home Audience 6 Neuropathy of the medial calcaneal branches of the tibial nerve. Symptoms and treatment of tibial nerve neuritis

Neuropathy of the medial calcaneal branches of the tibial nerve. Symptoms and treatment of tibial nerve neuritis

In the diagnosis of pathology, the main thing is the analysis of anamnestic data and a neurological examination, auxiliary methods are EMG, ENG, ultrasound of the nerve, radiography and CT scan of the foot and ankle. Treatment is possible conservative (anti-inflammatory, neurometabolic, analgesic, vasoactive therapy) and surgical (neurolysis, decompression, removal of nerve tumor).

Tibial nerve neuropathy is part of the group of so-called peripheral mononeuropathies lower limbs which includes sciatic nerve neuropathy, femoral neuropathy, neuropathy of the peroneal nerve, neuropathy of the external cutaneous nerve of the thigh. The similarity of the clinic of tibial neuropathy with the symptoms of traumatic injuries to the musculoskeletal system of the leg and foot, as well as the traumatic etiology of most cases of the disease, makes it the subject of study and joint management of specialists in the field of neurology and traumatology. The connection of the disease with sports overload and repeated injuries determines the relevance of the problem for sports doctors.

The tibial nerve (n. tibialis) is a continuation of the sciatic nerve. Starting at the top of the popliteal fossa, the nerve passes it from top to bottom medially. Then, passing between the heads of the gastrocnemius muscle, the nerve lies between the flexor pollicis longus and the flexor digitorum longus. This way it reaches the medial malleolus. Approximately midway between the ankle and the Achilles tendon, you can feel the point of passage of the tibial nerve. Next, the nerve enters the tarsal canal, where it, together with the posterior tibial artery, is fixed by a powerful ligament - the flexor retinaculum. Upon exiting channel n. tibialis is divided into terminal branches.

In the popliteal fossa and beyond, the tibial nerve gives off motor branches to the triceps muscle, flexor pollicis and flexor digitorum, popliteal, posterior tibial and plantaris muscles; sensory internal cutaneous nerve of the leg, which, together with peroneal nerve innervates the ankle joint, the posterolateral surface of the lower 1/3 of the leg, the lateral edge of the foot and the heel. Terminal branches n. tibialis - medial and lateral plantar nerves - innervate the small muscles of the foot, the skin of the inner edge of the sole, the first 3.5 fingers and the dorsum of the remaining 1.5 fingers. The muscles innervated by the tibial nerve provide flexion of the lower leg and foot, elevation of the inner edge of the foot (i.e., internal rotation), flexion, adduction and abduction of the toes, and extension of their distal phalanges.

Causes of tibial nerve neuropathy

Femoral neuropathy is possible as a result of nerve injury with tibia fractures, isolated tibial fractures, dislocations ankle joint, injuries, tendon damage and foot sprains. The etiological factor can also be repeated sports injuries to the foot, foot deformities (flat feet, hallux valgus), prolonged uncomfortable position of the lower leg or foot with compression n. tibialis (often in those suffering from alcoholism), diseases of the knee or ankle joint ( rheumatoid arthritis, deforming osteoarthritis, gout), nerve tumors, metabolic disorders (diabetes mellitus, amyloidosis, hypothyroidism, dysproteinemia), nerve vascularization disorders (for example, vasculitis).

Most often, neuropathy of the tibial nerve is associated with its compression in the tarsal tunnel (the so-called tarsal tunnel syndrome). Compression of the nerve at this level can occur with fibrous changes in the canal in the post-traumatic period, tendovaginitis, hematomas, bone exostoses or tumors in the canal area, as well as with neurodystrophic disorders in the ligamentous-muscular apparatus of the joint of vertebrogenic origin.

Depending on the topic of the lesion n. tibialis in the clinical picture of its neuropathy, several syndromes are distinguished.

Tibial neuropathy at the level of the popliteal fossa is manifested by a disorder of downward flexion of the foot and impaired movement of the toes. The patient cannot stand on his toes. Walking with emphasis on the heel, without rolling the foot onto the toe, is typical. There is atrophy of the posterior group of muscles on the lower leg and muscles on the foot. As a result of muscle atrophy on the foot, it becomes like a clawed paw. There is a decrease in the tendon reflex from the Achilles. Sensory disorders include disturbances in tactile and pain sensitivity on the entire back of the lower leg and along the outer edge of its lower 1/3, on the sole, totally (on the dorsal and plantar surface) on the skin of the first 3.5 fingers and on the back of the remaining 1.5 fingers. Neuropathy of the tibial nerve of traumatic origin is characterized by a pronounced causalgic syndrome with hyperpathy (perverted hypersensitivity), edema, trophic changes and autonomic disorders.

Tarsal tunnel syndrome is sometimes caused by long walk or run. Characterized by burning pains in the sole, often radiating into the calf muscle. Patients describe painful sensations as deep, an increase in their intensity is noted when standing and walking. There is hypoesthesia of both the inner and outer edges of the foot, some flattening of the foot and slight “clawing” of the toes. The motor function of the ankle joint is fully preserved, the Achilles reflex is not impaired. Percussion of the nerve at the point between the inner malleolus and the Achilles tendon is painful and gives a positive Tinel sign.

Neuropathy at the level of the medial plantar nerve is common in long-distance and marathon runners. Manifests with pain and paresthesia on the inner edge of the sole and in the first 2-3 toes. Pathognomonic is the presence in the area of the scaphoid bone, percussion of which leads to the appearance of burning pain in the thumb.

Defeat n. tibialis at the level of the common digital nerves is called "Morton's metatarsal neuralgia." Typical for older women who are obese and walk a lot in heels. Pain is typical, starting at the arch of the foot and going through the bases of 2-4 toes to their tips. Walking, standing and running increase pain. Examination reveals trigger points between 2-3 and/or 3-4 metatarsal bones, Tinel's sign.

Calcanodynia is a neuropathy of the calcaneal branches of the tibial nerve. It can be triggered by jumping on your heels from a height, walking for a long time barefoot or wearing shoes with thin soles. Manifested by pain in the heel, numbness, paresthesia, hyperpathia. With pronounced intensity specified symptoms the patient walks without stepping on the heel.

Diagnosis of tibial nerve neuropathy

Important diagnostic value has a history taking. Establishing the fact of injury or overload, the presence of joint pathology, metabolic and endocrine disorders, orthopedic diseases, etc. helps determine the nature of the damage to the tibial nerve. A thorough study of the strength of various muscle groups of the lower leg and foot, the sensitive sphere of this area, carried out by a neurologist; identifying trigger points and Tinel's sign allows us to diagnose the level of damage.

Electromyography and electroneurography are of auxiliary importance. Determining the nature of nerve damage can be done using ultrasound. If indicated, an ankle x-ray, foot x-ray, or ankle CT scan is performed. In controversial cases, a diagnostic blockade of trigger points is performed, the positive effect of which confirms the compressive nature of the neuropathy.

Treatment of tibial nerve neuropathy

In cases where tibial nerve neuropathy develops as a consequence background disease, it is necessary first of all to treat the latter. It could be wearing orthopedic shoes, therapy for arthrosis of the ankle joint, correction of endocrine imbalance, etc. For compression neuropathies, therapeutic blockades with triamcinolone, diprospan or hydrocortisone in combination with local anesthetics (lidocaine) have a good effect. It is mandatory to include drugs to improve metabolism and blood supply to the tibial nerve in the prescribing list. These include injections of Vit B1, Vit B12, Vit B6, nicotinic acid, pentoxifylline drips, and alpha-lipoic acid.

According to indications, therapy may include reparants (Actovegin, Solcoxeril), anticholinesterase agents (neostigmine, ipidacrine). For intense pain and hyperpathy, it is recommended to take anticonvulsants (carbamazepine, pregabalin) and antidepressants (amitriptyline). Of the physiotherapeutic methods, the most effective are ultraphonophoresis with hydrocortisone ointment, shock wave therapy, magnetic therapy, electrophoresis with hyaluronidase, and UHF. To restore muscles that atrophy as a result of neuropathy n. tibialis, requires massage and exercise therapy.

Surgical treatment is necessary to remove formations compressing the trunk of the tibial nerve, as well as if it is unsuccessful conservative therapy. The intervention is carried out by a neurosurgeon. During the operation, it is possible to perform decompression, remove a nerve tumor, release the nerve from adhesions, and perform neurolysis.

Neuropathy and other tibial nerve injuries

Damage to the tibial nerve is enough serious illness, which is accompanied by unpleasant sensations in the form of severe pain; in addition, with neuropathy or neuritis of the lower extremities, it is very difficult to move and there is a feeling of severe discomfort throughout the body.

Neuritis often occurs due to damage to the nerves in the extremities, compression, or various traumatic lesions.

If appropriate treatment is not provided in time, this disorder may develop into a more complicated form of the disease.

Anatomy of the tibial nerve

The tibial nerve is part of the sacral plexus. Its formation occurs due to the fourth and fifth lumbar nerve, the first, second and third sacral nerves also participate in its formation.

The origin of the tibial nerve is in the region where the apex of the fossa poplitea is present. Further, it continues in a vertical position in relation to the angle of the distal type fossa; it is located in it in the area in the middle of the fascia and vessels of the fossa under the knee.

Then there is its continuation, which is located in the area in the middle of the heads of the gastrocnemius muscle, then the nerve lies on the surface of the dorsal type of the popliteus muscle, follows along with the tibial vessels and is closed by the soleus muscle in the area of its tendinous arch.

Further, the continuation of the nerve is located in the deep fascial layer of the leg, located in the middle of the medial edge of the long flexor of the first digit, as well as the lateral edge of the long flexor of the digitorum. Then it reaches the surface of the dorsal type of the medial malleolus, located in the middle of the calcaneal tendon and the medial malleolus. Passing under the flexor retinaculum, it gives rise to two terminal branches - nn. plantari laterale et mediale (nerves of the sole of the lateral and medial type).

Possible diseases

Before starting treatment, it is worth finding out the type of damage to the tibial nerve, there may be several of them, it is worth highlighting the most common:

neuropathy;
neuritis;
neuralgia.

What these diseases have in common is that they are all accompanied by compression of the nerve, which results in severe pain. Often the pain is very severe, it prevents you from walking normally, bending your foot or toes. Often you have to walk on your heels.

More details about each disease:

During this neuropathy, the tibial nerve is affected at the level of the head of the fibula. Typically, compression or compression of the nerve occurs during incorrect position limbs, for example when long stay V sitting position, most often if the leg is crossed over the leg.
Neuritis of the tibial nerve is accompanied by severe pain that interferes with normal movement. The innervation of the posterior surface of the lower leg, soles, and plantar surface of the fingers depends on the functionality of the tibial nerve. With this lesion, it is impossible to bend the toes, and the foot also does not bend. In addition, gait is impaired; the patient cannot step on his toes and walks on his heels.
Tibial neuralgia is usually accompanied by unbearable pain in the ankle, foot and toes. The disease occurs due to compression or damage to the tibial nerve, which innervates the heel or sole. The tibial nerve passes through the back of the calf, through the bony canal near the heel, and then enters the heel area. During inflammatory process soft tissues of the heel, compression of the nerve occurs, which provokes the development of pain.

Causes of nerve damage

Causes, causing diseases tibial nerve:

Shin injuries - fractures, cracks. During a bruise, swelling of certain areas of the limb may occur. The resulting swelling causes compression of the nerve and impairs the conduction of impulses.
Isolated fracture of the tibia.
Dislocation of the ankle joint.
Various injuries.
Tendon damage.
Sprains in the foot area.
Repeated traumatic injuries to the foot.
Foot deformities – flat feet, hallux valgus deformity.
Long uncomfortable position of the leg or foot under pressure.
Various diseases of the ankle or knee joint - arthritis of the rheumatoid type, osteoarthritis of the deforming type, gout.
Tumor lesions of the nerve.
Metabolic problems, namely diabetes. Often during this disease, neuropathy or neuritis of the tibial nerve may appear. The risk of this disorder is increased in people with the disease long time, and also if the patient has increased body weight. Often occurs in older people.
Due to infectious diseases and poisoning. May have an effect on the nervous system negative impact various compounds of lead, mercury, arsenic.
Nerve vascularization disorders.
Long-term treatment with drugs that have a negative effect on the condition of neurons.
During renal failure Uremia may occur - a condition in which a large level of metabolic end products accumulates in the body.

Typical clinical picture

Symptoms of each possible defeats The tibial nerve has some features. During the examination, the doctor should initially find out what symptoms accompany each disease and only then prescribe effective treatment.

Symptoms of neuropathy

Clinical picture the disorder depends on the pathological process and the location of the nerve damage. The symptoms of this disease are divided into primary and secondary.

Tibial nerve neuropathy is accompanied by the following main symptoms:

the occurrence of problems with sensitivity, it can be painful, tactile, vibration;
the occurrence of severe pain.

In addition, other associated symptoms may appear:

Features of the clinic for neuritis

With neuritis, similar symptoms occur as with neuropathy:

problems walking;
inability to bend the foot;
pain when bending fingers;
inability to walk on toes;
problems when turning the foot inward.

Signs of neuralgia

The main symptoms of neuralgia include the appearance of the following conditions:

pain in the foot area;
the appearance of crawling sensations on the surface of the leg;
burning;
cold snap;
the pain is localized around the ankle and goes down to the fingers;
difficulty walking.

Diagnosis of the disease

During the examination, all medical history data are collected. Find out possible reasons violations - perhaps the disease occurred as a result traumatic injury or endocrine disruptions, tumors and so on.

The following studies are required:

Providing medical care

Any damage to the tibial nerve requires the following treatment:

if the nerve damage occurs due to any concomitant disease, then the root cause of the disease is initially treated;
It is recommended to wear orthopedic shoes;
endocrine imbalance is corrected;
therapeutic blockades are carried out using Kenalog, Diprospan or Hydrocortisone with local anesthetics (Lidocaine);
injections of the following vitamins are required - B1, B12, B6;
injections of Neurobin, nicotinic acid, drip administration of Trental, administration of Neurovitan, alpha-lipoic acid are also administered;
physiotherapy is carried out in the form of ultraphonophoresis together with hydrocortisone ointment, shock wave therapy, magnetic therapy, electrophoresis;
Massage sessions are performed to restore muscles.

Consequences and prevention

The positive outcome of the disease depends on the degree of the disorder and the factor that caused the disease. In any case, if curative therapy will be provided on time, then usually the disorder can be cured.

Usually heavy treatment required as a result of a genetic disorder and if the disease is detected at the stage of severe damage to nerve fibers.

Main preventive measures is to comply with the following recommendations:

timely treatment of all diseases that may cause damage to the tibial nerve;
complete cessation of bad habits;
complete healthy diet.

Tibial nerve

The nervous system performs the most important function in the body; it regulates the functioning of all systems and provides sensitivity. If damage to the tibial nerve occurs, the limb stops working normally and the person begins to limp.

It is worth understanding that the nerve can only be restored by starting treatment in a timely manner. If it is severely damaged, then most likely the person will never be able to return to normal life, and the leg will not work properly. Neuropathy requires urgent medical attention when the first symptoms of the disease appear.

General

The tibial nerve belongs to the sacral plexus, it continues the sciatic nerve. It originates in the popliteal fossa and runs along the gastrocnemius muscle, resting on the popliteus and soleus muscles. The tibial nerve reaches the flexor retinaculum, and there it divides into its final branches.

Neuritis of the tibial nerve is an inflammatory pathology in which the patient experiences pain, muscle weakness at the site of inflammation. Loss of sensation is also often observed; a person cannot move his leg normally, which causes lameness.

Neuropathy is classified as peripheral mononeuropathies of the lower extremities. The pathology occurs quite often, especially among athletes, and the disease often occurs due to various injuries. Treatment of neuritis must be carried out, especially for people who lead active image life.

Causes

Neuritis of the tibial nerve can occur for the following reasons:

Injuries. This could be a sprained ankle, a broken tibia, or a broken tibia. Nerve damage often occurs due to repeated injuries in athletes.
Compression of the foot and its uncomfortable position, for example, if the leg is pinched with a heavy object.
Foot deformity, for example, flat feet, hollow foot.
Pathologies of the knee or ankle joint, for example, arthritis, arthrosis, gout.
Metabolic disorders, endocrine pathologies, in particular diabetes.
Circulatory disorders, for example, with vasculitis.
Nerve tumor.
Poisoning harmful substances, including alcoholism;
Infections, in this case there is a high probability of polyneuritis.

Athletes, particularly runners, and people who walk for long periods of time are more susceptible to the disease. The disease also often occurs in people who work in a dangerous enterprise, carry heavy loads and risk injuring their legs.

Obese people are also more susceptible, as the load on the foot increases greatly, and deformation and nerve damage can occur. For the same reason, women who constantly wear heels can get sick, especially in old age and with the presence of excess weight. People who wear shoes with thin soles or walk barefoot are also more susceptible; heel damage can occur when jumping.

Symptoms

Symptoms of tibial nerve neuropathy depend on which part of the nerve is affected, so let’s look at the signs of pathology in more detail.

Sign of a pinched nerve in the half-patellar fossa

If there is a violation in the popliteal fossa, the person cannot bend the foot and move the toes normally. The patient walks by stepping on the heel and cannot rest on the toe of the foot; atrophy of the muscles in the lower leg and foot occurs, and it becomes deformed.

If the cause is injury, then swelling, increased sensitivity, poor circulation, and pain are observed. In other cases, the patient loses sensation in the lower leg and foot, the pain can vary, it intensifies when walking.

If the foot is affected in the area of the medial nerve, the patient complains of pain in the foot, which occurs periodically, and a burning sensation is also often bothered. If the nerve in the toes is affected, the pain is localized in the foot and toes, and intensifies when standing and walking. When the heel is affected, pain occurs in this area, numbness, tingling, and distortion of sensitivity.

If you experience pain, numbness or a burning sensation in your leg, you should immediately consult a doctor. You need to understand that over time the disease can progress and the nerve will die, which will inevitably lead to complete loss sensitivity. Ultimately, paralysis of the limb may occur, and the patient will become disabled.

Diagnostics

Only a doctor can correctly diagnose the disease, so the first thing the patient needs to do is seek help at the hospital. As a rule, neuritis is treated by a neurologist, but in case of injuries, the patient first needs to see a traumatologist to begin treatment for a fracture, if one is present.

When contacting a neurologist, the doctor first takes an anamnesis, which allows you to identify the cause of the disease. The specialist must be informed if there have been recent injuries or are present chronic pathologies, joint diseases, etc. Next, the doctor conducts an examination, he checks the sensitivity of the limb, its performance, which helps to identify the area of nerve damage.

To confirm the diagnosis and clarify how badly the nerve is damaged, the patient may be sent for the following studies:

Electromyography is a test that tests muscle activity;
Electroneurography is a test that tests the speed of nerve impulses;
X-rays are performed as indicated;
Therapeutic and diagnostic blockade of trigenic points, in this case, medicine is injected into the affected area to accurately determine the extent of nerve damage;
CT, MRI - these methods are more accurate and allow you to identify pathology even in controversial cases.

Treatment

In most cases, tibial nerve neuritis is treated conservatively. The therapy is complex; it is necessary to first eliminate the cause of the disease.

If the pathology arose as a result of infection, then it must be identified and eliminated, with joint diseases Doctors treat them, prescribe wearing orthoses and taking medications. In case of diabetes mellitus, it is necessary to reduce sugar levels; for this purpose, a diet and appropriate medications are prescribed.

Drug treatment of neuritis consists of taking the following medications:

If the neuropathy is associated with nerve compression, that is, with compression, for example, due to a tumor or due to tissue swelling, then a therapeutic blockade with an anti-inflammatory and analgesic agent, for example, Hydrocortisol, is prescribed.
To improve nerve nutrition and blood circulation in tissues, B vitamins, Pentoxifylline, nicotinic acid.
Reparants are prescribed for the regeneration of mucous membranes and skin, but for certain indications. Such medications include Actovegin and Solcoseryl.
Anticholinesterase drugs are prescribed to suppress nervous excitability, such drugs include Ipidacrine;
For severe pain, antidepressants, such as Amitriptyline, are prescribed.

Patients are also prescribed physiotherapy, exercise therapy and massage. Magnetic therapy, UHF, electrophoresis and other procedures are used to treat nerves. Physiotherapeutic treatment in combination with exercise therapy helps improve blood circulation in tissues and speed up recovery, as well as strengthen muscles.

The operation is scheduled for severe cases when conservative methods do not help, as well as in the presence of large tumors that compress the nerve. Indications for surgery include severe pain and loss of sensitivity in the limb. Doctors can also restore a nerve after injury if scars and adhesions have formed on it.

Also, during the treatment period, it is necessary to eat properly, the food should be balanced and tasty, but weight gain should not be allowed, so it must also be dietary. For quick recovery nerve you need to eat meat, yeast, vegetable juices, milk, cheese.

Folk remedies

Treatment of neuritis should be carried out under the supervision of a physician, therefore folk remedies can only be used in combination to alleviate the condition. It is worth understanding that traditional treatment is not a panacea, so it will not be possible to get rid of neuropathy without physical therapy and taking necessary medications. You also need to remember that it is very important to first identify and eliminate the cause of the pathology, and this is only possible through examination in a hospital.

Treatment with herbs, in particular chamomile, helps well against neuritis, as it has anti-inflammatory and mild sedative effect. Chamomile can be brewed as tea and drunk throughout the day, as well as making relaxing baths or compresses on a sore spot. Linden flowers, motherwort, valerian, and rubbing with fir oil.

Rubbing a limb as a method of therapy

Traditional healers recommend combining medicinal baths and rubbing, as well as warm compresses. To begin with, the patient should lie in a warm bath for a few minutes; the water should not be hot. After water procedures, you need to massage the affected area well with fir oil, after which you can warm the sore spot, for example, with warm sand.

Prevention

To avoid the development of tibial nerve neuritis, you must first take care of your legs. If a person plays sports and his body undergoes heavy loads, it is necessary to be regularly examined by a specialist, and also use special and comfortable shoes for training.

People with overweight It is recommended to reset it to reduce the load on the feet and prevent their deformation. Women who wear heels all the time are advised to change their shoes during the day and do therapeutic exercises for their feet so that their legs rest and blood circulation in them is normalized.

The main complication of tibial nerve neuritis is foot paresis, which leads to disability. Therefore, you should not delay treatment.

Tibial nerve neuropathy

Tibial nerve. Muscles innervated by the tibial nerve:

1) m. triceps surae;

2) m. tibialis posterior;

3) m. flexor digitorum longus;

4) m. flexor digitorum brevis;

5) m. flexor hallucis longus;

6) m. flexor hallucis brevis;

7)mm. lumbricales;

8)mm. interossei, etc.

The listed muscles perform following functions: flexion of the foot and leg; internal rotation of the foot (raising the inner edge of the foot); flexion of the fingers and extension of the distal phalanges; bringing and spreading fingers.

Cutaneous innervation of the tibial nerve: back surface shin (n. cutaneus surae medialis), outer edge of the foot (together with the peroneal nerve - n. suralis), plantar surface of the foot and fingers, dorsum of the distal phalanges of the fingers.

Symptoms of tibial nerve neuropathy

Damage to the nerve at the level of the popliteal fossa is accompanied by impaired flexion of the foot and toes, inward rotation of the foot, abduction and adduction of the toes, and weakened flexion of the lower leg. The heel tendon reflex and plantar reflex are lost. The muscles of the leg (posterior group) and foot (deepened arch, retraction of the intermetatarsal spaces) atrophy. A sensitivity disorder is detected on the back surface of the lower leg, the plantar surface of the foot and fingers, and on the dorsal surface of the distal phalanges.

The foot is in an extension position, the toes take a “clawed” position, and calcaneal foot(pes calcaneus). Walking is difficult, patients stand on their heels and cannot stand on their toes.

Damage to the tibial nerve, as well as the median and sciatic nerves, entails the development of pronounced vasomotor, secretory, and trophic disorders. Its partial defeat may be accompanied by the formation of causalgic syndrome (complex regional pain syndrome - CRPS). If the tibial nerve is damaged on the lower leg (below the origin of the branches to calf muscles and long flexor fingers, internal cutaneous nerve of the leg) only the small muscles of the foot will be paralyzed, and sensitivity disorders are limited to the area of the foot.

At the level of the ankle joint, the tibial nerve along with the vessels is located in a rigid osteofibrous tunnel - the tarsal canal, which is a prerequisite for the development of compression-ischemic syndrome. Clinically, the syndrome is manifested by pain, paresthesia, and a feeling of numbness of the plantar part of the foot and fingers. Usually these phenomena intensify during walking (“intermittent claudication”). There may be a decrease in sensitivity on the sole and paresis of small muscles of the foot with the formation of a “clawed” paw. Percussion and palpation between the calcaneal tendon and the inner ankle, pronation of the foot provoke pain and paresthesia in the sole. Compression in the tarsal tunnel is usually caused by ankle injury, swelling, or hematoma.

The terminal branches of the tibial nerve - the common plantar digital nerves - pass under the deep transverse metatarsal ligament and are vulnerable to compression due to functional or organic deformation of the foot (wearing tight high-heeled shoes, prolonged squatting, etc.). Neuropathy of the common plantar digital nerves develops - burning, paroxysmal pain in the area of the plantar surface of the metatarsus (when walking, later spontaneously, often at night).

Tibial nerve function testing

1. The patient lying on his stomach is asked to bend his leg in knee joint, the doctor resists this movement.

2. The patient, lying on his back, is asked to flex his foot (then bend and rotate it inward), overcoming the doctor’s resistance.

3. The patient is asked to bend his fingers, bring his fingers together and spread them, overcoming the doctor’s resistance.

4. The patient is asked to stand on his toes, walk on his toes.

5. A decrease (absence) of reflexes from the heel tendon and plantar tendon is documented.

6. Establish the area of sensitivity disorders (back surface of the lower leg, plantar surface of the foot and fingers).

7. The appearance of the foot is assessed, atrophy of the calf muscles and interosseous muscles is recorded.

8. Be sure to pay attention to vasomotor, secretory, and trophic disorders; clarify the nature of the pain syndrome (CRPS).

Consultation regarding treatment using traditional methods oriental medicine (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug treatment methods) is carried out at the address: St. Petersburg, st. Lomonosova 14, K.1 (7-10 minutes walk from the Vladimirskaya/Dostoevskaya metro station), from 9.00 to 21.00, no lunches and weekends.

It has long been known that best effect in the treatment of diseases is achieved through the combined use of “Western” and “Eastern” approaches. Treatment time is significantly reduced, and the likelihood of disease relapse is reduced. Since the “eastern” approach, in addition to techniques aimed at treating the underlying disease great attention pays attention to “cleansing” of blood, lymph, blood vessels, digestive tracts, thoughts, etc. - often this is even a necessary condition.

The consultation is free and does not oblige you to anything. It is highly desirable to have all the data from your laboratory and instrumental methods research over the past 3-5 years. By spending just a minute of your time you will learn about alternative methods treatment, learn how you can increase the effectiveness of already prescribed therapy, and, most importantly, how you can fight the disease yourself. You may be surprised how logically everything will be structured, and understanding the essence and reasons is the first step to successfully solving the problem!

Tibial nerve neuritis

Tibial nerve (n. tibialis)

The tibial nerve (n. tibialis) is a nerve of mixed function (responsible for both movement and sensitivity). The tibial nerve is the other main branch of the sciatic nerve. The tibial nerve consists of fibers from L4 to S3 - the spinal nerves.

Functionally, the tibial nerve is largely an antagonist of the peroneal nerve. Its motor fibers innervate the foot flexor muscles, the finger flexor muscles and the muscles that rotate the foot medially.

Sensitive fibers of the tibial nerve innervate the back surface of the leg, the sole and plantar surface of the fingers, reaching the dorsal surface of the terminal phalanges and the outer edge of the foot, consisting of fibers of the peroneal and tibial nerves.

Damage to the tibial nerve (tibial nerve neuritis) causes paralysis of the muscles that flex the foot and toes (plantar flexion) and medially rotate the foot. The Achilles reflex is lost in neuritis of the tibial nerve.

Sensory disorders with neuritis of the tibial nerve occur on the back of the leg, sole, plantar surfaces of the fingers, and on the back of their terminal phalanges. Articular-muscular sensation in the toes, while the function of the peroneal nerve is preserved, does not suffer (it is impaired only when both nerves are jointly damaged, i.e., the peroneal and tibial or the main trunk of the sciatic nerve).

Muscle atrophy with neuritis of the tibial nerve is usually significant and concerns the posterior group of muscles of the leg and sole (deepened arch of the foot, retraction of the intermetatarsal spaces). The foot is in extension. Gait is difficult, but less than with a dangling “peroneal” foot; in this case, the patient stands on his heel due to the existing extension of the foot.

Tests to determine movement disorders in tibial nerve neuritis are:

Inability to flex (plantar) the foot and toes and rotate the foot medially
Inability to walk on toes

Pain due to neuritis of the tibial nerve (and its fibers as part of the sciatic nerve) is often extremely intense.

Injuries to the tibial nerve and its bundles in the trunk of the sciatic nerve can cause causalgic syndrome. Vasomotor-secretory-trophic disorders are also usually significant. In this respect, there is a certain similarity between the tibial nerve and the median nerve.

Treatment of tibial nerve neuritis

Treatment for neuritis of the tibial nerve is selected individually in each specific case. It includes a set of conservative procedures:

The use of acupuncture is very effective in the treatment of tibial neuritis.

Inflammation of the tibial nerve

Neuritis of the tibial nerve can be caused by mechanical impact on it, permanent injuries in this area, as well as trophic disorders (disturbance in the process of cell nutrition). With neuritis, the patient's motor function of the limb is impaired, a decrease in sensitivity is noted below the site of injury, swelling and spasms of the muscles of the lower leg and foot develop.

Neuritis is an inflammation of nerve fibers, often of non-infectious origin.

Causes of the problem

The development of neuritis of the tibial nerve can be provoked by the influence of the following factors on the human body:

the presence of a chronic source of infection in the body;
degenerative diseases of the vertebrae;
insufficient intake of B vitamins into the body;
weakened immune defense;
hypothermia;
harmful working conditions;
tissue trophism disorder;
diabetes;
history of nerve trunk injury;
autoimmune diseases;
vascular pathology.

The nerve is responsible for the motor activity of the posterior muscles of the leg.

Neuritis can be caused by a disorder of the trophism of nerve tissue due to mechanical compression of the ending itself or compression of the vessels feeding this formation. Play an important role in the development of the disease hormonal disorders and damage to the body’s own cells as a result of autoaggression. A deficiency of vitamin-mineral complexes makes a person less resistant to damaging environmental factors.

Symptoms of pathology

Signs of the disease depend on the level of damage to the nerve trunk. When the damage is localized in the popliteal fossa, there is a violation of the extension of the foot and normal movement of the fingers. When walking, the patient relies more on the heel, and significant muscle atrophy is clearly visible in the lower leg area. During a neurological examination, tendon reflexes decrease, and the foot becomes like a clawed paw. In addition, the sensitivity of the back surface of the lower leg, the back of the foot and the first 3, as well as half of the 4th toe suffers. Swelling of the diseased limb, trophic and autonomic disorders may also be observed.

When the calcaneal branches of the tibial nerve are affected, the patient experiences pain in the heel, numbness and paresthesia (impaired sensitivity), as well as problems with the trophism of the skin in this area. When the common digital nerves are damaged, Morton's metatarsal neuralgia develops (damage to the plantar nerve). As a result, pain develops in the arch of the foot and 2-4 toes, which intensifies with movement. In addition, patients with tibial nerve neuropathy may experience involuntary spasms or cramps of individual muscle groups, they experience symptoms of trophic disorders, swelling or crawling on the legs.

Diagnosis of tibial nerve neuritis

A neurologist can identify neuritis during an external examination of the patient and during questioning about the circumstances of its occurrence. discomfort. To confirm the diagnosis, it is recommended to conduct magnetic resonance imaging of the diseased limb, and ultrasound diagnostics is used as an additional method. With its help, areas of the nerve that have been affected by inflammation or have been injured as a result of mechanical action are determined. In addition, electroneuromyography is indicated to determine neuropathy of the tibial nerve. If you suspect a pathology skeletal system, which provokes nerve trunk injuries, an X-ray examination is carried out in several projections.

Treatment of neuritis

Therapy of the tibial nerve requires an integrated approach and the main thing is to eliminate the provoking factor. For people involved in sports and physical work, it is important to wear orthopedic and comfortable shoes. Trophic disorders and hormonal imbalances are also corrected. In case of severe pain, the patient is recommended to undergo anesthesia. It is carried out in severe cases using novocaine blockade with the use of analgesic drugs, later indicated intramuscular injections non-steroidal anti-inflammatory drugs "Dikroberl" or "Ibuprofen" and the use of ointments for external use, which contain the same active ingredients.

Restorative procedures after neuritis will help restore lost limb activity.

Maintenance vitamin therapy is mandatory; the consumption of B vitamins, which improve the trophism of nerve tissue, is especially important. After eliminating pain and inflammation, physiotherapeutic measures are recommended, including electrophoresis, acupuncture, mud therapy and paraffin wraps. Therapeutic gymnastics and massage will be useful. These procedures are carried out in a sanatorium-resort setting.

Symptoms and treatment of neuropathy of the tibial and peroneal nerve

Neuropathies are non-inflammatory diseases of the peripheral nerves that develop through various reasons and are manifested by dysfunction. When nerve fibers or sheaths are damaged, movements in the innervated muscles are disrupted and loss of sensitivity is noted. Peripheral nerves have a complex but thin structure that is easily damaged. Due to the fact that the load on the legs is greater, neuropathies of the lower extremities develop more often: the peroneal and tibial nerves.

The International Classification of Diseases (ICD 10) distinguishes mononeuropathies - damage to one nerve, and polyneuropathy - simultaneous involvement of several nerves in the pathological process.

Etiology of the disease

The main causes of neuropathy are:

diabetes mellitus and other endocrine diseases;
infectious diseases(HIV infection, herpes);
toxic damage ( long-term use medications, alcohol);
post-traumatic neuropathy (damage to myelin sheaths, compression by tissue edema);
compression-ischemic neuropathy (compression in anatomical “tunnels”).
lack of vitamins;
vascular diseases - vasculitis, blood diseases.

The development of neuropathy is facilitated by topographical features: nerves are vulnerable in certain areas. For example, neuropathy of the peroneal nerve occurs when it is pinched at the point where it exits the foot.

Clinical picture

When nerve trunks are damaged, the transmission of impulses from the central nervous system to muscles, skin, organs. Sensory and motor disorders, disturbances of trophic functions, and autonomic dysfunctions occur.

Neuropathies manifest themselves with a variety of symptoms. Patients usually complain of the following conditions:

feeling of numbness and lack of pain response;
paresthesia - tingling, crawling, burning sensations;
pain, spasms;
weakness and decreased muscle tone; gait changes;
muscle atrophy.

For example, with neuropathy of the peroneal nerve, the function of the foot is impaired - it droops and turns in, the patient is forced to lift and bend the leg at the knee when walking, the gait begins to resemble a “cock” or “horse”. Shoes like flip-flops fall off your feet. The upward flexion of the foot and the extension of the toes are impaired, and there is no pain or temperature sensitivity. With a long course of the disease, muscle atrophy and varus deformity of the foot are noted. Symptoms of neuropathy of the left peroneal nerve are no different from the manifestations of pathology on the right.

With tibial nerve neuropathy, downward flexion of the foot is impaired, patients cannot stand on their toes, and sensitivity in the foot is impaired. The muscles of the back of the leg and foot atrophy. The foot has the appearance of a “clawed paw”, and the gait acquires a characteristic emphasis on the heel.

Tibial nerve neuropathy causes pain when walking, running, or standing. The pain syndrome is especially pronounced in obese patients who wear heels.

Diagnostics

Of great importance in diagnosis is the collection of anamnesis: an indication of injuries, physical overload, the presence of endocrine and metabolic diseases.

A neurological examination reveals the level of nerve damage. Based on this study, additional diagnostic methods are prescribed.

Blood tests can detect increased blood glucose levels, hypovitaminosis, impaired renal and liver function, and signs of immune diseases.

Electromyography and ultrasound are of secondary importance. The nature of damage to the neurovascular bundle is determined by x-ray examination of the joints. CT and MRI can detect a compressive tumor.

Therapy

Treatment of neuropathy is aimed at curing the underlying disease and eliminating the etiology of the disease. This allows you to reduce symptoms and stop the progression of the disease. Patients are advised to give up alcohol, undergo detoxification therapy, and control glycemic levels.

Recovery of nerve function occurs very slowly. Therefore, the course of treatment is usually long and includes a complex of measures: drug therapy, physiotherapeutic procedures and massage, and, if necessary, surgical treatment.

Drug treatment helps relieve pain and inflammation and improve the trophism of affected fibers. For this purpose, nonsteroidal anti-inflammatory drugs (NSAIDs), B vitamins, blockade with glucocorticosteroid hormones, vasoactive substances, and metabolic agents are prescribed.

Physiotherapeutic methods of treatment include electromyostimulation, electrophoresis, and magnetic therapy.

If there is no effect from conservative therapy within six months, the issue of surgery is resolved - eliminating compression of the nerve trunk, freeing it from adhesions.

Forecast

The prognosis of the disease depends on the underlying disease and the timeliness of treatment. Irreversible changes significantly worsen the prognosis and cause the patient to develop permanent disability.

Symptoms of tibial nerve damage

The tibial nerve (n. tibialis) is formed by fibers of the LIV-SIII spinal roots. In the distal part of the popliteal fossa, the medial cutaneous nerve of the leg arises from the tibial nerve. It passes between the two heads of the gastrocnemius muscle and pierces the deep fascia in the middle third of the back of the leg. At the border of the posterior and lower third of the leg, the lateral cutaneous branch of the common peroneal nerve joins this nerve, and from this level it is called the sural nerve (n. suralis).

Next, the nerve passes along the Achilles tendon, giving off a branch to the back outer surface lower third of the leg. At the level of the ankle joint it is located behind the tendons peroneal muscles and gives here the external calcaneal branches to the ankle joint and heel. On the foot, the sural nerve is located superficially. It gives off branches to the ankle and tarsal joints and supplies the skin of the outer edge of the foot and fifth toe to the level of the terminal interphalangeal joint. In the foot, the sural nerve also communicates with the superficial peroneal nerve. The area of innervation of the sural nerve depends on the diameter of this anastomosis. It can include a significant part of the dorsum of the foot and even adjacent surfaces of the third and fourth interdigital spaces.

Symptoms of damage to the sural nerve manifest themselves in the form of pain, paresthesia and a feeling of numbness and hypoesthesia or anesthesia in the area of the outer edge of the foot and the fifth toe. There is pain on palpation corresponding to the location of nerve compression (behind and below the outer ankle or on the outer part of the heel, at the outer edge of the foot). Digital compression at this level causes or intensifies pain in the area of the outer edge of the foot.

The initial sections of the tibial nerve supply the following muscles: triceps surae, flexor digitorum longus, plantar, popliteal, posterior tibial flexor pollicis longus, etc.

The triceps surae muscle is formed by the gastrocnemius and soleus muscles. The gastrocnemius muscle flexes the lower limb at the knee and ankle joints.

Tests to determine calf muscle strength:

the subject, lying on his back with the lower limb straightened, is asked to bend it at the ankle joint; the examiner resists this movement and palpates the contracted muscle;
the examinee, lying on his stomach, is asked to bend the lower limb at the knee joint at an angle of 15°; the examiner resists this movement.

The soleus muscle flexes the lower limb at the ankle joint.

Test to determine the strength of the soleus muscle: the subject, lying on his stomach with the lower limb bent at an angle of 90 ° at the knee joint, is asked to bend it at the ankle joint; the examiner resists this movement and palpates the contracted muscle and tendon.

The plantaris muscle, with its tendon, is woven into the medial part of the Achilles tendon and is involved in flexion at the ankle joint.

The popliteus muscle is involved in flexion at the knee joint and internal rotation of the tibia.

The tibialis posterior adducts and elevates the inner edge of the foot (supinates) and promotes flexion at the ankle joint.

Test to determine the strength of the tibialis posterior muscle: the subject is in a supine position with the lower limb straightened, flexes it at the ankle joint and simultaneously adducts and lifts the inner edge of the foot; The examiner resists this movement and palpates the contracted muscle and tense tendon.

The flexor digitorum longus bends the nail phalanges of the II - V toes.

Test to determine the strength of the flexor digitorum longus: the subject, lying on his back, is asked to bend the distal phalanges of the II - V toes at the joint; the examiner prevents this movement and holds the proximal phalanges straightened with the other hand. The flexor hallucis longus flexes the first toe; its function is checked in the same way.

From the tibial nerve, slightly above the medial malleolus, internal calcaneal cutaneous branches depart, which innervate the skin of the posterior part of the calcaneal region and the posterior part of the sole. At the level of the ankle joint, the main trunk of the tibial nerve passes through a rigid osteofibrous tunnel, the tarsal canal. This canal goes obliquely down and forward, connecting the area of the ankle joint with the sole, and is divided into 2 floors: the upper - malleolar and lower - submalleolar. The upper floor is limited externally by an osteoarticular wall. From the inside, the upper floor is limited by the internal annular ligament, formed from the superficial and deep aponeurosis of the leg. The lower floor is limited from the outside inner surface calcaneus, from the inside - by the adductor pollicis muscle, enclosed in a duplicator of the internal annular ligament. The tarsal canal has two openings: superior and inferior. The canal passes through the tendons of the tibialis posterior, flexor digitorum longus, and flexor pollicis longus muscles, as well as the posterior tibial neurovascular bundle. It is located in a fibrous sheath and includes the tibial nerve and the posterior tibial artery with satellite veins. In the upper floor of the tarsal canal, the neurovascular bundle passes between the tendons of the flexor pollicis longus. The nerve is located outside and behind the artery and is projected at an equal distance from the calcaneal tendon to the posterior edge of the inner malleolus. In the lower floor of the canal, the neurovascular bundle is adjacent to the posterolateral surface of the flexor pollicis longus tendon. Here the tibial nerve divides into terminal branches - the internal and external plantar nerves. The first of them innervates the skin of the plantar surface of the inner part of the foot and all phalanges of the fingers, the dorsal surface of the terminal phalanges of the I - III and the inner half of the IV finger, as well as the short flexor muscles of the fingers, which bend the middle phalanges of the II - V fingers, the short flexor of the big toe, the muscle, abductor hallucis, and I and II lumbrical muscles. The external plantar nerve supplies the skin of the outer part of the plantar surface of the foot, the plantar surface of all phalanges of the fingers and the dorsal surface of the terminal phalanges of the V and the outer half of the IV finger. Motor fibers innervate the quadratus plantae muscle; flexion is facilitated by the I-IV interosseous and II-IV lumbrical muscles, the abductor little toe muscle, and, partly, the short flexor of the little toe. The skin of the heel area is innervated by the internal calcaneal nerve, which arises from the common trunk of the tibial nerve slightly above the tarsal canal.

When the common trunk of the tibial nerve is damaged in the popliteal fossa, muscle paralysis develops and the ability to flex the lower limb at the ankle joint, in the joints of the distal phalanges of the toes, the middle phalanges of the II - V fingers and the proximal phalanx of the first toe is lost. Due to the antagonistic contraction of the extensors of the foot and toes innervated by the peroneal nerve, the foot is in extension (dorsiflexion); The so-called heel foot (pes calcaneus) develops. When walking, the patient rests on his heel, raising his toes is impossible. Atrophy of the interosseous and lumbrical muscles leads to a claw-like position of the toes (the main phalanges are straightened at the joints, and the middle and terminal phalanges are bent). Abduction and adduction of the fingers are impossible.

When the tibial nerve is damaged below the origin of the branches to the gastrocnemius muscles and long flexor fingers, only the small muscles of the plantar part of the foot are paralyzed.

For topical diagnosis of the level of damage to this nerve, the zone of sensitivity impairment is important. Sensitive branches sequentially depart to innervate the skin on the back surface of the leg (medial cutaneous nerve of the calf - in the popliteal fossa), the outer surface of the heel (medial and lateral calcaneal branches - in the lower third of the leg and at the level of the ankle joint), on the outer edge of the foot (lateral dorsal cutaneous nerve), on the plantar surface of the foot and fingers (I - V common plantar digital nerves).

When the tibial nerve is damaged at the level of the ankle joint and below, sensory disorders are localized only on the sole.

In case of partial damage to the tibial nerve and its branches, causalgic syndrome often occurs. Excruciating pain spread from the back of the shin to the middle of the sole. The touch on the plantar side of the foot is extremely painful, which interferes with walking. The patient rests only on the outer edge of the foot and on the toes, limping when walking. The pain can radiate throughout the lower limb and sharply intensify with light touch to any area of the skin on this limb. Patients cannot walk, even using crutches.

Pain is often combined with vasomotor, secretory and trophic disorders. Atrophy of the muscles of the back of the leg and interosseous muscles develops, as a result of which the metatarsal bones clearly protrude on the back of the foot. Achilles and plantar reflexes decrease or disappear.

When the terminal branches of the tibial nerve are affected, reflex contracture is sometimes observed in the affected limb with edema, hyperesthesia of the skin and osteoporosis of the bones of the foot.

Most often, the tibial nerve is affected in the area of the tarsal canal through the mechanism of tunnel (compression-ischemic) syndrome.

With tarsal tunnel syndrome, pain comes to the fore. Most often they are felt in the back of the lower leg, often in the plantar part of the foot and toes, and less often they radiate to the thigh. Paresthesia is observed along the plantar surface of the foot and toes. Here, a feeling of numbness often occurs and a decrease in sensitivity is detected within the zone of innervation of the external and/or internal plantar nerve, and sometimes in the area supplied by the calcaneal nerve. Less common are sensory disorders and motor disorders - paresis of small muscles of the foot. In this case, bending and spreading the fingers is difficult, and in advanced cases, due to muscle atrophy, the foot takes on the appearance of a clawed paw. The skin becomes dry and thinner. In tarsal tunnel syndrome, mild percussion or digital pressure in the area between the medial malleolus and the Achilles tendon causes paresthesia and pain in the plantar region of the foot, which may be felt in the back of the leg. Painful sensations are provoked by pronation and simultaneously formed extension of the foot, as well as by forced plantar flexion of the first toe against the action of a resistance force.

With this tunnel syndrome, sensory disorders in the heel region rarely occur. Weakness of flexion of the leg and foot, as well as hypoesthesia along the posterior outer surface of the leg - signs of damage to the tibial nerve above the level of the tarsal canal

Pain and discomfort in the foot area can be a signal that a nerve conduction disorder has occurred. Their consequence is hypotrophy of the tissues of the lower leg. This is how neuropathy of the tibial nerve manifests itself, which is dangerous due to its complications.

What is tibial nerve neuropathy

A disease in which the tibialis nerve is affected, leading to impaired motor functions of the lower leg, is called tibial nerve neuropathy. It affects the functions of the muscles that are responsible for the motor ability of the feet, legs, toes and ankle joints.

This condition causes discomfort and makes walking difficult and is expressed by acute pain.

Tibial nerve neuropathy is a peripheral mononeuropathy. This group includes various lesions of the nerves of the lower extremities. Such pathologies are studied by traumatologists and neurologists, and specialists in the field of sports medicine often encounter this.

The causes of the disease may be different character. Regardless of the origin, assistance must be provided without delay to prevent more serious complications.

Reasons for development

The causes of tibialis lesions can be different.

Among them the most common:

Traumatic factor. Fractures, injuries, sprains, wounds, tendon ruptures and dislocations can lead to complications in the form of neuropathy due to tissue disruption or compression.
Injuries sustained during exercise sports, and specific foot deformity (valgus), flat feet.
Long term syndrome squeezing.
Heavy infectious diseases and their complications.
Poisoning substances acting on the central nervous system.
Diseases joints (knee and ankle).
Exchange violations processes in the body caused by diseases endocrine system and other reasons.
Tumors nerve.
Changes vascularization nerve.
Uncontrolled reception drugs and long-term therapy, the side effects of which include adverse effects on neurons.

The disease most often occurs due to tarsal tunnel syndrome, caused by its fibrotic changes in the post-traumatic period. Neuropathy is often caused by neurodystrophic disorders in muscles and ligaments. In this case, the pathology is vertebrogenic in nature.

Symptoms

The syndromes characteristic of tibial nerve neuropathy are different and depend on the location of the lesion. If the patient cannot stand on his toes, bend his foot down, and at the same time there is difficulty in the motor activity of the toes, then we are talking about localizing the lesion at the level of the popliteal fossa.

In this case, the patient’s gait looks like this: he rests on his heel and is unable to roll his foot onto his toe. Upon examination, the specialist notes atrophy of the calf muscles and foot. Decreased in the Achilles plexus tendon reflex. In those areas where dynamics and trophism are impaired, the patient notes severe pain upon palpation.

Pain syndromes are particularly acute when traumatic genesis disorders. It's about about hypersensitivity. Also noted against the background of injuries is the formation of swelling and disturbances in blood circulation and nutrition, localized at the suspected site of nerve damage.

If a patient complains of burning pain in the sole area, radiating to the lower leg area, due to prolonged walking or running, the doctor raises the question of the presence of tarsal tunnel syndrome. In this case, the pain can be deep and tends to increase both when walking and while standing.

During a diagnostic examination, hypoesthesia of the edges of the foot is observed. It may be flattened in appearance, the toes are bent like a bird's claw, and the arch of the foot is often deepened. Wherein physical activity the ankle does not reveal any deficiencies.

The Achilles reflex is also intact. There is a positive Tinel's sign in the area of the medial malleolus relative to the Achilles tendon.

Tarsal tunnel syndrome creates conditions for the progression of compression-ischemic syndrome. The clinical picture is: pain, paresthesia, numbness in the toes and feet. These symptoms, aggravated by walking, are expressed in intermittent claudication. Often the cause of this condition is swelling or hematoma resulting from injury.

At the level of the plantar middle (medial) nerve, the disease occurs in professional runners. Characterized by pain and paresis of the inner part of the foot. Percussion in the scaphoid region causes sharp pain burning in the area of the big toe.

If the nerve is affected at the level of the toes, characteristic pain appears at the arch of the foot. It runs along the base of 2-4 fingers to their tips. This condition is most common in obese women who often wear high-heeled shoes.

The disease appears with age. Tinel's sign is noted for this condition. This pathology is called "Morton's metatarsal neuralgia."

Calcanodynia is a lesion of the calcaneal nerve branches. Such damage to the tibial nerve may occur due to heavy loads on the heel, walking without shoes for a long time, jumping from heights. The main symptom for determining this pathology is walking, in which the person suffering from the disease does not stand on his heel.

Diagnostics

The doctor will ask the patient to carry out certain actions in order to assess the functionality of the muscles and the condition of the tibial nerve.

The following actions are carried out for the study:

From a prone position flexion movements in the knee joint. Wherein medical worker applies counter force.
From a supine position, flexion movements stop and turning inward in the presence of resistance created by the doctor.
Flexion and extension movements fingers legs
Attempt to walk on socks.
Examination reflexes tendons (soles and heels). The doctor determines the location of the damage by examining the sensitivity of the affected areas.
Grade deformation feet, presence of dietary changes.
Fixing trophic and secretory changes, identifying the nature of pain.

To begin diagnosing the disease, an anamnesis is collected from the patient. Special attention focuses on the presence of injuries, increased stress, diseases with metabolic disorders, endocrine pathologies, orthopedic diseases.

Summarizing and analyzing the information received, they begin a thorough examination and identify the location of damage to the tibial nerve. The neurologist identifies trigger points and the presence of Tinel's symptom. Using these aspects, the level of nerve damage can be assessed.

As an additional diagnostic examination the patient can be recommended the following types diagnostics: electromyography and electroneurography. To clarify, you can prescribe the patient to undergo an ultrasound examination.

If there are difficulties in making a diagnosis, you can X-ray studies feet, legs, joints. Sometimes trigger point blockade helps identify the compressive nature of tibial nerve neuropathy.

Treatment

If underlying pathologies form the basis of the disease, therapy should be started aimed at eliminating the underlying causes of the disease. In such cases, patients are strongly recommended to wear orthopedic shoes; therapy aimed at normalizing the endocrine balance in the body; treatment of arthrosis.

If the compressive nature of the disease is identified, therapeutic blockades will have a good effect. As an active agent, drugs such as Triamcinolone, Diprospan, Hydrocortisone with a local analgesic (Lidocaine) are used.

To improve the condition of the nerve, it is imperative to carry out therapy aimed at normalizing blood supply and metabolism. For this purpose, B vitamins and nicotinic acid (vitamin PP) are prescribed. In addition, Pentoxifylline is given intravenously. Positive effect observed when prescribing alpha lipoic acid.

In cases of severe pain, the patient is prescribed anticonvulsants and antidepressants. If there are indications, agents aimed at regenerating wound surfaces, anticholinesterase drugs and reparants are used in treatment.

To restore motor abilities and nourish muscles, massage complexes and physical therapy. Physiotherapeutic procedures, such as UHF, ultraphonophoresis with hydrocortisone ointment, wave and magnetic procedures, also have a good effect.

If there are factors putting pressure on the trunk of the tibial nerve, or as a result of the ineffectiveness of conservative treatment, it is required surgical method treatment. Such operations are performed by neurosurgeons. During surgical intervention They remove nerve tumors, perform neurolysis, and perform decompression.

Consequences and complications

The prognosis and effectiveness of treatment for tibial nerve neuropathy depends on the stage of the disease at which the patient sought help. This disease is quite serious. Elimination of the cause that led to neuropathy leads to complete recovery. It is important to seek help in a timely manner and not resort to self-medication, which can cause significant harm and lead to irreversible changes.

If time is lost, treatment becomes difficult and sometimes impossible. If you contact a medical facility in a timely manner, the prognosis is positive. It is important to follow all doctor's orders correctly.

You should not postpone a visit to the doctor at the first symptoms of the disease. This can make the situation worse and cause more serious problems and illnesses.

If you ignore the symptoms of tibial nerve neuropathy, there is a risk of immobilization of the joint, which leads to complete disability and disability.

Prevention

Preventive measures for tibial nerve neuropathy include active physical activity alternating with rest, wearing high-quality shoes with medium heels, a healthy lifestyle, and giving up bad habits.

TO important aspects In the prevention of the disease, control over body weight and endocrine balance of the body should be noted. Risk of injury should be avoided whenever possible. This is especially important for athletes and elderly people.

Our clinic is engaged in examination, treatment and rehabilitation measures for pinched, inflammation and injuries of the nerves of the legs (sciatic, tibial, peroneal and their branches). You will need . if any studies have been previously performed, be sure to take their results for consultation, incl. themselves x-rays . If the studies have not been performed, we will do everything necessary in our clinic or with our colleagues in other clinics.

How the treatment will be structured:

Let's establish the location and cause of nerve damage. We perform electromyography of the fibular, tibial and other and. The potential benefit of non-surgical treatment or strict indications for surgery (risk of complete nerve loss) can be determined using needle myography.
We will find out and discuss with you the possibility of non-surgical treatment and the prospects for restoring nerve function. Medicines can be used here, incl. administration of anti-inflammatory and absorbable drugs directly to the point of compression or damage to the nerve. For rehabilitation treatment Magnetic stimulation of the sciatic, tibial and peroneal nerves is very effective: improvement is noticeable immediately or a few days after the procedure.
If the chances of restoring the peroneal or tibial nerve without surgery are low, we recommendsurgery. We perform most of the operations on an outpatient basis. You will be able to go home on the day of surgery. The budget for surgery without hospitalization is significantly less. If hospitalization is required, we will refer you to a trusted specialist. After surgical treatment, we will offer a course of rehabilitation treatment.

What are the causes of damage to the tibial and peroneal nerves?

B The tibial and peroneal nerves pass in narrow canals, formed by bones, ligaments, tendons and muscles. Nerve tissue is very delicate and vulnerable. Often we detect nerve suffering even with slight narrowing or deformation of the nerve canal. Narrowing or deformation of the tibial and peroneal nerve canals occurs:

In case of injury(bone fracture, bruise, hemorrhage, sprain or wound); Often, when injured, the nerve is pulled into scarred tissue or compressed by a bone fragment; nerve injury can also be represented by a nerve bruise, partial or complete interruption.
When compressed in an awkward position(tucked or compressed leg when wearing uncomfortable shoes, posture, unconscious or intoxicated, under anesthesia);
For thickening and deformation of the knee and ankle joints and ligaments, with chronic injury and overload of the joints, often associated with the type of activity (sports, walking, forced posture, vibration, weight). Very often, such changes are facilitated by diseases and deformities of the spine. These types of neuropathy are called tunnel syndromes ulnar, radial and median nerves;
With deformation of the feet due to flat feet (tarsal tunnel syndrome, meralgia).

The function of nerves is to conduct electrical impulses from the brain to muscles and organs, and to the brain from sensory receptors in the body. Any damage to the nerve leads to disruption of the conduction of excitation along the nerve, which means disconnection of the affected part of the body from the brain.

Therefore, if the tibial and peroneal nerves suffer, the following are possible:

Decreased strength and weight loss of leg muscles, twisting of the foot when walking and even fractures;
Decreased sensitivity (numbness)
Pain along the nerve or in the foot, fingers.

Symptoms of Tibial and Peroneal Nerve Suffering

One or more of the following symptoms are possible:

Pain under the knee and along the back of the shin;
Pain and/or burning, “electric shock” in the lower leg, foot, fingers;
Weakness of the lower leg muscles, weakness of the foot muscles, frequent twisting of the foot;
Weakness in flexion or extension of fingers;
Numbness of part of the lower leg and/or foot;
Losing weight in the muscles of the lower leg and foot.

Diagnosis of neuropathies of the tibial and peroneal nerves

The most successful treatment for neuropathy is therapeutic effects directly at the point of nerve damage. For successful treatment, your treating doctor will find out:

At what exact point is the nerve damaged (compressed); this helps us provide targeted treatment;
What exactly led to the nerve suffering (trauma, scar, compression);
The degree of nerve suffering (complete or partial damage, the presence of a recovery process, the presence of complete death of the nerve, etc.).

Often To determine the cause of nerve damage, a detailed neurological examination is sufficient, in which the strength of the muscles controlled by the nerve, the possibility of certain movements, sensitivity, the presence of pain points and seals along the nerve are assessed. Auxiliary diagnostic methods are electroneuromyography, radiography and computed tomography.

allows you to assess the speed and volume of impulses along the nerve, detect the location of damage/compression, and determine the prognosis for recovery. Electromyography helps us evaluate the effect of certain types of treatment and choose the most suitable ones. The Echinacea clinic uses a modern computer electroneuromyograph.

Joints and feet will give complete information about the deformation of the joints and bone canals of the nerves, the causes and points of nerve compression.

Stimulation electromyography of the lower extremities

Treatment of damage to the tibial and peroneal nerves at the Echinacea clinic

When it is clear where, how and why nerve compression occurs, local treatment in the form of physiotherapy, therapeutic blockades, massage, manual therapy, it becomes much more effective. That's why Treatment in our clinic begins with identifying the cause and location of nerve damage.

The main goals of treatment for nerve compression:

Remove nerve compression. To do this, we use powerful resorption therapy: we use enzymes that resolve and soften scar tissue, bone and cartilage growths (Karipazim enzyme, etc.), massage, and injecting medications directly into the site of nerve compression. Sometimes, to release the nerve, manual therapy and massage of the areas of compression of the tibial and peroneal nerves (spine, leg joints, etc.) are sufficient.
Accelerate healing and restoration of the nerve. To do this, we use modern medications that help restore the nerve that has been released from compression in the scars.
Restore muscle function and volume. Here are used special exercises, electrical muscle stimulation, physiotherapy. The rehabilitator will tell you in detail and show you how to perform rehabilitation procedures at home.

When is surgery necessary?

In case of nerve injury, it is very important to decide in a timely manner whether conservative or surgical treatment. The answer to this question can be obtained after conducting a test, which will answer the question of what is the degree of damage to the nerve and whether it has a tendency to recover. If during this study it turns out that at least partially the nerve is preserved, we carry out active conservative treatment, after which we must repeat the study to make sure that the treatment had an effect. If, during needle myography, it turns out that the nerve is completely damaged and its restoration is impossible, we resort to the help of a neurosurgeon who suturing the nerve or releasing it from significantly narrowed canals. Then we perform the entire range of restoration procedures.

What is tibial nerve neuropathy

This condition causes discomfort and makes walking difficult and is expressed by acute pain.

The causes of the disease can be different. Regardless of the origin, assistance must be provided without delay to prevent more serious complications.

Reasons for development

The causes of tibialis lesions can be different.

Among them the most common:

Traumatic factor. Fractures, injuries, sprains, wounds, tendon ruptures and dislocations can lead to complications in the form of neuropathy due to tissue disruption or compression.
Injuries sustained during exercise sports, and specific foot deformity (valgus), flat feet.
Long term syndrome squeezing.
Heavy infectious diseases and their complications.
Poisoning substances acting on the central nervous system.
Diseases joints (knee and ankle).
Exchange violations processes in the body caused by diseases of the endocrine system and other reasons.
Tumors nerve.
Changes vascularization nerve.
Uncontrolled reception drugs and long-term therapy, the side effects of which include adverse effects on neurons.

The disease most often occurs as a result of tarsal tunnel syndrome, caused by its fibrous changes in the post-traumatic period. Neuropathy is often caused by neurodystrophic disorders in muscles and ligaments. In this case, the pathology is vertebrogenic in nature.

Symptoms

In this case, the patient’s gait looks like this: he rests on his heel and is unable to roll his foot onto his toe. Upon examination, the specialist notes atrophy of the calf muscles and foot. The tendon reflex is reduced in the Achilles plexus. In those areas where dynamics and trophism are impaired, the patient notes severe pain upon palpation.

Pain syndromes are especially acute during the traumatic genesis of the disorder. We are talking about increased sensitivity. Also noted against the background of injuries is the formation of swelling and disturbances in blood circulation and nutrition, localized at the suspected site of nerve damage.

During a diagnostic examination, hypoesthesia of the edges of the foot is observed. It may be flattened in appearance, the toes are bent like a bird's claw, and the arch of the foot is often deepened. At the same time, the motor activity of the ankle does not reveal any deficiencies.

The Achilles reflex is also intact. There is a positive Tinel's sign in the area of the medial malleolus relative to the Achilles tendon.

The disease appears with age. Tinel's sign is noted for this condition. This pathology is called "Morton's metatarsal neuralgia."

Calcanodynia is a lesion of the calcaneal nerve branches. Such damage to the tibial nerve can occur due to heavy loads on the heel, walking without shoes for a long time, or jumping from a height. The main symptom for determining this pathology is walking, in which the person suffering from the disease does not stand on his heel.

Diagnostics

The doctor will ask the patient to carry out certain actions in order to assess the functionality of the muscles and the condition of the tibial nerve.

The following actions are carried out for the study:

From a prone position flexion movements in the knee joint. In this case, the medical worker applies a counterforce.
From a supine position, flexion movements stop and turning inward in the presence of resistance created by the doctor.
Flexion and extension movements fingers legs
Attempt to walk on socks.
Examination reflexes tendons (soles and heels). The doctor determines the location of the damage by examining the sensitivity of the affected areas.
Grade deformation feet, presence of dietary changes.
Fixing trophic and secretory changes, identifying the nature of pain.

To begin diagnosing the disease, an anamnesis is collected from the patient. Particular attention is paid to the presence of injuries, increased stress, diseases with metabolic disorders, endocrine pathologies, and orthopedic diseases.

As an additional diagnostic examination, the following types of diagnostics can be recommended to the patient: electromyography and electroneurography. To clarify, you can prescribe the patient to undergo an ultrasound examination.

If there are difficulties in making a diagnosis, X-ray examinations of the feet, legs, and joints can be performed. Sometimes trigger point blockade helps identify the compressive nature of tibial nerve neuropathy.

Treatment

To improve the condition of the nerve, it is imperative to carry out therapy aimed at normalizing blood supply and metabolism. For this purpose, B vitamins and nicotinic acid (vitamin PP) are prescribed. In addition, Pentoxifylline is given intravenously. A positive effect is observed when alpha lipoic acid is prescribed.

To restore motor abilities and nourish muscles, complexes of massage and physical therapy are prescribed. Physiotherapeutic procedures, such as UHF, ultraphonophoresis with hydrocortisone ointment, wave and magnetic procedures, also have a good effect.

If there are factors that put pressure on the trunk of the tibial nerve, or as a result of the ineffectiveness of conservative treatment, surgical treatment is required. Such operations are performed by neurosurgeons. During surgery, they remove nerve tumors, perform neurolysis, and perform decompression.

Consequences and complications

You should not postpone a visit to the doctor at the first symptoms of the disease. This can make the situation worse and cause more serious problems and illnesses.

If you ignore the symptoms of tibial nerve neuropathy, there is a risk of immobilization of the joint, which leads to complete disability and disability.

Prevention

Preventive measures for tibial nerve neuropathy include active physical activity alternating with rest, wearing high-quality shoes with medium heels, a healthy lifestyle, and giving up bad habits.

Important aspects in the prevention of the disease include control of body weight and endocrine balance of the body. Risk of injury should be avoided whenever possible. This is especially important for athletes and elderly people.

Tibial nerve. Muscles innervated by the tibial nerve:

1) m. triceps surae;

2) m. tibialis posterior;

3) m. flexor digitorum longus;

4) m. flexor digitorum brevis;

5) m. flexor hallucis longus;

6) m. flexor hallucis brevis;

7)mm. lumbricales;

8)mm. interossei, etc.

The listed muscles perform the following functions: flexion of the foot and lower leg; internal rotation of the foot (raising the inner edge of the foot); flexion of the fingers and extension of the distal phalanges; bringing and spreading fingers.

Cutaneous innervation of the tibial nerve: the posterior surface of the leg (n. cutaneus surae medialis), the outer edge of the foot (together with the peroneal nerve - n. suralis), the plantar surface of the foot and fingers, the dorsum of the distal phalanges of the fingers.

Symptoms of tibial nerve neuropathy

The foot is in an extension position, the toes take a “clawed” position, and the heel foot (pes calcaneus) is formed. Walking is difficult, patients stand on their heels and cannot stand on their toes.

Damage to the tibial nerve, as well as the median and sciatic nerves, entails the development of pronounced vasomotor, secretory, and trophic disorders. Its partial defeat may be accompanied by the formation of causalgic syndrome (complex regional pain syndrome - CRPS). If the tibial nerve is damaged on the lower leg (below the origin of the branches to the gastrocnemius muscles and long flexor fingers, the internal cutaneous nerve of the lower leg), only the small muscles of the foot will be paralyzed, and sensitivity disorders are limited to the foot area.

Tibial nerve function testing

1. The patient, lying on his stomach, is asked to bend his leg at the knee joint, the doctor resists this movement.

2. The patient, lying on his back, is asked to flex his foot (then bend and rotate it inward), overcoming the doctor’s resistance.

3. The patient is asked to bend his fingers, bring his fingers together and spread them, overcoming the doctor’s resistance.

4. The patient is asked to stand on his toes, walk on his toes.

5. A decrease (absence) of reflexes from the heel tendon and plantar tendon is documented.

6. Establish the area of sensitivity disorders (back surface of the lower leg, plantar surface of the foot and fingers).

7. The appearance of the foot is assessed, atrophy of the calf muscles and interosseous muscles is recorded.

8. Be sure to pay attention to vasomotor, secretory, and trophic disorders; clarify the nature of the pain syndrome (CRPS).

Consultation on treatment using traditional oriental medicine methods (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug treatment methods) is carried out at the address: St. Petersburg, st. Lomonosova 14, K.1 (7-10 minutes walk from the Vladimirskaya/Dostoevskaya metro station), with 9.00 to 21.00, no lunches and weekends.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of “Western” and “Eastern” approaches. Treatment time is significantly reduced, the likelihood of disease relapse is reduced. Since the “eastern” approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the “cleansing” of blood, lymph, blood vessels, digestive tracts, thoughts, etc. - often this is even a necessary condition.

The consultation is free and does not oblige you to anything. on her All data from your laboratory and instrumental research methods are highly desirable over the last 3-5 years. By spending just 30-40 minutes of your time you will learn about alternative treatment methods, learn How can you increase the effectiveness of already prescribed therapy?, and, most importantly, about how you can fight the disease yourself. You may be surprised how logically everything will be structured, and understanding the essence and reasons - the first step to successfully solving the problem!