Peroneal Nerve Dysfunction in Patients with Clubfoot Deformity: Evaluation of Clinical Presentation and Treatment (original) (raw)
Related papers
The Open Anatomy Journal, 2010
A detailed knowledge of the branching patterns and the variations of the cutaneous nerves of the extremities will help to decrease iatrogenic injury to these nerves. A case of abnormal distribution of the superficial peroneal nerve, observed during the routine dissection of the right leg of an 81 year old male cadaver at AIMST University, Kedah, Malaysia is reported here. The nerve after supplying the peroneal muscles of lateral compartment gave a medial dorsal cutaneous branch and a lateral dorsal cutaneous branch. The medial dorsal cutaneous branch descended in front of the middle of the ankle to the dorsum of the foot and supplied the skin of medial side of the great toe, the medial side of the 1 st metatarsal region and the 1 st web space including the adjacent sides of great and second toes. The lateral dorsal cutaneous branch descended in front of the lateral malleolus to enter the lateral aspect of the dorsum of the foot where it divided into medial and lateral terminal branches to supply adjacent sides of the 2nd, 3rd, 4 th and 5th toes. On the other hand, the deep peroneal nerve after supplying the muscles of anterior compartment of leg continued on dorsum of foot without dividing into terminal branches and without supplying the skin of first web space and adjacent sides of great and second toes. It ended by supplying the extensor digitorum brevis muscle. Surgical and clinical significance of this rare variation of the superficial peroneal nerve is discussed and relevant literature is reviewed.
Ultrasound diagnosis of peroneal nerve variant in a child with compressive mononeuropathy
Journal of Pediatric Surgery, 2011
We report on a 6-year-old child presenting with subacute foot drop. Neurophysiologic and radiologic studies revealed a peroneal nerve compression secondary to fibular exostosis. Before undergoing surgical removal of the exostosis, the patient underwent further neurophysiologic and ultrasonographic evaluation that showed the presence of an accessory peroneal nerve branch that caused gastrocnemius involvement. Findings at surgery confirmed the supposed anatomical variant. Both nerve components were carefully preserved during the operative procedure. The association of ultrasonographic and neurophysiologic studies was crucial in identifying the etiopathologic mechanism and anatomical picture and provided clinicians and surgeons with important information in planning the procedure.
Idiopathic congenital clubfoot: Initial treatment
Orthopaedics & traumatology, surgery & research : OTSR, 2013
Clubfoot (talipes equinovarus) is a three-dimensional deformity of unknown etiology. Treatment aims at correction to obtain a functional, plantigrade pain-free foot. The "French" functional method involves specialized physiotherapists. Daily manipulation is associated to immobilization by adhesive bandages and pads. There are basically three approaches: the Saint-Vincent-de-Paul, the Robert-Debré and the Montpellier method. In the Ponseti method, on the other hand, the reduction phase using weekly casts usually ends with percutaneous tenotomy of the Achilles tendon to correct the equinus. Twenty-four hour then nighttime splinting in abduction is then maintained for a period of 3 to 4 years. Recurrence, mainly due to non-compliance with splinting, is usually managed by cast and/or anterior tibialis transfer. The good long-term results, with tolerance of some anatomical imperfections, in contrast with the poor results of extensive surgical release, have led to a change in cl...
The management of dorsal peroneal nerve compression in the midfoot
Foot (Edinburgh, Scotland), 2018
The foot and ankle specialist will frequently encounter patients with dorsal midfoot pain in clinic. In the presence of midfoot pain and/or paraesthesia, nerve entrapment must be considered. The authors report the outcome of a case series of patients who underwent surgical release of the DPN. Between 2011-2017, a single surgeon operated on seven patients with a diagnosis of DPN entrapment. A retrospective review of the patient's clinical notes was performed, including the operative findings. The average age at presentation was 47 years (range, 31-70 years), and the left foot was affected in four cases. In all cases the patient presented with dorsal midfoot pain, with three cases associated with paraesthesia. The mean follow up was 25 months (range, 4-70 months), with six of the patients discharged with their pre-operative symptoms settled. One patient who had good immediate pain relief following DPN neurolysis, EHB tendon resection and reduction of exostosis developed recurrence...
Peroneal neuropathy from Ankle-Foot orthoses
Pediatric Neurology, 2003
Mononeuropathies are uncommon in childhood but can be a cause of significant disability. A considerable proportion of pediatric peroneal palsies arise as iatrogenic complications of casting, footboards, and intraoperative positioning. This article provides a description of a patient who developed bilateral peroneal palsies after cardiac transplantation. Factors predisposing this patient to neuropathy included hemophilia and prolonged immobilization, with focal involvement of the peroneal nerves being likely related to the use of ankle-foot orthoses. Peroneal nerve palsies are a significant, but potentially avoidable, iatrogenic complication of lower-extremity orthoses.
Knee Surgery, Sports Traumatology, Arthroscopy, 2010
Despite the fact that the superficial peroneal nerve is the only nerve in the human body that can be made visible; iatrogenic damage to this nerve is the most frequently reported complication in anterior ankle arthroscopy. One of the methods to visualize the nerve is combined ankle plantar flexion and inversion. In the majority of cases, the superficial peroneal nerve can be made visible. The portals for anterior ankle arthroscopy are however created with the ankle in the neutral or slightly dorsiflexed position and not in combined plantar flexion and inversion. The purpose of this study was to undertake an anatomical study to the course of the superficial peroneal nerve in different positions of the foot and ankle. We hypothesize that the anatomical localization of the superficial peroneal nerve changes with different foot and ankle positions. In ten fresh frozen ankle specimens, a window, only affecting the skin, was made at the level of the anterolateral portal for anterior ankle arthroscopy in order to directly visualize the superficial peroneal nerve, or if divided, its terminal branches. Nerve movement was assessed from combined 10°plantar flexion and inversion to 5°dorsiflexion, standardized by the Telos stress device. Also for the 4th toe flexion, flexion of all the toes and for skin tensioning possible nerve movement was determined. The mean superficial peroneal nerve movement was 2.4 mm to the lateral side when the ankle was moved from 10°plantar flexion and inversion to the neutral ankle position and 3.6 mm to the lateral side from 10°plantar flexion and inversion to 5°dorsiflexion. Both displacements were significant (P \ 0.01). The nerve consistently moves lateral when the ankle is manoeuvred from combined plantar flexion and inversion to the neutral or dorsiflexed position. If visible, it is therefore advised to create the anterolateral portal medial from the preoperative marking, in order to prevent iatrogenic damage to the superficial peroneal nerve.
Deep Peroneal Nerve: Orientation and Branching at the Ankle and Proximal Part of the Foot
Siriraj Medical Journal
Objective: This study investigated the frequency and types of 1) orientation of the deep peroneal nerve (DPN) and its branches relative to the dorsalis pedis artery (DPA) and the extensor hallucis longus tendon (EHLT) and 2) branching site and pattern of DPN at the distal area of leg and the proximal zone of the foot.Materials and Methods: One-hundred and sixty specimens from the lower extremities of 80 formalin-embalmed cadavers were investigated for anatomical position, orientation and the branching pattern of DPN by manual dissection, starting from the anterior side of lower extremity just proximal to ankle joint down to the area distal to inferior extensor retinaculum.Results: The most prevalent medial-to-lateral orientation of structures in the area anterior to ankle joints was the EHLT/DPA/DPN. Comparing DPA with the branching of DPN in the areas inside anterior tarsal tunnel (ATT) and distal to ATT, the most common type was an orientation of DPA that was lateral to both the D...
Evaluation of the deformity in club foot by somatosensory evoked potentials
Journal of Bone and Joint Surgery-british Volume, 2000
S omatosensory evoked potentials (SSEPs) measure the conduction pathways from the periphery to the brain and can demonstrate the site of neurological impairment in a variety of locomotor conditions. SSEPs were studied in 44 children (64 feet) with surgically corrected club feet. Four children had unreproducible responses, 18 showed abnormal recordings and 22 showed normal responses. In a further 31 feet (21 children) subjected to motor electrophysiological tests, 16 (52%) were abnormal.
Foot and Ankle Clinics of North America, 2010
The treatment of children who have clubfeet has been revolutionized with the belated acceptance of Ponseti's method of serial stretching and casting. The improved results from nonoperative treatment have greatly reduced the need for early surgical correction of clubfoot, and rates of surgery have decreased tremendously in recent years to as low as 2.5% in the best hands. 1 Most doctors who have a significant practice of treating clubfeet will have two groups of patients: those treated with Ponseti's method and those from preceding years who were managed surgically. Additionally, there are two broad groups, the idiopathic clubfeet and those that are deemed to be complex, either because of teratologic or neurologic etiology. Each group of patients has a similar presentation, but different treatment options may be required depending on the etiology and previous treatment. Despite best efforts, some feet remain recalcitrant to treatment and residual deformities do occur. This article discusses the deformities that can present and the treatment options. The challenge in treating clubfeet is to provide children who have a functional plantigrade foot. After the treatment of primary and recurrent deformity, residual deformity may be present, not all of which will cause functional deficit. The treating physician must decide what is relevant and can be improved and what has no influence on function or symptoms. As with all treatment decisions, attending surgeons must decide whether they have a realistic opportunity to improve function for the child and reduce symptoms. The appearance of the foot is important, but only when pain and function have been assessed. Any intervention must address these two factors first. Often appearance also will improve, but treatment priority must be identified. Recurrence of the deformities associated with idiopathic clubfoot occurs in 20% to 30% of patients, and continued follow-up of children who have clubfeet is essential to identify and treat recurrences expeditiously. Even after successful conservative treatment, 2% to 20% may still require surgical procedures to correct residual deformities. 2 Long-term studies evaluating patient function show that the outcome is not exclusively dependent on anatomic considerations. Ippolito and colleagues 3 followed two groups