SPECIFIC CONDITIONS
- Many pain complaints in athletes present as neuro-
logic signs and symptoms. - Athletes most frequently complain of numbness or
tingling and focal weakness in the foot. - Although most long distance runners do not complain of
symptoms of neuropathy, they do appear to have sub-
clinical changes in quantitative sensory thresholds and
nerve conduction velocities (Dyck et al, 1987). Runners
may present with focal nerve entrapments (Table 19-5). - Athletes with nerve pain describe a burning, shooting,
tingling, numb, and/or electric quality to their pain.- Athletes may commonly present with tibial and per-
oneal nerve problems which can be evaluated by EDX
techniques.
- Athletes may commonly present with tibial and per-
TIBIAL NERVE- There are specific EDX techniques to evaluate the
tibial nerve and its terminal branches (Park and Del
Toro, 1998). - The tibial nerve has four terminal branches: (a) medial
plantar nerve, (b) lateral plantar nerve, (c) inferior cal-
caneal nerve, and (d) medial calcaneal nerve.
116 SECTION 2 • EVALUATION OF THE INJURED ATHLETE
TABLE 19-4 Timing of EDX Findings with Axonal Injury
TIME NCS NE
Day 0 Decreased CMAP/SNAP amplitudes proximally Decreased recruitment
Normal distal to lesion
Day 1-3 Decreased CMAP/SNAP amplitudes proximally
Normal distal to lesion
Day 3-7 Decreasing CMAP then SNAP amplitudes, proximally
and distally
Day 7-9 Decreased or absent CMAP amplitudes, proximally and Increased insertional activity in proximal muscles
distally
Day 10-14 Decreased or absent SNAP amplitudes Large PSW/Fibs in proximal denervated muscle
Week 3-6 — Large PSW/Fibs in distal denervated muscle
Week 6-8 Increasing amplitude w/recovery Nascent reinnervation of proximal muscles
(VMUP =polyphasic, low amplitude, increased duration)
Month 3-4 Increasing amplitude w/recovery
Proximal CV 80% of normal
Month 4 Nascent reinnervation of distal muscles
Maturing reinnervation of proximal muscles
(VMUP =polyphasic, high amplitude, increased duration)
Month 4-5 Maturing reinnervation of distal muscles
Year 1 Smaller PSW/Fibs
ABBREVIATIONS: NCS =nerve conduction studies; NE =needle examination; PSW =positive sharp waves; Fibs =fibrillations; SNAP =sensory nerve
action potential; CMAP =compound muscle action potential; VMUP =voluntary motor unit potential; CV =conduction velocity.
TABLE 19-5 Focal Entrapment Neuropathies Seen in Runners
SYNDROME/NERVE SYMPTOMS ENTRAPMENT SITE
Tarsal tunnel syndrome (tibial nerve Plantar pain/paresthesias, worse at night and with Under flexor retinaculum
proper) prolonged standing or walking
Medial calcaneal neuritis Medial heel pain At medial heel
Inferior calcaneal nerve (first branch Chronic heel pain, no numbness, weakness of Between AH and QP or calcaneal heel spur
of lateral plantar nerve) ADM
Medial plantar nerve (jogger’s foot) Medial arch pain At master knot of Henry (hypertrophy of AH)
Morton’s toe (interdigital nerve) N/T in toes At intermetatarsal ligament
Superficial peroneal nerve Lateral ankle pain At deep crural fascia as exits lateral
Fascial herniation compartment
Deep peroneal nerve Dorsum of foot pain At inferior extensor retinaculum
Tightly laced shoes
Common peroneal nerve N/T in lateral leg, dorsum of foot Compression in fibular tunnel by
fibrous edge of peroneus longus
Traction from ankle sprains
ABBREVIATIONS: N/T =numbness/tingling; AH =abductor hallucis; QP =quadratus plantae; ADM =abductor digiti minimi