Medial Plantar Nerve: Difference between revisions

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== '''Description'''<br> ==
==Description==
[[File:Gray833.png|alt=|right|frameless|390x390px]]
The medial plantar nerve is the larger one of the two terminal branches of the tibial nerve<ref name=":0">De Maeseneer M, Madani H, Lenchik L, Kalume Brigido M, Shahabpour M, Marcelis S, De Mey J, Scafoglieri A. [https://d1wqtxts1xzle7.cloudfront.net/43175196/De_Maeseneer_RGPHS_2015-libre.pdf?1456704498=&response-content-disposition=inline%3B+filename%3DMUSCULOSKELETAL_IMAGING_Normal_Anatomy_a.pdf&Expires=1676916375&Signature=BM~Cbw6BG7TmOW8JRYmb3MmXKlDAtlBfXuoyFabTix42lcLI7KU5YU-O4hpJxOrYl4HYfZplzRd6g2qAjiWIzfXxRH4bsZlf0FA1eMrXyG8Ak1epkO2mCciDxxfLxI8wpRz3KGKY4rcMHseuW-5BoZjWocOvuG~D1NkgjlQW88LDVfRA9bUvacU17B-xuo-h7dEFGsqHstFUtz-UbkOAYelDM9gBiAolQGScudVra9sNwYpKyFQhORcsjFJyjgFDSE~o2lYS36yt0fxq9iiS3tOQaNbi2rAK7nlpgxF0suh8u5JM1L9fhW8K00~8OYQ2mhWOnnBroCfXUvPYjIqyIQ__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA Normal anatomy and compression areas of nerves of the foot and ankle: US and MR imaging with anatomic correlation.] Radiographics. 2015 Sep;35(5):1469-82.</ref>, it covers most of the sole of the foot and supplies multiple intrinsic muscles of foot.&nbsp;


[[Image:Gray833.png|thumb|right|250x300px]]
==Anatomy==
==== General Course of Nerve: ====
The medial plantar nerve originates under the flexor retinaculum<ref name=":1">Hacking, C. (2022) ''Medial plantar nerve: Radiology reference article'', ''Radiopaedia Blog RSS''. Radiopaedia.org. Available at: https://radiopaedia.org/articles/medial-plantar-nerve (Accessed: February 20, 2023).</ref>, crosses the lateral surface of posterior tibial artery and runs anterior to the lateral plantar nerve<ref name=":0" />. Proximally, this nerve runs between the quadratus plantae and abductor hallucis muscles and continues until it is in close proximity to the master knot of Henry<ref name=":0" />. More distally, it courses along the medial border of the flexor digitorum brevis muscle and then divides into the  articular, muscular, and cutaneous branches<ref name=":0" />.  


The medial plantar nerve is the larger one of the two terminal branches of the tibial nerve, it covers most of the sole of the foot and supply multiple muscles which functioning on the toes.&nbsp;
==== Branches: ====


== '''Anatomy&nbsp;<ref name="Clinical anatomy">Richard S. Snell,1992,Clinical Anatomy for Medical Students,fourth edition,little brown and company,Boston</ref>'''  ==
'''Cutaneous branches''': Plantar digital nerves run to the sides of the medial three and the medial half of the fourth toe and extend onto the dorsum of the foot.  


=== General Course of Nerve:  ===
'''Muscular branches'''


It arises under the flexor retinaculum and runs forward deep to the abductor hallucis with the medial plantar artery on its medial side. It comes to lie in the interval between the abductor hallucis and the flexor digitorum brevis. &nbsp;
'''Articular branches''' 


=== Branches:  ===
==Function==
Cutaneous branches supply most of the skin on the anterior two-thirds of the sole as well as the adjacent surfaces of the medial three and one-half toes, including the big toe<ref name=":1" />.  


<u>Cutaneous branches:</u> plantar digital nerves run to the sides of the medial three and the medial half of the fourth toe. The nerves extend onto the dorsumand supply the nail beds and the tips of the toes.<br>  
Muscular branches supply the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis and first lumbrical muscles<ref name=":0" />.


<u>Muscular branches:</u> it gives a branches to these four muscles, abductor hallucis, flexor digitorum brevis, the flexor hallucis brevis and the first lumbrical muscle.  
Articular branches supply the articulations of the tarsus and metatarsus<ref name=":0" />.


== '''Function''' ==
== Pathology/Injury ==
 
=== Innervates (sensory and motor):<br>  ===
 
See the branches section above.&nbsp;
 
=== Movements produced:&nbsp;  ===


Flexion and abduction of the big toe (flexor hallucis brevis and abductor hallucis)
'''Medial plantar nerve entrapment'''


Flexion of the toes (flexor digitorum brevis and the first lumbrical muscle)
Compression of the medial plantar nerve can occur  deep to the flexor retinaculum, adjacent to the master knot of Henry<ref name=":0" /> or in the distal tarsal tunnel<ref name=":2">Feger, J. (2022) ''Medial plantar nerve entrapment: Radiology reference article'', ''Radiopaedia Blog RSS''. Radiopaedia.org. Available at: https://radiopaedia.org/articles/medial-plantar-nerve-entrapment (Accessed: February 20, 2023).</ref>. This may occur due to repetitive foot eversion and is sometimes referred to as "jogger's foot"<ref name=":0" />. Other causes of entrapment include space-occupying lesions, previous surgery or tenosynovitis of the flexor hallucis longus and flexor digitorum longus tendons<ref name=":2" />. 


== Pathology/Injury ==
Symptoms include:  


'''Medial plantar nerve entrapment:'''
* paraesthesia of the medial sole and at the navicular tuberosity<ref name=":0" />
 
* paraethesia of plantar aspect of the first and second toes<ref name=":2" /> 
It is a compression of the nerve branches, where the nerve branches are compressed between bones, ligaments and other connective tissues causing a pain at the inner heel area.&nbsp;
* pain/tenderness of the medial plantar arch and heel<ref name=":2" />
 
Symptoms include almost constant pain whenever adding a pressure to the foot either by walking or sitting, just standing is often difficult.<ref name="Med.p">Medial and Lateral Plantar Nerve Entrapment, http://www.msdmanuals.com/home, (accessed 11 Jan 2017)</ref>  


== Physiotherapy Assessment  ==
== Physiotherapy Assessment  ==


=== Observation: ===
Observation:  


Local observation for the sole of the foot is the first step of examination, notice any difference compared with the unaffected side, &nbsp;injury or incision, bruises, lump and the skin colour on the related area.  
Local observation for the sole of the foot is the first step of examination - take note of differences compared with the unaffected side.  


*The atrophy muscle is a sign to indicate if there is an impairment of the nerve that innervates the affected muscle, but it is difficult to be recognised with small muscles.
Palpation:


=== Palpation:  ===
You can assess the sensation of the areas supplied by the medial plantar nerve and palpate the related area to check any problems relating to the sensation (either hyper sensitivity or impaired sensation) and/or the tenderness degree.


You can assess the sensation of the areas supplied by the medial plantar nerve and palpate the related area to check any problems relating to the sensation (either hyper sensitivity or impaired sensation) and/or the tenderness degree.<br>
Muscle testing:


=== Manual muscle test:&nbsp; ===
Resisted muscle testing of the muscles innervated by the medial plantar nerve motor muscular branches.
== References ==
<references />


Examine the strength of the muscles that Innervated by the medial plantar nerve, by resisting the movement of the big toe flexion/abduction and toes flexion.&nbsp;
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
[[Category:Anatomy]]
<references /></div>

Latest revision as of 13:04, 26 February 2024

 

Original Editor - Asma Alshehri

Lead Editors - Asma Alshehri, Kim Jackson, George Prudden, Shaniel Walters, Rachael Lowe, Tony Lowe, WikiSysop, Jaroslaw Pospiech and Wendy Snyders  

Description[edit | edit source]

The medial plantar nerve is the larger one of the two terminal branches of the tibial nerve[1], it covers most of the sole of the foot and supplies multiple intrinsic muscles of foot. 

Anatomy[edit | edit source]

General Course of Nerve:[edit | edit source]

The medial plantar nerve originates under the flexor retinaculum[2], crosses the lateral surface of posterior tibial artery and runs anterior to the lateral plantar nerve[1]. Proximally, this nerve runs between the quadratus plantae and abductor hallucis muscles and continues until it is in close proximity to the master knot of Henry[1]. More distally, it courses along the medial border of the flexor digitorum brevis muscle and then divides into the articular, muscular, and cutaneous branches[1].

Branches:[edit | edit source]

Cutaneous branches: Plantar digital nerves run to the sides of the medial three and the medial half of the fourth toe and extend onto the dorsum of the foot.

Muscular branches

Articular branches

Function[edit | edit source]

Cutaneous branches supply most of the skin on the anterior two-thirds of the sole as well as the adjacent surfaces of the medial three and one-half toes, including the big toe[2].

Muscular branches supply the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis and first lumbrical muscles[1].

Articular branches supply the articulations of the tarsus and metatarsus[1].

Pathology/Injury[edit | edit source]

Medial plantar nerve entrapment

Compression of the medial plantar nerve can occur deep to the flexor retinaculum, adjacent to the master knot of Henry[1] or in the distal tarsal tunnel[3]. This may occur due to repetitive foot eversion and is sometimes referred to as "jogger's foot"[1]. Other causes of entrapment include space-occupying lesions, previous surgery or tenosynovitis of the flexor hallucis longus and flexor digitorum longus tendons[3].

Symptoms include:

  • paraesthesia of the medial sole and at the navicular tuberosity[1]
  • paraethesia of plantar aspect of the first and second toes[3]
  • pain/tenderness of the medial plantar arch and heel[3]

Physiotherapy Assessment[edit | edit source]

Observation:

Local observation for the sole of the foot is the first step of examination - take note of differences compared with the unaffected side.

Palpation:

You can assess the sensation of the areas supplied by the medial plantar nerve and palpate the related area to check any problems relating to the sensation (either hyper sensitivity or impaired sensation) and/or the tenderness degree.

Muscle testing:

Resisted muscle testing of the muscles innervated by the medial plantar nerve motor muscular branches.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 De Maeseneer M, Madani H, Lenchik L, Kalume Brigido M, Shahabpour M, Marcelis S, De Mey J, Scafoglieri A. Normal anatomy and compression areas of nerves of the foot and ankle: US and MR imaging with anatomic correlation. Radiographics. 2015 Sep;35(5):1469-82.
  2. ↑ 2.0 2.1 Hacking, C. (2022) Medial plantar nerve: Radiology reference article, Radiopaedia Blog RSS. Radiopaedia.org. Available at: https://radiopaedia.org/articles/medial-plantar-nerve (Accessed: February 20, 2023).
  3. ↑ 3.0 3.1 3.2 3.3 Feger, J. (2022) Medial plantar nerve entrapment: Radiology reference article, Radiopaedia Blog RSS. Radiopaedia.org. Available at: https://radiopaedia.org/articles/medial-plantar-nerve-entrapment (Accessed: February 20, 2023).
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