Technique for determining when plantar heel pain can be neural in origin

NewsBot · Jul 16, 2008

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Technique for determining when plantar heel pain can be neural in origin.
Dellon AL.
Microsurgery. 2008 Jul 11. [Epub ahead of print]

The surgeon doing microsurgery will encounter problems related to the heel not only in terms of how to reinnervate the transferred tissue, but also in patients presenting with heel pain. While most heel pain is thought to be related to the plantar fascia arising from the calcaneus, conceptually heel pain can be of neural origin. The technique for documenting sensibility in the heel is described using the Pressure-Specified Sensory Device. Knowledge of calcaneal nerve sensibility can determine whether there is sufficient sensation to prevent ulceration, whether there is a nerve entrapment that would benefit from neurolysis, or whether there is a neuroma that would benefit from resection.
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Stanley · Jul 16, 2008

If you ask your patient if there is "burning, shooting, or tingling" on the history, or if you ellicit a positive Tinel's sign on palpation of the first or second branch of the medial calcaneal nerve, then you can be sure that the pain is neural in origin locally.

Admin2 · Jul 16, 2008

Related:
Heel pain: Biomechanical and sensory differences

Stanley · Jul 17, 2008

Admin2 said: ↑

Related:
Heel pain: Biomechanical and sensory differences
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I agree with the paper that is quoted. I find, however, the compressive neuropathy is a later stage of the condition. In other words, the patient first develops post static dyskinesia. Secondly, the patient develops pain on walking at the end of the day which progresses to earlier in the day. Finally the patient develops entrapment neuropathy.

Adrian Misseri · Jul 18, 2008

Stanley said: ↑

I agree with the paper that is quoted. I find, however, the compressive neuropathy is a later stage of the condition. In other words, the patient first develops post static dyskinesia. Secondly, the patient develops pain on walking at the end of the day which progresses to earlier in the day. Finally the patient develops entrapment neuropathy.
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Well that would make sence as oedema consistent with chronic inflammation of teh area entraps the first lateral brance of the medial calcaneal nerve as it passes under the plantar fascia near the insertion. Often found these to be the most difficult to treat, even with orthoses, taping physical therapies and camm walkers.

NewsBot · Feb 3, 2022

Prevalence for plantar fasciitis of neural origin in community-dwelling adults
Hetakshi Dhananjay Thakar et al
DOI: 10.4103/mjdrdypu.mjdrdypu_501_20

Introduction: Plantar fasciitis (PF) is one of the most common causes of heel pain in adults. Common causes of PF include prolonged standing, obesity, flat foot, and nerve entrapment. PF caused due to nerve entrapment is often left unnoticed when making a diagnosis or management for PF. Lateral and medial plantar nerves are the common nerves to get entrapped causing pain and tingling in the foot ultimately leading to PF. Aims: This study aimed to come up with the prevalence of PF of neural origin in community-dwelling adults. Settings and Design: A cross-sectional study was conducted on fifty patients with PF attending Department of Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune, over a 6 months period. Subjects and Methods: Patients were assessed based on their symptoms and whether they meet the criteria for diagnosing the condition as PF. Assessment for classifying PF of neural origin was done using Standard Neurodynamic Testing for Plantar nerves branch of tibial nerve. Statistical Analysis Used: Descriptive statistics was presented as frequency percentage. Results: The prevalence of neural origin PF among fifty patients was 54%. Forty-eight percent of them were females and 6% were males. Conclusion: This study concludes that the burden of PF of Neural Origin is more in Community Dwelling Adults yet goes undiagnosed due to the tendency of following a set battery of physical examination by physiotherapists which does not include neurodynamic tests.
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Technique for determining when plantar heel pain can be neural in origin

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Technique for determining when plantar heel pain can be neural in origin

NewsBot The Admin that posts the news.

Stanley Well-Known Member

Admin2 Administrator Staff Member

Stanley Well-Known Member

Adrian Misseri Active Member

NewsBot The Admin that posts the news.

The signed helical angle: A technique for characterizing midfoot motion during gait

Silicone moulding techniques

Impact of hydration back packs on the running technique

Cultural variation in running techniques

Inforatio Technique for Diabetic Foot Ulcers

Surgery techniques

Muscle energy technique versus ischemic compression for plantar fasciitis

Share This Page

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