Name the nerves on the foot?
Know the names of these nerves?
Name the dermatomes in the foot?
1. Saphenous nerve
2. Deep peroneal nerve
3. Superficial peroneal nerve
4. Medial plantar nerve
5. Lateral plantar nerve
6. Calcaneal branch
7. Sural nerve
Name the dermatome nerves in these areas?
Know the sagittal dermatome areas:
What is tarsal tunnel sydrome?
Entrapment of the 1? around the 2?
Caused generally by 3?
worst at 5?
6? bilateral or unilateral
1. tibial nerve
2. medial malleolus and in the tarsal tunnel
3. proliferation or oedema of the connective tissues within the tarsal tunnel, reducing the tunnel volume.
4. diagnosis with insidious onset of heel pain, radiating to the plantar and at times proximally.
5. At night.
Later stage muscle wasting can be found in AbH.
6. Generally unilateral.
What are the risk factors for Tarsal tunnel syndrome?
Varicoities, heel valgus/everted heel
Less common nerve entrapments
Deep peroneal nerve (dpn) entrapment (anterior tarsal tunnel syndrome ATTS)/ Why 1? Look at what 2?
Superficial peroneal nerve (spn) entrapment
Positive test when 4?
Sural nerve entrapment
Compression from 5?
1. Talonavicular joint ossicles impingmentin sports people. Tarsometatarsal pain when stretched over osteophytes in older. 2. Look at shoes, lacing technique
3. Trauma, local masses i.e. ganglion
4. Palpating in active dorsiflexion and eversion of the foot against resistance causes pain.
5. other disorder ie, styloid fracture, malleolus fracture, ankle trauma leading to muscle hypertrophy and fascial scarring.
Less common nerve entrapments
Saphenous nerve entrapment
•More proximal entrapment 1?
•Completely sensory!! If not think radiculopathy.
Medial plantar nerve entrapment (syn: joggers foot)
Foot conditions 3?
Entrapment of the first branch of the lateral plantar nerve (Baxter’s nerve)
1. around knee or from gastrocswith medial knee and calf pain experienced with paraesthesia of the dorsum medial foot through to 1stray.
2. Athletes with intermittent medial midfoot pain, high arched orthotics causing impingement
3. Valgus hindfoot, positive Tinel’s, pain on ankle eversion and worse on tip toe.
4. Heel pain radiating into the ankle without paraesthesia’s.
5.Cushioning heel cup orthoses with NSAID’s.
What are the common observations and simple assessments for nerve entrapments?
Oedema or lesion causing 3?
Balance-single leg and double heel raise
Cold/heat perception tests
1. tonicity-?unilaterally similar
2. alignment-?muscular weakness
3. causing ^ pressure
4. strength-?muscular deficit
What is the straight leg raise test :
Positive on reproduction 1? when 2? . Can rule out radiculopathy!
Tightness of 3?
Dorsiflex and evert/invert depending on medial or lateral nerve specification
1. of neural symptoms 2. less than 40degrees and is indicative of herniated disc
3.hamstrings able to be assessed for contribution
Reflexes and clonus
Patella reflex-when absent consider 1?
Achilles reflexes-when absent consider 2?
Sciatic nerve pathology such as disc herniation at 3? level
Clonus is a series of 4?
Could be a 5?
1. L2-L4 nerve root concern
2. S1-S2 nerve root concern
4. involuntary, rhythmic, muscular contractions and relaxations
5. cerebellar concern, upper motor neuron lesion, hyperthyroidism, anxiety, previous stroke, multiple sclerosis, hepatic encephalopathy.
Percussion along the 1?
Positive when 2?
When positive indicates the 3?
Check all potential nerves and mark each point that is positive-multiple is common
1. nerve pathways
2. Reproduction of symptoms experienced
3. local area of nerve irritation, damage or concern.
What could be done in terms of footwear and lacing for nerve entrapments?
1? footwear with rocker bottoms.
3? for ankle support and midfoot relief.
2. High ankle cupping
3. Loop lock lacing
•‘Reza Special’ 1?
The action 2?
1. Kenacort1ml, dexamethasone 1ml, lignocaine 1% 1ml-inject up to 2ml depending on location.
2. Decreases inflammation, sensitisation AND healing
1. Lignocaine 2% 5ml, saline 5ml-dependent on location 5-20ml
2. Separate tissues whilst desensitising nerve. Nociceptive reset ?
Used to 2?
1. Dextrose up to 25% in lignocaine 2%-surrounding irritated nerve.
2. stimulate inflammatory pathway to repair tissues.
What are the actions of LLLT/PBMT?
1. Tissue repair
What are the branches of Sciatic nerve:
1. Tibial nerve
2. Common peroneal nerve
What are the branches of common peroneal nerve:
1. Superficial peroneal nerve
2. Deep peroneal nerve
Where does Sural nerve come from?
Sural nerve has a branch from the tibial nerve and the common peroneal nerve
What is the lateral cutaneous nerve and where does it intervate in the leg?
Lateral cutaneous nerve is the first branch of the common peroneal nerve and it innervates the upper 2/3 of lateral leg
Where does the Sural nerve innervate?
Sural nerve innervate the lateral dorsal part of the foot
Where does the tibial nerve innervate?
Basically all the posterior muscle of the leg and foot
except flexor digitorium brevis and flexor hallucis brevis
At which level does the tibial nerve divide into medial and lateral brnaches?
At the level of medial malleoli
Know the motor of sensory innervation of the medial and lateral plantar nerves:
1. What is Baxter's nerve and what does it do?
2. How can it get trapped?
1. Baxter's nerve is the first branch of lateral plantar nerve and carries pain sensation to the plantar fasciitis.
2. The Baxter nerve can get trapped between the abductor hallucis and quadratus plantea.
What are the medial and lateral brnaches of superficial peroneal nerve and where does it innervate?
Medial branch: Medial dorsal cutaneous nerve
Lateral branch: Intermediate dorsal cutaneous nerve
Which part of the leg does the sepahneous nerve run?
Runs throught the medial part of the leg
Name the cutaneous nerve supply to the planat aspect of the foot from medial to lateral:
Medial plantar nerve
Lateral plantar nerve
At the heel: Medial calcaneal branch