Nerve Compression Syndromes of the Lower Extremities
In general, compression of the nerves is caused indirectly. Usually it is a result of bone fractures, sprains or defective foot posture such as splayed or flat feet. Nerve compression can also result in the course of rheumatoid arthritis because the tendons and ligaments can become inflamed or thickened. Tendon inflammations can also occasionally be caused through certain sports activities or through strain in certain work-related activities. Metabolism disorders such as diabetes or kidney disease can also have an effect on the tendons and thicken them, causing pressure on the nerves. However, nerve compression syndromes can also occur without any apparent reason, in other words they are idiopathic, which is often the case in the upper extremities in carpal tunnel syndrome.
The sciatic nerve, which comes from the spinal cord, is often unwantedly made familiar to many patients suffering from lumbago. The part of this nerve reaching the thigh is called the femoral nerve and divides on its course through the leg into the tibial nerve and the common fibular nerve. These nerves can be particularly susceptible to compression at several narrow points along the leg.
Branches of the femoral nerve and sciatic nerve can be compressed or injured at around knee height, causing pain. These symptoms can, under certain circumstances, be treated in a partial knee join denervation using the Dellon method. For more details on what has been until now a less well-known operation, please contact us and we will be glad to advise you.
The tibial nerve can get compressed on its way through the calf in an area called the tendinous arch of soleus muscle and is at further at risk of compression as it runs through tunnel-like structures in the tarsal region. Branches of this nerve supply sensation to the soles of the feet and innervate the small foot muscles.
Tarsal tunnel syndrome
Tarsal tunnel syndrome is a painful foot condition in which the tibial nerve is compressed, triggering burning pain and abnormal sensations in the area around the medial malleolus (the bump on the inside of the ankle). The pain and abnormal sensations typically radiate towards the heel and sole and can be intensified when pressure is applied to the medial malleolus or if the area is tapped. Patients often suffer from oversensitivity (hyperesthesia) in the sole of the foot, possibly with associated paralysis of the foot muscles. There can also be a reduction in sweat production on the feet.
Morton’s Neuralgia / Morton’s Metatarsalgia / Morton’s Neuroma
External pressure on the nerve branches in the toes can lead to nerve irritation, causing burning pain in the front part of the sole. This clinical picture is often described as Morton’s neuralgia or Morton’s metatarsalgia (sometimes also Morton’s neuroma although it is not a “real” neuroma). It usually affects the space between the 2nd and 3rd or the 3rd and 4th toes.
Peroneal / Fibular Nerve
When symptoms appear on the back of the foot then it is the fibular nerve that is affected. It runs under a ligament band on the back of the foot and it is here, often possibly assisted by the patient’s wearing of overly narrow shoes, that it can be compressed.
A further position where the fibular is prone to compression is at the height of the head of the fibula, where the nerve has to wind its way around it as it exists the back of the knee. Pressure is often the cause, but other causes can be injuries or operations when there has been swelling or the nerve can be directly injured itself. The foot and toe muscles lose their function and there is sensation loss between the 1st and 2nd toes, or when only the sensory part of the nerve is affected, the sensation on the back of the foot is affected.
The surgery of peripheral nerves and the treatment of chronic pain triggered by these nerves are key areas of work at our practice. We will gladly advise and examine you should you identify any of the above as being related to your problems.