Swipe om te navigeren naar een ander artikel
The online version of this article (doi:10.1186/1757-1146-4-14) contains supplementary material, which is available to authorized users.
Kathleen M Galloway, Mark E Lester and Rachel K Evans contributed equally to this work.
The authors declare that they have no competing interests.
KG carried out the nerve conduction studies. KG performed statistical analysis. All authors participated in the design and coordination of the study. All authors helped draft the manuscript, and have read and approved the final manuscript.
Standard tibial motor nerve conduction measures are established with recording from the abductor hallucis. This technique is often technically challenging and clinicians have difficulty interpreting the information particularly in the short segment needed to assess focal tibial nerve entrapment at the medial ankle as occurs in posterior tarsal tunnel syndrome. The flexor hallucis brevis (FHB) has been described as an alternative site for recording tibial nerve function in those with posterior tarsal tunnel syndrome. Normative data has not been established for this technique. This pilot study describes the technique in detail. In addition we provide reference values for medial and lateral plantar orthodromic sensory measures and assessed intrarater reliability for all measures.
Eighty healthy female participants took part, and 39 returned for serial testing at 4 time points. Mean values ± SD were recorded for nerve conduction measures, and coefficient of variation as well as intraclass correlation coefficients (ICC) were calculated.
Motor latency, amplitude and velocity values for the FHB were 4.1 ± 0.9 msec, 8.0 ± 3.0 mV and 45.6 ± 3.4 m/s, respectively. Sensory latencies, amplitudes, and velocities, respectively, were 2.8 ± 0.3 msec, 26.7 ± 10.1 μV, and 41.4 ± 3.5 m/s for the medial plantar nerve and 3.2 ± 0.5 msec, 13.3 ± 4.7 μV, and 44.3 ± 4.0 msec for the lateral plantar nerve. All values demonstrated significant ICC values (P ≤ 0.007).
Motor recording from the FHB provides technically clear waveforms that allow for an improved ability to assess tibial nerve function in the short segments used to assess tarsal tunnel syndrome. The reported means will begin to establish normal values for this technique.
Authors’ original file for figure 113047_2010_341_MOESM1_ESM.pdf
Moore KL, Dalley AF, Agur AM: Clinically Oriented Anatomy. 2009, Philadelphia: Lippincott Williams & Wilkins, 6
Trepman E, Kadel NJ, Chisholm K, Razzano L: Effect of foot and ankle position on tarsal tunnel compartment pressure. Foot & Ankle International. 1999, 20: 721-6. CrossRef
Aldridge T: Diagnosing heel pain in adults. Am Fam Physician. 2004, 70: 332-8. PubMed
Budak F, Bamac B, Ozbek A, Kultuay P, Komsuoglu S: Nerve conduction studies of lower extremities in pes planus subjects. Electromyogr Clin Neurophysiol. 2001, 41: 443-6. PubMed
Garcher DJ, Lewis JE, DiDomenico LA: Hypertrophic sustentaculum tali causing a tarsal tunnel syndrome: A case report. J Foot Ankle Surg. 2001, 40: 110-112. 10.1016/S1067-2516(01)80053-3. CrossRef
Tsai C, Lin T, Lai C, Lin S: Tarsal tunnel syndrome secondary to neurilemoma- a case report. Kaohsiung J Med Sci. 2001, 17: 216-220. PubMed
Fu R, DeLisa J, Kraft G: Motor nerve latencies through the tarsal tunnel in normal adult subjects: standard determinations corrected for temperature and distance. Arch Phys Med Rehabil. 1980, 61: 243-8. PubMed
Kimura J: Electrodiagnosis in Diseases of Nerve and Muscle. 2001, New York: Oxford University Press, 3
Powell G: Electrodiagnosis: an overview. Clin Podiatr Med Surg. 1994, 11: 571- PubMed
Felsenthal G, Butler DH, Shear MS: Across-tarsal-tunnel motor-nerve conduction technique. Arch Phys Med Rehabil. 1992, 73: 64-9. PubMed
Iyer KS, Kaplan E, Goodgold J: Sensory nerve action potentials of the medial and lateral plantar nerve. Arch Phys Med Rehabil. 1984, 65: 529-30. PubMed
Kim W, Kim HJ, Blumenthal FS, Joynt RL: Antidromic sensory nerve conduction studies of medial and lateral plantar nerves in normals. Electromyogr Clin Neurophysiol. 1993, 33: 289-94. PubMed
Belen J: Orthodromic sensory nerve conduction of the medial and lateral plantar nerves. A standardization. Am J Phys Med. 1985, 64: 17-23. PubMed
Antunes AC, Nobrega JA, Manzano GM: Nerve conduction study of the medial and lateral plantar nerves. Electromyogr Clin Neurophysiol. 2000, 40: 135-8. PubMed
Dumitru D, Amato AA, Zwarts M: Electrodiagnostic Medicine. 2002, Philadelphia, Hanley and Belfus Inc, 2
Portney LG, Watkins MP: Foundations of clinical research: Applications to practice. 2008, Upper Saddle River, Prentice Hall Health, 3
Galardi G, Amadio S, Maderna L, Meraviglia MV, Brunati L, Dal Conte G, et al: Electrophysiologic studies in tarsal tunnel syndrome. Diagnostic reliability of motor distal latency, mixed nerve and sensory nerve conduction studies. Am J Phys Med Rehabil. 1994, 73: 193-8. 10.1097/00002060-199406000-00008. CrossRefPubMed
- Clinical utility of tibial motor and sensory nerve conduction studies with motor recording from the flexor hallucis brevis: a methodological and reliability study
Kathleen M Galloway
Mark E Lester
Rachel K Evans
- BioMed Central