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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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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.
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.
Donald E Baxter - 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.
David N Herrmann - One of the best experts on this subject based on the ideXlab platform.
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yield of the sural radial ratio versus the medial Plantar Nerve in sensory neuropathies with a normal sural response
Journal of Clinical Neurophysiology, 2008Co-Authors: John P Sullivan, Eric L Logigian, Naira Kocharian, David N HerrmannAbstract:Abstract:The electrodiagnostic yield of the medial Plantar Nerve action potential (NAP) amplitude versus the sural/radial amplitude ratio (SRAR) was determined in 110 consecutive patients with clinically diagnosed distal sensory polyneuropathy (SN) and normal sural responses. Forty-five consecutive
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Plantar Nerve ap and skin biopsy in sensory neuropathies with normal routine conduction studies
Neurology, 2004Co-Authors: David N Herrmann, Michele Ferguson, Valerie Pannoni, Richard L Barbano, Michael Stanton, Eric L LogigianAbstract:Objective: To assess the medial Plantar Nerve action potential (NAP) and skin biopsy in the evaluation of suspected distal sensory neuropathies (SN) with normal routine Nerve conduction studies (NCS). Methods: A total of 110 consecutive patients with suspected distal SN and normal routine NCS underwent medial Plantar NAP testing and punch skin biopsy. Patients were clinically stratified as having pure small fiber sensory neuropathy (SFSN), or distal SN with large fiber involvement (SN-LFI). Results: A total of 56 patients were classified as SN-LFI and 54 SFSN. The medial Plantar NAP, a measure of large fiber function, was abnormal in 31.8% of patients, more frequently in SN-LFI than SFSN. Distal leg epidermal Nerve fiber (ENF) density, a measure of small fibers, was reduced in 47.3% of biopsies, with isolated ENF morphologic changes in 29.1% and normal findings in 23.6%. Biopsy abnormalities were more severe and prevalent in SN-LFI than in SFSN. In patients with a normal medial Plantar NAP, distal leg biopsy showed reduced ENF density in 34.7%, and isolated morphologic changes in a further 37% of cases. Conclusions: The medial Plantar Nerve action potential and skin biopsy are complementary in evaluation of distal SN with normal routine NCS. Small sensory Nerve fibers are affected early in SN, and more severely so when large fiber involvement is apparent clinically.
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class of Nerve fiber involvement in sensory neuropathies clinical characterization and utility of the Plantar Nerve action potential
Muscle & Nerve, 2002Co-Authors: Hiroyuki Nodera, Eric L Logigian, David N HerrmannAbstract:Precise classification of distal sensory polyneuropathies (SN) according to fiber type involvement is desirable for clinical and research purposes. The sural sensory response has served as an electrophysiologic gold standard for the assessment of large-fiber sensory dysfunction. However, patients labeled as having small-fiber sensory neuropathies on the basis of a normal sural response frequently have clinical evidence of large-fiber dysfunction. The surface-recorded medial Plantar potential has shown promise as a more sensitive indicator of large-fiber sensory dysfunction, but is not widely accepted because of concerns about age effects and a lack of large well-controlled studies in SN. We have thus correlated clinical type of SN: large-fiber sensory neuropathies (LFSN), small-fiber sensory neuropathies (SFSN), and mixed (large- and small-fiber) sensory neuropathies (MFSN) with sural and medial Plantar Nerve conduction studies in 133 consecutive patients with distal SN and 108 control subjects. A combination of stringent clinical characterization and electrophysiologic features, especially the surface-recorded medial Plantar rather than sural potential, was complementary, and permitted a more clear separation of LFSN, MFSN, and SFSN than with either approach used alone.
Bahman Jabbari - One of the best experts on this subject based on the ideXlab platform.
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painful legs and moving toes associated with tarsal tunnel syndrome and accessory soleus muscle
Movement Disorders, 1996Co-Authors: Timothy R Dillingham, Nicholas T Spellman, Edgar Colon, Bahman JabbariAbstract:: Painful legs, moving toes is a rare syndrome characterized by leg pain and uncontrolled toe movements. We present a 35-year-old man with a 1-year history of unilateral knee, calf, and medial ankle pain with spontaneous movements of second through fifth toes. Electrodiagnostic studies showed an absent lateral Plantar Nerve response consistent with a tarsal tunnel entrapment neuropathy. Cine magnetic resonance imaging revealed a large accessory soleus muscle compressing the flexor hallucis longus in the tarsal tunnel of the affected extremity. Lidocaine block of the tibial Nerve at the popliteal fossa did not stop these movements, but blockade of the medial and lateral Plantar Nerves distal to the medial malleolus stopped them temporarily. Treatment with foot orthotics and cessation of running activity decreased the symptoms. We conclude that painful leg and moving toes in this patient resulted from a compression neuropathy at the tarsal tunnel possibly caused by a large adjacent accessory soleus muscle.
