Updated: 8/19/2018

Leg Nerve Entrapment Syndromes

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Questions
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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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Questions (7)
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(OBQ10.251) Figure A is a dissection of the medial aspect of the left ankle and foot. Which of the following nerves indicated in Figure A is most commonly implicated in nerve entrapment? Review Topic

QID: 3349
FIGURES:
1

A

51%

(835/1629)

2

B

24%

(386/1629)

3

C

3%

(50/1629)

4

D

13%

(217/1629)

5

E

8%

(133/1629)

L 3

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(OBQ08.20) A 40-year-old runner complains of heel pain for 4 months. He reports tenderness over the abductor hallucis origin with a positive Tinel's sign radiating to the lateral foot. The pain worsens with prolonged activity. What is the most likely diagnosis? Review Topic

QID: 406
1

plantar fasciitis

1%

(24/2236)

2

heel fat pad fat atrophy

0%

(1/2236)

3

compression of the first branch of the lateral plantar nerve (Baxter's nerve)

87%

(1947/2236)

4

achilles tendinitis

0%

(3/2236)

5

tarsal tunnel syndrome

11%

(256/2236)

L 1

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(OBQ07.150) Which nerve innervates the abductor digiti quinti and can be compressed as it travels under the fascia of the abductor hallucis muscle leading to symptoms of plantar heel pain? Review Topic

QID: 811
1

Medial plantar

6%

(103/1747)

2

Medial calcaneal

2%

(36/1747)

3

Sural

1%

(18/1747)

4

Superficial peroneal

1%

(9/1747)

5

First branch of the lateral plantar nerve

90%

(1576/1747)

L 1

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(SBQ07SM.6) A competitive marathoner reports 6 months of pain over the lateral distal leg and dysesthesia over the dorsum of the foot. There is a tender fullness over the distal lateral fibula with a positive Tinel's sign. There is normal motor strength, but pain with passive plantar flexion and inversion of the ankle. The most appropriate surgical treatment is: Review Topic

QID: 1391
1

Repair muscle herniation and closure of the fascial defect

8%

(117/1461)

2

Fascial release and superficial peroneal neurolysis

82%

(1198/1461)

3

Fascial release of all four compartments

2%

(35/1461)

4

Superficial peroneal neurectomy

7%

(103/1461)

5

Lumbar discectomy

0%

(3/1461)

L 2

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(OBQ04.6) A 24-year-old male suffered an inversion injury 6 months ago. Since then he has had persistent numbness and tingling across the dorsum of his foot that is worse with plantar flexion and inversion of foot. A release of the involved nerve, shown in Figure V, is performed. Which of the following most likely describes the cause of his symptoms? Review Topic

QID: 117
FIGURES:
1

Compression of the superficial peroneal nerve by fascial band proximal to lateral malleolus

52%

(1503/2906)

2

Compression of the superficial peroneal nerve by the superior extensor retinaculum

40%

(1172/2906)

3

Compression of the deep peroneal nerve by the inferior extensor retinaculum

3%

(93/2906)

4

Compression of the superficial peroneal nerve by a ganglion cyst

2%

(62/2906)

5

Compression of the sural nerve 2cm proximal to the tip of the fibula

2%

(51/2906)

L 4

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SUBMIT RESPONSE 1
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