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Tun Hing Lui - One of the best experts on this subject based on the ideXlab platform.
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endoscopic decompression of the first branch of the Lateral Plantar Nerve and release of the Plantar aponeurosis for chronic heel pain
Arthroscopy techniques, 2016Co-Authors: Tun Hing LuiAbstract:Entrapment of the first branch of the Lateral Plantar Nerve is a commonly missed cause of recalcitrant Plantar heel pain. The diagnosis is made on a clinical ground with maximal tenderness at the site of Nerve entrapment. Treatment of the Nerve entrapment is similar to that for Plantar fasciitis, with rest, activity modification, nonsteroidal anti-inflammatory drugs, stretching exercise, and local steroid injection. Surgical release of the deep abductor hallucis fascia is indicated when conservative treatment failed. Endoscopic release of the Nerve through the dorsal and Plantar portals, as well as endoscopic Plantar aponeurosis release, is a feasible approach.
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neurilemmoma of the first branch of the Lateral Plantar Nerve causing tarsal tunnel syndrome
Foot and Ankle Specialist, 2009Co-Authors: Ka Bon Kwok, Tun Hing LuiAbstract:In this article, the authors report a case of tarsal tunnel syndrome caused by neurilemmoma of the first branch of the Lateral Plantar Nerve, with symptom resolved after excision. A 42-year-old man presented with left medial heel pain radiating to the Lateral sole for 6 months. On examination, there was positive Tinel sign over the medial heel with pain radiating to the Lateral sole. Ultrasonography and magnetic resonance imaging confirmed the presence of a 1-cm neurogenic tumor inside the tarsal tunnel. Intraoperatively, a 1-cm neurilemmoma was found at the first branch of the Lateral Plantar Nerve inside the tarsal tunnel. The lesion was excised completely with preservation of its fascicle. The symptom resolved completely after the operation.
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anatomy of the portal tract for endoscopic decompression of the first branch of the Lateral Plantar Nerve
Arthroscopy, 2008Co-Authors: L K Chan, Tun Hing Lui, Kwok Bill ChanAbstract:Purpose Our purpose is to study the anatomy of the portal tract for endoscopic decompression of the first branch of the Lateral Plantar Nerve. Methods The anatomy of the portals and portal tract with endoscopic release of the first branch of the Lateral Plantar Nerve was studied in 12 feet in 6 cadaveric bodies. Results The proximal portal is located at the fascial opening for the first branch of the Lateral Plantar Nerve and is about 16 mm inferior and 23 mm posterior to the tip of the medial malleolus. The distal portal is located at the inferior edge of the deep fascia of the abductor hallucis muscle and just distal to the medial calcaneal tubercle. The portal tract is deep to the deep surface of the whole width of the deep abductor fascia. In 1 of 12 specimens, the Nerve lay superficial to a rod placed between the portals, whereas the Nerve was deep to the rod in the remaining 11 specimens. In all specimens the first branch of the Lateral Plantar Nerve, after it pierced the deep fascia of the abductor hallucis at the fascial defect, ran anteriorly and distally, approximately parallel to the direction of the rod. Conclusions The proximal portal for endoscopic decompression of the first branch of the Lateral Plantar Nerve is located at the fascial opening for the first branch of the Lateral Plantar Nerve. This can be consistently located with the Wissinger rod technique. The portal tract thus created is effective for deep abductor fascia release. However, percutaneous release without endoscopic visualization of the first branch of the Lateral Plantar Nerve is not safe because of the potential risk of Nerve injury, because the Nerve can be sandwiched between the instrument and the deep abductor fascia without being noticed. Clinical Relevance The study confirmed the first branch of the Lateral Plantar Nerve can be effectively released endoscopically.
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arthroscopy and endoscopy of the foot and ankle indications for new techniques
Arthroscopy, 2007Co-Authors: Tun Hing LuiAbstract:The scope of arthroscopy and endoscopy of the foot and ankle is expanding. New techniques are emerging to deal with diverse ankle pathology. Some of the conditions that can be dealt with arthroscopically are as follows: hallux valgus deformity, lesser toe deformity, first metatarsophalangeal instability, cock-up deformity of the big toe, peroneal tendon instability, Lateral ankle and subtalar instability, hindfoot deformity or arthrosis, first metatarsocuneiform hypermobility, Lisfranc joint arthrosis, various stages of posterior tibial tendon insufficiency, foot and ankle arthrofibrosis, late complications after calcaneal fracture, acute and chronic Achilles tendon rupture, insertional Achilles tendinopathy, entrapment of the first branch of the Lateral Plantar Nerve, Freiberg's infarction, flexor digitorum longus tenosynovitis, flexor hallucis longus pathology, calcaneonavicular coalition or "too-long" anterior process of the calcaneus, and ganglions. With sound knowledge regarding the indications, merits, and potential risks of new techniques, they will be powerful tools in foot and ankle surgery.
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endoscopic decompression of the first branch of the Lateral Plantar Nerve
Archives of Orthopaedic and Trauma Surgery, 2007Co-Authors: Tun Hing LuiAbstract:Entrapment of the first branch of the Lateral Plantar Nerve is one the cause of Plantar heel pain. It is easily overlooked. Surgical treatment classically utilizes a long medial incision with release of both the superficial and deep fascia of the abductor hallucis muscle. We decompress the Nerve by release of the deep abductor hallucis fascia under arthroscopic visualization. By this approach, the soft tissue trauma and risk of wound complications can be minimized.
C Hildebrand - One of the best experts on this subject based on the ideXlab platform.
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functional projection of sensory Lateral Plantar and superficial peroneal Nerve axons to glabrous and hairy skin of the rat hindfoot after sciatic Nerve lesions
Experimental Neurology, 1994Co-Authors: B Povlsen, C Hildebrand, N StankovicAbstract:The functional regeneration of C-fibers mediating polymodal nociception and low-threshold mechanoreceptive axons in the Lateral Plantar Nerve (LPN) and the foot branch of the superficial peroneal Nerve (fSPN) was evaluated in normal rats and 3 months after uniLateral sciatic Nerve crush or neurotomy and suture. The area covered by low-threshold mechanoreceptors (LTMs) was tested through gentle mechanical skin stimulation and recording from the relevant Nerve. In regenerated animals the glabrous skin area with functional LPN-related LTMs was severely reduced following a crush lesion. Functional receptors of that type were absent after neurotomy and suture. The hairy skin area with fSPN-related LTMs was smaller than normal, particularly following neurotomy and suture. The distribution of polymodal C-fibers was tested through stimulation-induced extravasation of Evans blue albumin (EBA). In the glabrous LPN skin domain the area showing EBA extravasation did not return to normal after any of the lesion types. However, in the hairy fSPN skin area the distribution of EBA extravasation appeared largely normal following both injuries. We conclude that polymodal nociception reappears to a greater extent than low threshold mechanosensitivity, and that both modalities regenerate better in hairy skin than in glabrous skin.
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axonal regeneration in the foot branch of the superficial peroneal Nerve and the Lateral Plantar Nerve of the rat after sciatic Nerve lesions
Restorative Neurology and Neuroscience, 1994Co-Authors: B Povlsen, N Stankovic, P Danielsson, C HildebrandAbstract:Hand injuries with Nerve lesions often leave the patient with a persistent sensory deficit, particularly with respect to glabrous skin. The present study examines axonal regeneration in the foot branch of the superficial peroneal Nerve (fSPN) and the Lateral Plantar Nerve (LPN), supplying hairy skin and glabrous skin together with some intrinsic muscles, respectively, after sciatic Nerve lesions in the rat. Following crush lesions, the number of myelinated axons is normal in the fSPN, and the occurrence of C-fibers appears slightly reduced. In the LPN, the numbers of myelinated axons and C-fibers are both significantly increased. Post-crush regenerated myelinated fSPN and LPN axons show normal size ranges, but the proportion of small myelinated axons is increased. After neurotomy and suture, the numbers of myelinated axons and C-fibers in the fSPN are not significantly different from normal. The LPN exhibits a significantly increased number of myelinated axons, but the number of C-fibers is not significantly abnormal. In both Nerves, the myelinated axons present an abnormally narrow size range. These findings show that the quantitative outcome of regeneration in a Nerve innervating glabrous skin (and some intrinsic muscles) differs significantly from that of branches to hairy skin of the foot, with respect to myelinated as well as unmyelinated axons. To what extent these differences mirror functional differences awaits elucidation.
B Povlsen - One of the best experts on this subject based on the ideXlab platform.
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functional projection of sensory Lateral Plantar and superficial peroneal Nerve axons to glabrous and hairy skin of the rat hindfoot after sciatic Nerve lesions
Experimental Neurology, 1994Co-Authors: B Povlsen, C Hildebrand, N StankovicAbstract:The functional regeneration of C-fibers mediating polymodal nociception and low-threshold mechanoreceptive axons in the Lateral Plantar Nerve (LPN) and the foot branch of the superficial peroneal Nerve (fSPN) was evaluated in normal rats and 3 months after uniLateral sciatic Nerve crush or neurotomy and suture. The area covered by low-threshold mechanoreceptors (LTMs) was tested through gentle mechanical skin stimulation and recording from the relevant Nerve. In regenerated animals the glabrous skin area with functional LPN-related LTMs was severely reduced following a crush lesion. Functional receptors of that type were absent after neurotomy and suture. The hairy skin area with fSPN-related LTMs was smaller than normal, particularly following neurotomy and suture. The distribution of polymodal C-fibers was tested through stimulation-induced extravasation of Evans blue albumin (EBA). In the glabrous LPN skin domain the area showing EBA extravasation did not return to normal after any of the lesion types. However, in the hairy fSPN skin area the distribution of EBA extravasation appeared largely normal following both injuries. We conclude that polymodal nociception reappears to a greater extent than low threshold mechanosensitivity, and that both modalities regenerate better in hairy skin than in glabrous skin.
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axonal regeneration in the foot branch of the superficial peroneal Nerve and the Lateral Plantar Nerve of the rat after sciatic Nerve lesions
Restorative Neurology and Neuroscience, 1994Co-Authors: B Povlsen, N Stankovic, P Danielsson, C HildebrandAbstract:Hand injuries with Nerve lesions often leave the patient with a persistent sensory deficit, particularly with respect to glabrous skin. The present study examines axonal regeneration in the foot branch of the superficial peroneal Nerve (fSPN) and the Lateral Plantar Nerve (LPN), supplying hairy skin and glabrous skin together with some intrinsic muscles, respectively, after sciatic Nerve lesions in the rat. Following crush lesions, the number of myelinated axons is normal in the fSPN, and the occurrence of C-fibers appears slightly reduced. In the LPN, the numbers of myelinated axons and C-fibers are both significantly increased. Post-crush regenerated myelinated fSPN and LPN axons show normal size ranges, but the proportion of small myelinated axons is increased. After neurotomy and suture, the numbers of myelinated axons and C-fibers in the fSPN are not significantly different from normal. The LPN exhibits a significantly increased number of myelinated axons, but the number of C-fibers is not significantly abnormal. In both Nerves, the myelinated axons present an abnormally narrow size range. These findings show that the quantitative outcome of regeneration in a Nerve innervating glabrous skin (and some intrinsic muscles) differs significantly from that of branches to hairy skin of the foot, with respect to myelinated as well as unmyelinated axons. To what extent these differences mirror functional differences awaits elucidation.
N Stankovic - One of the best experts on this subject based on the ideXlab platform.
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functional projection of sensory Lateral Plantar and superficial peroneal Nerve axons to glabrous and hairy skin of the rat hindfoot after sciatic Nerve lesions
Experimental Neurology, 1994Co-Authors: B Povlsen, C Hildebrand, N StankovicAbstract:The functional regeneration of C-fibers mediating polymodal nociception and low-threshold mechanoreceptive axons in the Lateral Plantar Nerve (LPN) and the foot branch of the superficial peroneal Nerve (fSPN) was evaluated in normal rats and 3 months after uniLateral sciatic Nerve crush or neurotomy and suture. The area covered by low-threshold mechanoreceptors (LTMs) was tested through gentle mechanical skin stimulation and recording from the relevant Nerve. In regenerated animals the glabrous skin area with functional LPN-related LTMs was severely reduced following a crush lesion. Functional receptors of that type were absent after neurotomy and suture. The hairy skin area with fSPN-related LTMs was smaller than normal, particularly following neurotomy and suture. The distribution of polymodal C-fibers was tested through stimulation-induced extravasation of Evans blue albumin (EBA). In the glabrous LPN skin domain the area showing EBA extravasation did not return to normal after any of the lesion types. However, in the hairy fSPN skin area the distribution of EBA extravasation appeared largely normal following both injuries. We conclude that polymodal nociception reappears to a greater extent than low threshold mechanosensitivity, and that both modalities regenerate better in hairy skin than in glabrous skin.
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axonal regeneration in the foot branch of the superficial peroneal Nerve and the Lateral Plantar Nerve of the rat after sciatic Nerve lesions
Restorative Neurology and Neuroscience, 1994Co-Authors: B Povlsen, N Stankovic, P Danielsson, C HildebrandAbstract:Hand injuries with Nerve lesions often leave the patient with a persistent sensory deficit, particularly with respect to glabrous skin. The present study examines axonal regeneration in the foot branch of the superficial peroneal Nerve (fSPN) and the Lateral Plantar Nerve (LPN), supplying hairy skin and glabrous skin together with some intrinsic muscles, respectively, after sciatic Nerve lesions in the rat. Following crush lesions, the number of myelinated axons is normal in the fSPN, and the occurrence of C-fibers appears slightly reduced. In the LPN, the numbers of myelinated axons and C-fibers are both significantly increased. Post-crush regenerated myelinated fSPN and LPN axons show normal size ranges, but the proportion of small myelinated axons is increased. After neurotomy and suture, the numbers of myelinated axons and C-fibers in the fSPN are not significantly different from normal. The LPN exhibits a significantly increased number of myelinated axons, but the number of C-fibers is not significantly abnormal. In both Nerves, the myelinated axons present an abnormally narrow size range. These findings show that the quantitative outcome of regeneration in a Nerve innervating glabrous skin (and some intrinsic muscles) differs significantly from that of branches to hairy skin of the foot, with respect to myelinated as well as unmyelinated axons. To what extent these differences mirror functional differences awaits elucidation.
Glenn B Pfeffer - One of the best experts on this subject based on the ideXlab platform.
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treatment of chronic heel pain by surgical release of the first branch of the Lateral Plantar Nerve
Clinical Orthopaedics and Related Research, 1992Co-Authors: Donald E Baxter, Glenn B PfefferAbstract:Sixty-nine heels (53 patients) with chronic heel pain had a surgical release of the first branch of the Lateral Plantar Nerve. The average duration of heel-pain symptoms was 23 months (range, six months to eight years). No patient had less than six months of conservative treatment before surgery. Th
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treatment of chronic heel pain by surgical release of the first branch of the Lateral Plantar Nerve
Clinical Orthopaedics and Related Research, 1992Co-Authors: Donald E Baxter, Glenn B PfefferAbstract:Sixty-nine heels (53 patients) with chronic heel pain had a surgical release of the first branch of the Lateral Plantar Nerve. The average duration of heel-pain symptoms was 23 months (range, six months to eight years). No patient had less than six months of conservative treatment before surgery. The average duration of preoperative conservative treatment was 14 months. Forty-four patients (83%) had taken nonsteroidal antiinflammatory agents. Sixty-three heels (91%) had used heel cups and/or orthoses. Fifty-nine heels (86%) had received one or more injections of a steroid preparation. Thirty-four heels had developed pain initially during a sports activity. Postoperatively, 61 heels (89%) had excellent or good results; 57 heels (83%) had complete resolution of pain. The average follow-up period was 49 months. In general, heel pain resolves with conservative treatment. In recalcitrant cases, however, entrapment of the first branch Lateral Plantar Nerve should be suspected. Surgical release of this Nerve can be expected to provide excellent relief of pain and facilitate return to normal activity.
