Plantar Nerve Supply - Its Clinical Significance and Management

Introduction:

All of the nerve cells in the body are part of the nervous system. We communicate with the outside world through our nervous system, which also regulates a number of internal bodily systems. The nervous system receives information from our senses, interprets it, and causes responses, such as causing the muscles to contract or causing us to experience pain. According to their locations throughout the body, the nervous system is divided into two parts, the central nervous system, and the peripheral nervous system. The nerves in the brain and spinal cord are part of the central nervous system (CNS). It is securely enclosed inside the spinal canal and skull. The peripheral nervous system (PNS) includes every other nerve in the body. Additionally, the voluntary and involuntary nervous systems can be distinguished. The somatic nervous system, also known as the voluntary nervous system, regulates all of our conscious and voluntary bodily movements. People can perceive leg position, pain, temperature, and touch thanks to their nerves.

What is Plantar Nerve Supply?

• Medial plantar nerve:

The medial plantar nerve, the larger of the two terminal divisions of the tibial nerve, runs parallel to the medial plantar artery. The proper digital plantar nerve emerges above the foot, passes through muscles, and divides into three common digital plantar nerves opposite the metatarsal bone bases. The cutaneous, muscular, and articular, (4) a proper digital nerve to the medial side of the big toe, and (5) three common digital nerves are the branches of the medial plantar nerve. The skin of the foot's sole is covered with cutaneous branches. The muscular branches supply both the surface and deep muscles. The skin on the great toe's medial side is supplied by the proper digital nerve. The adjacent sides of the great and second toes are supplied by the first common digital nerve; the adjacent sides of the second and third toes are supplied by the second common digital nerve; and the adjacent sides of the third and fourth toes are supplied by the third common digital nerve.

• Lateral Plantar Nerve

The skin of the fifth toe and the lateral part of the fourth, as well as the majority of the deep muscles, are supplied by the lateral plantar nerve. The common digital nerve separates into two proper digital nerves that feed the neighboring sides of the fourth and fifth toes, while the superficial branch splits into a proper and a common digital nerve. The proper digital nerve provides the lateral side of the little toe.

• Medial Calcaneal Nerve

Usually, it originates from the tibial nerve. The medial side of the heel is sensorily innervated by the medial calcaneal nerve. Based on studies, it is a recognized clinical cause of heel pain.

What Is The Clinical Significance of Plantar Nerve Supply?

• Jogger’s Foot

As it travels through the fascia and muscles, the medial plantar nerve could be compressed. Jogger's foot may be more common in long-distance runners with flat feet. Exercise-related symptoms include discomfort across the medial portion of the sole of the foot that spreads distally to the third toes, medial heel, and ankle. The initial course of therapy includes altering the mechanical forces at work that initially cause nerve irritation, including the inclusion of different non-impact cross-training routines so the athlete may keep up their cardiovascular condition.

• Baxter’s Neuropathy

Nerve entrapment, muscular hypertrophy, bone spurs, plantar fasciitis, bursitis, and nerve stretching are all common among athletes. Chronic medial plantar heel discomfort that becomes worse with movement, foot eversion, and abduction are the symptoms of Baxter's neuropathy. Normal side effects usually don't include paresthesias or weakness. The abductor hallucis muscle feels painful when deeply palpated during a physical examination. Treatment options often include rest, cold therapy, physical therapy, custom orthotics, and injection therapy with local anesthetic and corticosteroids.

• Tarsal Tunnel Syndrome

The posterior tibial nerve, which travels down the back of the lower thigh, or the plantar nerves in the foot are compressed in tarsal tunnel syndrome, which results in discomfort in the feet and legs. It affects females more frequently. Sharp, shooting pain in the inner ankle and down the foot, numbness on the bottom of the foot, discomfort with the movement of the foot, and a tingling or burning feeling are all signs of tarsal tunnel syndrome. The symptoms may get worse at night when standing or walking, or right after exercise. After resting, the discomfort frequently fades. Wearing uncomfortable shoes and hurting the feet or legs might lead to tarsal tunnel syndrome.

• Morton’s Neuroma

In Morton's neuroma, thicker tissues squeeze the nerves in the space between the toes. Long-term nerve irritation can result in foot pain in the ball of the foot. The discomfort frequently leads to nerve swelling and the development of Morton neuromas, noncancerous (benign) growths of nerve tissue that typically appear between the bases of the third and fourth toes. These growths might, however, appear between any two toes. Neuromas are more frequent in women and often only affect one foot. Nerve irritability is caused by a variety of reasons, most notably unsupportive or uncomfortable footwear. Other causes include improper foot posture, thinning of the nerve-protecting fat, and atypical foot anatomy that strains the nerves.

A neuroma may initially just cause a slight soreness around the third or fourth toe, possibly accompanied by a burning or tingling feeling as the condition worsens. When a person wears particular types of shoes, especially those that are too tight for the front of the foot, like pointed shoes, these sensations are typically more prominent. No matter what shoes are worn, a persistent burning sensation may develop as the problem worsens and spreads to the tips of the toes. Most people eventually lose the ability to wear the majority of closed-toe shoes. Additionally, a stone or pebble may feel as though it is lodged inside the foot's ball. Changes in footwear, injections of a corticosteroid/anesthetic combination, wearing the right footwear, and occasionally orthoses (devices worn in the shoe) may all help to alleviate the symptoms. It could also be advised to get some rest and apply ice. Pain can occasionally be reduced by alcohol injections or cryotherapy (the use of a cold). If none of these therapies work, surgical excision of the neuroma frequently results in permanent numbness in the region but totally eliminates the symptoms.

How to Relieve the Nerve Pain?

Below is all that can help ease nerve and foot discomfort:

• Applying heat.

• Cold packs resting over-the-counter painkillers like Ibuprofen (Advil).

• Deep tissue massages.

• Wearing a splint for support.

• Avoid prolonged sitting or standing.

• Wearing broad, soft-soled, laced shoes with low heels.

• Physical exercise.

• NSAIDs (nonsteroidal inflammatory drugs) and injections of corticosteroids.

• Surgical decompression if a hernia or tumor is the underlying reason.

Conclusion:

The entrapment neuropathies related to plantar nerves typically get better with rest, NSAIDs, and sporadic steroid injections. It is also effective to get rid of any external compressive causes, reduce swelling and inflammation, and rectify any osseous anomalies or deformities. Surgery to remove any tissues that are compressing the damaged nerve and decompress the affected nerve in recalcitrant situations has usually produced positive outcomes. It is important to take care of the plantar nervous system to better preserve effective function, as a whole.