Term
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Definition
sensory only
•Split to form the proper digital nerves supplying the webspace, particularly digits III-IV.
•Runs over the deep transverse tarsal ligament.
•Tractioning of the nerve over the transverse tarsal ligament is most prominent
•when the toes are hyperextended at the metatarsophalangeal (MP) joints.
•Decreased pressure of the ligament against the nerve and decreased neural tension with MTP flexion. |
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Term
Interdigital nerves
CAUSATIVE FACTORS |
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Definition
•Presence of a neuroma, or overgrowth of fibrotic nerve tissue may be present
•The 3/4 nerve is most easily stressed, but it can occur elsewhere. 2/3
•intermetatarsal spaces most common for Morton’s neuroma.
•Wearing high heeled shoes
•A fixed hyperextended MTP
•Hallux valgus
•Impaired push-off or plantar flexion weakness
•Shortened Achilles/Gastroc/Soleus –results in compensatory MTP hyperextension
•Toe-touch gait pattern
•Swelling or direct trauma to foot
•Poor Shoe fit
•Shortened extremity or flexion contracture
•Occupational (electrician) |
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Term
Interdigital nerves
Examination: |
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Definition
•Sensory exam of interspaces and tips of the toes (neurovascular)
•Point tenderness between the metatarsal heads with PFT
•Differentiate from metatarsalgia through palpation of MTP from interspace
•Movement analysis, provocation with MTP extension, relief with plantar flexion
•Compression of metatarsals towards midline to compress nerve |
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Term
Interdigital nerves
Treatment: |
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Definition
•Removing the source of the compression is key. May be accomplished by
•restoring plantarflexion mobility of toes, dorsiflexion of the ankle, using a metatarsal pad
•or bar to encourage MTP flexion or pad to place transverse ligament on slack. Patient
•Education to remove pathomechanical cause may be needed. Important to differentiate from Neuroma by lack of favorable response to treatment |
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Term
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Definition
sensory/motor
•Sensory supply is the plantar surfaces of the foot and distributions
•of the medial plantar nerve (heel and medial 3 ½ toes), lateral plantar nerve
•(lateral heel and border of foot including 1 ½ toes) and calcaneal nerve (medial
and plantar aspect of the heel).
•Paresthesia or burning pain, plantar aspect of foot and toes, medial plantar heel,
•Referred to as tarsal tunnel
•Entrapment behind the medial malleolus in the “tarsal tunnel” by the flexor retinaculum ( lacinate ligament).
•Travels with the tibialis posterior, flexor hallucis longus and flexor digitorum longus.
•Motor involvement creates intrinsic weakness, loss of flexion at the MTP joints and
•extension at the IP joints.
•Neuropathy will cause postural changes such as clawing of the toes and |
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Term
Posterior Tibial Nerve
CAUSATIVE FACTORS |
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Definition
•Space occupying lesion such as: thickened Flexor retinaculum (lacinate ligament), Fracture/displacement
•Tendon pathology or swelling .
•Pathomechanical- midfoot/rearfoot excessive pronation, talus laxity
•Vascular insufficiency (posterior tibial vein engorgement) |
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Term
Posterior Tibial Nerve
Examination |
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Definition
•Direct palpation (PFT)
•Special tests, Tinel’s sign
•Passive accessory tests at the rearfoot, midfoot, talocrural for laxity.
•Special Test: sustained rearfoot varus relieves symptoms, sustained rearfoot valgus increases symptoms. |
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Term
Posterior Tibial Nerve
Treatment |
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Definition
•Removing pressure.
•Treat underlying tendon problem if applicable
•Manipulation/stretching tight structures
•Decrease valgus of heel: i.e. medial heel or midfoot post
•Surgical decompression of tarsal tunnel |
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