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Updated: Mar 22 2022

Leg Nerve Entrapment Syndromes

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  • Ilioinguinal nerve
    • Can be caused by hypertrophied abdominal muscles as a result of intensive training
    • Hyperesthesia is common
    • Pain worse with hyperextension of hip
    • Treatment
      • operative
        • surgical release
          • indications
            • failure of nonoperative management
  • Obturator nerve
    • Found in patients with well-developed hip adductors (skaters)
    • Can cause chronic medial thigh pain
    • Nerve conductions studies help establish diagnosis
    • Treatment
      • nonoperative
        • supportive
  • Lateral femoral cutaneous nerve
    • Can lead to pain on lateral aspect of proximal leg
      • meralgia paresthetica
    • Exacerbated by tight belts and prolonged hip flexion
    • Treatment
      • nonoperative
        • PT, NSAIDS
          • postural exercises
          • release of compressive devices
  • Sciatic nerve
    • Can occur anywhere along the course of the nerve
    • Most common locations
      • at level of ischial tuberosity
      • at the piriformis muscle (piriformis syndrome)
  • Saphenous neuritis
    • Compression of the saphenous nerve, usually at Hunter's canal
      • also known as surfer's neuropathy
    • Caused by kneeling for long periods of time
    • Symptoms
      • pain inferior and medial to knee
    • Treatment
      • nonoperative
        • knee pads
          • indications
            • first line of treatment
  • Common peroneal nerve
    • Can be compressed behind fibula by a ganglion cyst or injured by a direct blow
    • Fusion of the proximal tibiofibular joint may be needed to prevent cyst recurrence
  • Superficial peroneal nerve
    • Due to a fascial defect
      • usually ~ 12 cm proximal to lateral malleolus where it exits the fascia of the anterolateral leg
    • Mechanisms include
      • inversion injury
      • fascial defect
    • Presentation
      • numbness and tingling over dorsum of foot
      • worsens with plantar flexion and inversion of foot
    • Treatment
      • nonoperative
        • observation
          • indications
            • usually preferred treatment
      • operative
        • fascial release
          • indications
            • may be indicated in refractory cases or for elite athletes
  • Deep peroneal nerve
    • Can be caused by inferior extensor retinaculum
    • Also known as anterior tarsal syndrome
  • Posterior tibial nerve
    • Also known as Tarsal Tunnel syndrome
  • Lateral plantar nerve
    • Caused by compression of the first branch of the lateral plantar nerve, also known as Baxter nerve (branch to the abductor digiti quinti)
      • common nerve entrapment in the running athlete
      • becomes compressed between fascia of abductor hallucis longus and medial side of quadratus plantae
    • Treatment
      • operative
        • surgical release of abductor hallucis fascia
  • Medial plantar nerve
    • Compression of medial plantar nerve at point where FDL and FHL cross (Knot of Henry)
      • also known as Jogger's foot
    • Most common cause of compression is foot orthotics
    • Treatment
      • nonoperative
        • discontinue foot orthosis
  • Sural nerve
    • Can occur anywhere along the course of the nerve
    • Most vulnerable 12-15mm distal to the tip of the fibula as the foot rests in equinus position
    • Treatment
      • operative
        • surgical release
  • Interdigital neuroma
    • Also known as Morton's neuroma
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