Introduction
The tibial nerve is a mixed sensory and motor nerve that supplies innervation to the ankle, foot, and lower leg muscles. The tibial nerve is divided into two branches known as the medial and lateral plantar nerves. The medial plantar nerve is the largest of the two branches, covering most parts of the foot. So, it contributes to the multitudinous intrinsic muscles in the foot. The lateral plantar nerve supplies the remaining aspects of the foot, including the sole and fifth toe.
What Is Medial and Lateral Plantar Nerve Entrapment?
Medial and lateral plantar nerve entrapment is the symptomatic painful condition occurring as a result of compression of medial and, or lateral nerve branches of the posterior tibial nerve. So, the nerves are pinched with the associated bones, connective tissue, and ligaments. Here, the pain and discomfort are felt at the medial aspect of the heel and proximal arch. The pain is triggered by intensive foot and ankle activities. The condition requires clinical diagnosis and nonoperative treatment.
What Causes Medial and Lateral Plantar Nerve Entrapment?
Medial and lateral plantar nerve entrapment does not possess causative factors. However, intense pressure on the concerned nerve would lead to a trap. The entrapment of the medial plantar nerve is generally due to repetitive impact on the abductor hallucis muscle, the muscles that run over the medial plantar nerve. So, the muscles result in inflammation and swelling that, in turn, presses the medial plantar nerve. This culminates in compression of the nerve, causing deep pain.
Overpronation is considered to be the primary cause of lateral plantar nerve entrapment. Overpronation is known for inward rolling and flattening the foot while walking and running. A supplementary pressure is applied to the lateral plantar aspects of the foot during overpronation. As a result, lateral plantar nerve entrapment occurs.
What Are the Signs and Symptoms of Medial and Lateral Plantar Nerve Entrapment?
Pain is the predominant feature of medial and lateral plantar nerve entrapment since it is compressed between the bones, muscles, ligaments, and connective tissue. The characteristic of such pain includes the following.
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Intense and constant pain with or without weight bearing.
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The pain is often chronic and unmanageable.
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Pain is felt inside the ankle, inner aspect of the foot, and heel.
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Difficulty with just standing.
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Pain worsens with ankle movements.
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The pain gets aggravated by highly-impact activities such as walking, jogging, and running.
Burning, tingling, and numbness are not usually seen with medial and lateral plantar nerve entrapment, while these feelings are apparent in cases of other nerve compressions.
How Is the Medial and Lateral Plantar Nerve Entrapment Diagnosed?
The medical healthcare professionals will first proceed with a physical examination, assessing the nature and intensity of the pain. Then, followed by manipulation and palpation of the affiliated nerve region to rule out the degrees of radiation of the pain. Finally, abduction and adduction are assessed. The doctors are keen on accurate and extensive examination as the medial and lateral plantar nerve entrapment can easily get misdiagnosed with the following differential diagnosis.
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Plantar fasciitis: A condition causing inflammation and pain in the region of plantar fascia.
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Tarsal tunnel syndrome: A condition characterized by the tibial nerve entrapment within the narrow space known as a tarsal tunnel.
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Other foot-related concerns.
Tinel’s Test: This test helps differentiate the pain between lateral plantar nerve entrapment and other nerve compressions. Here, the doctor will tap the nerve with a rubber hamper behind the medial malleolus bone, a bony prominence felt in the inner aspect of the ankle. The tinel’s test is considered positive when the tapping induces pain and severe discomfort.
How Is the Medial and Lateral Plantar Nerve Entrapment Treated?
The intervention of medial and lateral plantar nerve entrapment aims at alleviating pain and promoting motion. Therefore, the doctors might prescribe one or a combination of the following effective treatment options.
1. Orthoses: Orthotics play a vital part in conservative or nonoperative foot and ankle pathology treatment. Orthotic devices are strongly recommended to amend the biomechanical foot and ankle issues. It fits into the shoes and helps relieve ankle, heel, foot, sole, and toe pain. In addition, the device helps correct the overpronation problem.
2. Medication: Non-steroidal anti-inflammatory drugs are generally prescribed concerning pain.
3. Immobilization: Immobilization is a preferred treatment that helps improve chronic foot and ankle pain by localizing the primary cause of symptoms. Immobilization is also commercially available as ready equipment such as a short-leg walking cast, cam walker, and walking boot. The aid generally wraps around the foot, ankle, and lowest degree of the lower arm to enhance stability.
4. Corticosteroid Injection: Corticosteroid injection is recommended in cases of unsuccessful results from conservative treatment. Corticosteroids are the anti-inflammatory medication injected as a means of alleviating musculoskeletal problems. The infusion on appropriate doses and frequency helps relieve pain and inflammation, enabling the potential for exercise. In addition, corticosteroid infusion seems to be effective when used in combination with biomechanical aids and physical therapy.
5. Surgery: Surgical intervention is rarely prescribed as in aspects of failure of other treatments. The surgery is aimed at releasing the compressed nerve.
6. Physical Therapy: Physical therapy addresses pain and overall function. In addition, it helps prevent the recurrence of pain and discomfort. The physical therapy treatment involves the following.
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Gait education.
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Stretches.
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Footwear education.
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Therapeutic exercises.
7. Cold Therapy: Applying ice or a cold pack on the affected area for ten minutes every hour on initial days will help reduce pain and inflammation. One can gradually decrease the frequency of cold therapy with the improvement of symptoms.
8. Rest: Injuries and inflammation require rest to enhance recovery. However, healing takes up to several weeks, and thus, one should avoid strenuous activities until improvement.
Conclusion
One should seek professional help at the earliest when suspecting chronic intense pain in the foot, restricting daily functions. Furthermore, one should not ignore the pain and continue walking, running, and so on. Indulge in early diagnosis and appropriate intervention so as to achieve prevention of the progression of the condition. Recurrence can also be bypassed with the right treatment, physiotherapy advice, and supportive aids.
