placebo in controlled trials. Translumbosacral magnetic stimulation was beneficial in an uncontrolled trial; sham-controlled trials are necessary. Due to limited long-term efficacy, anal sphincteroplasty is typically reserved for younger patients with obstetric anal sphincter defects. Colostomy is considered a last resort. Injection of autologous muscle cells into the external anal sphincter has shown promise in small, uncontrolled trials, though has not yielded significant results in most controlled trials.

A Randomized Controlled Trial of Percutaneous Tibial Nerve Stimulation in the Treatment of Female Sexual Dysfunction.

Female sexual dysfunction (FSD) is a prevalent and multifaceted condition affecting women's sexual well-being. This randomized controlled trial aimed to evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS) compared to a validated sham control in the treatment of FSD. We conducted a single-center randomized controlled trial. Participants with FSD were recruited and randomly assigned at a 1:1 allocation ratio to either PTNS or a validated sham control using transcutaneous nerve stimulation (TENS). Treatment was performed through weekly 30-min session for 12 weeks total. Sexual function was assessed at baseline, 6 weeks, and 12 weeks primarily using the Female Sexual Function Index (FSFI) questionnaire. Urogenital distress inventory-6 was collected to evaluate for any baseline urinary incontinence/voiding dysfunction. Linear mixed-effect models for longitudinal data were used to compare FSFI scores across different time points. Statistical analysis was performed using SAS 9.4 (SAS Institute Inc. Cary, NC). In total, 34 PTNS and 31 TENS subjects were included in our final analysis. Overall, 48% (16/34) of PTNS subjects versus 29% (11/33) of TENS subjects were no longer at risk for FSD (FSFI > 26.55) after 12 weekly treatments. Both PTNS and TENS subjects demonstrated similar improvements in FSFI total scores after 12 weeks of treatments. Interestingly, patients who did not present with baseline urogenital distress symptoms reported a statistically significant larger improvement in sexual satisfaction after PTNS treatments as compared to placebo (p = 0.017). This study demonstrated a sustained efficacy of PTNS in improving sexual function. Specifically, patients who did not have coexisting urinary dysfunction reported significant improvement in sexual satisfaction after PTNS. Our study suggested that PTNS may have a direct neuromodulation effect on sexual dysfunction and may hold promise as a treatment modality for FSD.

Overview of nerve entrapment syndromes in the foot and ankle.

Tunnel syndromes around the foot and ankle are underrecognized and frequently misdiagnosed nerve entrapments that can significantly impact patients' quality of life. This review aims to provide a comprehensive overview of the etiology, clinical presentation, diagnostic challenges, and management strategies for these syndromes, focusing on the sural nerve, deep peroneal nerve, tibial nerve, medial plantar nerve, and inferior calcaneal nerve. A thorough literature review was conducted, examining studies and case reports on nerve entrapments in the foot and ankle. The review covers the clinical assessment, differential diagnosis, and treatment options, including conservative and surgical interventions. Tunnel syndromes of the foot and ankle can arise from various causes, including trauma, anatomical variations, repetitive strain, and systemic conditions. Clinical manifestations often include burning pain, tingling, and motor weakness, depending on the affected nerve. Accurate diagnosis relies on a detailed patient history, physical examination, and adjunctive tests such as electrodiagnostic and imaging. Conservative treatments, such as physical therapy, orthotics, and corticosteroid injections, are often effective, while surgical decompression is reserved for refractory cases. Recognizing and diagnosing tunnel syndromes in the foot and ankle is essential for effective management and preventing permanent nerve damage. A systematic approach that integrates clinical evaluation and appropriate imaging can improve patient outcomes. Timely intervention, whether conservative or surgical, is crucial for alleviating symptoms and restoring function.

Usefulness of serum neurofilament light chain in chronic inflammatory demyelinating polyradiculoneuropathy.

Usefulness of serum neurofilament light chain in chronic inflammatory demyelinating polyradiculoneuropathy.

Selective RNAi silencing of Schwann cell Piezo1 alleviates mechanical hypersensitization following peripheral nerve injury.

Selective RNAi silencing of Schwann cell Piezo1 alleviates mechanical hypersensitization following peripheral nerve injury.

Association of COMT genetic polymorphism with neuromodulation treatment response in women with fecal or urinary incontinence.

Association of COMT genetic polymorphism with neuromodulation treatment response in women with fecal or urinary incontinence.

Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations

Minimally invasive therapies for older patients with urgency urinary incontinence: Current evidence and recommendations

A First-In-Human Feasibility Study of a New Implantable Tibial Nerve Stimulator for Overactive Bladder Syndrome.

A First-In-Human Feasibility Study of a New Implantable Tibial Nerve Stimulator for Overactive Bladder Syndrome.

The management of urinary incontinence in nursing homes: a scoping review

The aim of the research was to identify interventions for the management of urinary incontinence (UI) in nursing homes. A scoping review was conducted with methods adapted from The Joanna Briggs Institute reviewers&amp;#x2019; manual 2015 methodology for conducting scoping reviews and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Findings were synthesised without meta-analysis. Databases that were searched were MEDLINE, Embase, PsychINFO, CINAHL, JBI Evidence-Based Practice Database and the Cochrane Database of Systematic Reviews from 2010 to September 2021. The search was augmented with hand searching. A total of 3,885 records were located. After exclusions and screening of 370 full-text articles, 30 publications were included &amp;#x2013; seven systematic reviews, 15 randomised-controlled trials, seven quasi-experimental studies and one cohort study. Studies addressed toileting assistance programs, exercise programs, drug therapies, technology-based interventions, education programs and multi-component interventions. Multi-component interventions facilitated by specialist healthcare professionals offer the strongest evidence. Evidence about exercise programs was limited and inconsistent, as was evidence for anticholinergics. Transcutaneous posterior tibial nerve stimulation is unlikely to reduce rates of UI in nursing homes with residents with high rates of cognitive impairment. Further evidence is required on the use of telemonitoring systems. Education programs for staff that provide on-site support and competency-based learning, led by specialist healthcare professionals, improve staff knowledge, attitudes and compliance with assessments, toileting and documentation. Education about person-centred approaches is required to provide appropriate care for residents living with dementia. We conclude that a multicomponent approach led by a specialist such as a nurse with advanced clinical and leadership skills offers the most benefit. Nursing home policies and practices should focus on education programs for staff, with interventions that increase residents&amp;#x2019; choice, activity level, nutritional status, hydration and toileting opportunities.

9 Percutaneous Tibial Nerve Stimulation for Overactive Bladder Syndrome: a single-arm trial

9 Percutaneous Tibial Nerve Stimulation for Overactive Bladder Syndrome: a single-arm trial

Impact of Bowel Diary Completion and Education on Fecal Incontinence Severity.

This study aimed to determine the effect of a run-in period on fecal incontinence (FI) symptom severity. This study conducted a planned secondary analysis of the run-in period to a study evaluating the effect of 12-week treatment with percutaneous tibial nerve stimulation versus sham in reducing FI severity in women. All participants completed a 4-week run-in period designed to exclude from randomization women whose symptoms reduced below the eligibility threshold after receiving education on FI and completing bowel diaries. Change in St Mark's (Vaizey) score and weekly FI episodes during the run-in period (week 1 vs week 4) was assessed. One hundred and eighty-five women completed the run-in period. The mean St Mark's (Vaizey) score was 17.8 ± 2.6 and 16.9 ± 3.5 at week 1 and week 4, respectively. There was no significant change in the St Mark's (Vaizey) score from week 1 to week 4 (mean change, -0.93 [95% CI, -1.56 to -0.31]). The average number of FI episodes per week did not change significantly between week 1 and week 4, nor did other bowel diary measures. Only 11 (6%) women became ineligible for the trial following the run-in period, all of whom had baseline St Mark's (Vaizey) scores of 18 or lower. Completion of a bowel diary and receiving education on FI during the 4-week run-in period did not significantly affect symptom severity in women with FI. Only 6% of women became ineligible for participation following the run-in period, suggesting that, in a refractory population, a run-in period may have minimal effect.

Optimizing Outcomes in Mangled Lower Extremity Reconstruction: Insights from a Retrospective Study of 93 Patients and Their Functional Scores.

Background/Objectives: Over the past 25 years, reconstructive techniques and patient management advancements have significantly improved outcomes in mangled lower extremity injuries. Functional results of limb salvage have been demonstrated to surpass those of primary amputations. Developments such as local fasciocutaneous flaps, vacuum-assisted closure, and hyperbaric oxygen therapy have enhanced the reconstructive ladder. Despite progress, the utility of the Mangled Extremity Severity Score (MESS) and Gustilo-Anderson classification remains debated, particularly in their prognostic value for limb salvage decisions. In the study, we aimed to evaluate the outcomes of optimizing mangled lower extremity reconstruction in 93 patients, focusing on their functional scores retrospectively. Methods: This retrospective study analyzed 93 patients treated for mangled lower extremities between January 2015 and October 2022. Patients were assessed for age, gender, injury location, MESSs, Gustilo-Anderson classifications, surgical methods, and functional outcomes using the Lower Extremity Functional Scale (LEFS). Surgical interventions included internal and external fixation, skin grafts, local flaps, muscle flaps, and free tissue transfer. LEFS scores were categorized into disability levels for functional evaluation. Correlations were drawn between LEFS and variables such as MESS, Gustilo-Anderson types, and nerve injuries. Results: Among the 93 patients, 16 had MESSs ≥ 7, and 77 had MESSs < 7. Reconstruction methods included local fasciocutaneous and muscle flaps (37 patients), free tissue transfer (29 patients), and skin grafting with vacuum-assisted closure (27 patients). Smoking was associated with delayed union and increased infection rates. LEFS scores were significantly lower in patients with MESSs ≥ 7, Gustilo grade 3C fractures, and tibial nerve injuries. Flap failures and a higher number of surgeries (>3) also correlated with poorer functional outcomes. The average soft tissue healing time was 18 days, and bone union time was 17 weeks. Conclusions: Lower extremity reconstruction demands precise surgical planning and execution, prioritizing functional restoration. MESSs and Gustilo-Anderson classifications provide practical frameworks but have limitations in predicting long-term functionality. Factors such as joint involvement, nerve injuries, and flap selection significantly influence outcomes. Smoking and delayed healing remain critical challenges. While free flaps are essential for complex defects, more straightforward methods yield better outcomes in suitable cases. LEFS emerged as a reliable tool.

Optimal interventions for low anterior resection syndrome: Bayesian network meta-analysis of randomized controlled trials

BackgroundThe optimal intervention for managing low anterior resection syndrome (LARS) remains uncertain. This Bayesian network meta-analysis was conducted to compare and rank the effectiveness of various interventions on LARS.MethodsRandomized controlled trials (RCTs) addressing interventions for LARS were extracted from six electronic databases until September 2023. A network meta-analysis was performed using a Bayesian random-effects and consistency model. The results were presented as mean differences (MDs) with credible interval (CrI) or standardized mean differences (SMDs) with CrI.ResultsA total of 11 RCTs were included. In the short term (≤ 6 months), transanal irrigation (TAI) had significant positive impacts on overall LARS symptoms (MD (95% CrI) −14.13 (−20.11, −7.83)) and the severity of bowel incontinence (SMD (95% CrI) −1.34 (−1.97, −0.71)) compared with the control group. Pelvic floor rehabilitation (PFR) also exhibited significant improvements in bowel incontinence as compared with the control group (SMD (95% CrI) −0.56 (−0.88, −0.23)). TAI was ranked highest for reducing LARS symptoms, followed by PFR, and percutaneous tibial nerve stimulation (PTNS). In the long term (> 6 months), the results indicated that TAI was most likely to rank first, followed by PTNS, and PFR; however, no significant differences were observed.ConclusionsIn the short term, TAI was identified as the most effective treatment for managing LARS, followed by PFR. Both TAI and PTNS demonstrated promising potential in enhancing bowel function over the long term. Further trials are needed to confirm these findings.

Comparison of the effects of transcranial direct current stimulation and transcutaneous tibial nerve stimulation on the urgency and frequency of women with overactive bladder syndrome: study protocol of a randomized clinical trial

BackgroundOveractive bladder syndrome is common, with a prevalence of 12–17% among adults. Posterior tibial nerve stimulation is the primary nonpharmacological and conservative treatment for overactive bladder syndrome. While several human brain imaging studies have shown the involvement of supraspinal centers in bladder control, a literature review has found that no research has specifically investigated cortical stimulation through transcranial direct current stimulation as a treatment for overactive bladder syndrome in women. Therefore, this study aims to assess the potential benefits of transcranial direct current stimulation (tDCS) and compare them with the effects of posterior tibial nerve stimulation on overactive bladder syndrome.Methods/designThe random allocation method will be used to divide the participants into two groups. Group 1 (n = 19) will undergo pelvic floor muscle training and transcutaneous tibial nerve stimulation. Group 2 (n = 19) will undergo pelvic floor muscle training and transcranial direct current stimulation. The transcranial direct current stimulation for group 2 will consist of 12 sessions occurring thrice a week, each lasting for 20 min. Anodal tDCS will be administered to FPz targeting the medial prefrontal cortex (mPFC) for 12 sessions, with the cathode electrode positioned between Oz and inion at an intensity of 2 mA for 20 min.DiscussionIt is believed that utilizing an approach involving non-invasive electrical stimulation of the cortex could lead to a more efficient treatment for individuals with overactive bladder. Additionally, it is theorized that combining the effects of tDCS and pelvic floor muscle training could present an innovative technique for alleviating the negative impacts of overactive bladder syndrome. Ultimately, this new method could provide help for patients who have not responded to conventional therapy.Trial registrationIranian Registry of Clinical Trials (IRCT) ID: IRCT20090301001722N26, registration date: May 17, 2023. https://en.irct.ir/.

Effect of Transcutaneous Tibial Nerve Stimulation in Multiparous Egyptian Women with Vaginal Laxity: A Randomized Controlled Trial.

Vaginal laxity (VL) is a common symptom of pelvic floor disorder, an underreported condition, and has a substantial impact on women's sex lives and relationships. The study aimed to determine the effect of transcutaneous tibial nerve stimulation (TTNS) on women with VL. Fifty women with vaginal laxity were chosen from an outpatient clinic in Egypt. They were randomly split into two equal categories (A and B). Group A (n = 25) received pelvic floor exercises (PFE), while Group B (n = 25) received TTNS and PFE. Every week, both groups performed three sessions for three months. The outcomes were evaluated both before and following treatment using ultrasound imaging to assess pelvic floor muscle (PFM) function and the Female Sexual Function Index to measure sexual function. Vaginal Laxity Questionnaire (VLQ) were used to examine vaginal looseness. The analysis demonstrated a significant improvement in vaginal laxity in both groups. Post-treatment comparisons revealed a statistically significant difference in VLQ scores and PFM strength between Groups B and A. These findings indicate that TTNS is notably more effective in improving PFM activity and VLQ scores in women with vaginal laxity.

The Recurrence of Painful Neuromas of the Limbs Following TMR.

Background/Objectives: Neuropathic pain associated with neuromas is a complex clinical problem to treat. Targeted Muscle Reinnervation (TMR) has been demonstrated to treat pain both as a prophylactic procedure in amputated patients and in patients affected by painful neuromas. It is not clear what its role could be in chronic situations: the literature reports amazing results but also unsuccessful pain relief. Methods: A retrospective analysis was conducted on patients treated with TMR for long-lasting painful neuromas in the upper and lower limbs. Following a clinical and instrumental diagnosis, all patients responded positively to a local anesthetic block. During follow-up visits, the NRS and DN4 questionnaires were used to assess improvement in pain. Results: Three patients were included in this study. TMR was performed 45 months after trauma. Two TMRs involved nerves of the upper extremity, in one case, the tibial nerve. The recipient muscles were the second lumbricalis, pronator quadratus, and flexor digitorum longus of the foot. After surgery, pain decreased for 3 months, but patients experienced a relapse that returned to levels close to the pre-operative period. The types of pain, as reported in DN4 questionnaire, changed slightly compared to those in the pre-surgical period. Follow-up ranged between 12 and 19 months. Conclusions: This small series collected the results of TMR in patients affected by long-lasting symptomatic neuromas in the upper and lower extremities. Despite what is published in other series, this procedure reduced pain for up to 6 months. At final follow-up, the type of pain changed slightly as reported in the DN4 questionnaire, and pain scores reduced by just one point as shown by the NRS. Our experience suggests that TMR might have a slight effect on long-lasting painful neuromas and in these cases, only short-term pain relief could be expected. This suggests using TMR as close as possible to the trauma in order to increase the chances of relieving pain.