Plantar tunnel syndrome

Introduction to fistula syndrome The fistula syndrome (metatarsaltunnelsyndrome), also known as fistula syndrome or fistula syndrome, refers to a series of clinical symptoms caused by the sacral nerve being squeezed through the stroke from the fistula to the plantar below the medial malleolus. Signs were first reported by Keck in 1962. The disease occurs mostly in young and middle-aged, engaged in strong manual workers or long-distance runners. basic knowledge The proportion of illness: 0.001%-0.003% (incidence rate is about 0.001%-0.003%, more common in heavy physical workers) Susceptible people: young adults Mode of infection: non-infectious Complications: rheumatoid arthritis gouty arthritis

Causes of fistula syndrome

(1) Causes of the disease

Congenital factors (20%):

Congenital factors such as abductor muscle hypertrophy and parasympathetic abductor muscles, calcaneus valgus deformity, flat feet, etc. can reduce the practical volume of the fistula, thereby causing sacral nerve compression.

Chronic injury (30%):

Engaged in strong physical labor, long-distance runners and ankle joints with frequent high-intensity stenosis and back extension, increased tendon slip, increased friction, can cause tenosynovitis, tendon sheath congestion and edema, and the flexor support band is correspondingly thickened, the expansion of the fistula is reduced. The internal pressure is increased, which can compress the phrenic nerve and affect its blood supply, and produce neurological dysfunction. In addition, rheumatoid arthritis, senile osteoarthrosis and other patients can form hyperplastic epiphysis, and the epiphysis into the fistula can also make The phrenic nerve is under pressure.

Internal factors (15%):

The ganglion cyst, lipoma, and varicose veins can also cause sacral nerve compression.

Poor fracture reduction (15%):

Calcaneal and ankle fractures If the reduction is poor, malunion can also reduce the volume of the fistula. In addition, the base of the fistula is not smooth and can cause compression, friction and injury to the phrenic nerve.

Other (20%):

Such as hypothyroidism, pregnancy, saphenous vein and small saphenous vein.

(two) pathogenesis

The most narrow part of the fistula is at its distal end, and the branch of the nerve passes through the fibrous hole of the origin of the abductor muscle before entering the foot. The medial nerve of the plantar has the upper rim of the scapula and the lateral nerve. The circumference is the iliac crest muscle, so the valgus can pull the support band and the abductor muscle to make the medial nerve of the iliac crest, the blood vessels are twisted and jammed, and the symptoms of nerve compression are prone to occur. In addition, when the ankle joint is dorsiflexed or deformed, The flexor support band plays a restraining role at the fistula to prevent the tendon from slipping. If the ankle and foot movements suddenly increase, the tendon slips and the friction increases, which can cause tenosynovitis. If the foot and ankle activity continues to increase, the tendon sheath becomes swollen and swollen. Severe, the flexor support band is also thickened accordingly, and the flexibility of the fistula is reduced, so the pressure inside the fistula is increased, and the phrenic nerve can be squeezed, affecting blood supply and making neurogenic dysfunction (Fig. 1).

Fistula syndrome prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Complications of fistula syndrome Complications rheumatoid arthritis gouty arthritis

Generally no complications.

Symptoms of fistula syndrome Common symptoms Heel pain convulsions shallow sensation loss or lack of muscle atrophy

The patient has a slow onset and often occurs on one side. In the early stage, it manifests as the sole of the foot, intermittent pain in the heel, tightness, swelling, discomfort or numbness. The pain sometimes radiates to the calf, sometimes along the arch of the foot, standing or walking for a long time. After aggravation, there is a history of nighttime awakening, most patients can relieve after taking off the shoes. As the disease progresses, the pain is often gradually worsened. Further, the phrenic nerve may feel reduced or disappear in the dominating area of the foot, and the skin of the heel The feeling can be normal, because the medial nerve of the iliac crest is separated from the sacral nerve above the humerus or the part of the iliac crest is under the fistula. In the late stage, the skin of the toe can be bright, the hair is shed, and sweat is less. Symptoms of the disorder, and even the manifestation of internal muscle atrophy, the disappearance of the distance between the two points during the examination is an important basis for early diagnosis; the Tinel sign below the medial malleolus is often positive; the external rotation of the foot can induce pain.

Examination of fistula syndrome

1. EMG examination can be seen in the plantar, the lateral nerve conduction velocity is slowed down, and the incubation period is prolonged.

2. X-ray examination can find and understand the healing of ankle and calcaneal fractures.

3. CT examination of bilateral contrast helps to find cysts and tumors in the fistula.

Diagnosis and diagnosis of fistula syndrome

Diagnosis can be established based on medical history, clinical manifestations, EMG examination, X-ray examination and CT examination.

Differential diagnosis

1. Itching is a symptom diagnosis. It is more common in women around 30 years old. It is good for those who wear pointed high heels. The earliest symptoms are pain in the forefoot, burning or tightness. In severe cases, the pain can affect the foot. The toe or calf is generally relieved after the shoe is replaced. There is tenderness outside the humeral head during the examination, which may be accompanied by sputum, and the toes may be buckling deformity.

2. The foot manifestation of diabetes has a history of diabetes. Due to the involvement of small blood vessels in the patient, small blood vessels are hardened and degenerated, resulting in insufficient blood supply to the affected organs, causing neuroischemia and hypoxia, metabolic deterioration, and, in addition, diabetes. The patient's white blood cell anti-infective ability is reduced, which is easy to cause infection. In the foot, it shows ischemic pain of the toes. The small toe is more common, the vibration of the foot is felt, the pain and temperature are gone, the internal muscle of the foot is atrophy, and the near toe is between the toes. In the dorsal aspect of the joint (the sacral muscle), the metatarsophalangeal joint of the metatarsophalangeal joint is deformed, so that the claw-toe deformity can be formed. In severe cases, the toe necrosis can be seen, and the calcified shadow of the ankle can be seen on the X-ray film. Foot bone dissolution and loose, Xia Ke arthritis.

3. Rheumatoid arthritis of the foot is a local manifestation of systemic lesions. Female patients are more common. The local manifestations are pain in the sole of the foot. When walking, the pain is heavy. The metatarsophalangeal joint is most susceptible. After that, it can invade any part of the foot. With tenosynovitis, swelling around the joint along the tendon sheath, pain, late foot deformity, such as pointed foot, foot varus, foot valgus, valgus valgus, etc., ESR increased at the onset, X-ray film visible joint space stenosis, Osteoporosis, joint destruction and dislocation.

4. Foot gouty arthritis is more common in men. It is often in the first metatarsophalangeal joint at the first time. The onset is rapid, the pain is severe, the tenderness is obvious, and the local skin is red and swollen. The pain can last from several days to several weeks, often repeated. There is no symptom during the episode, and the blood uric acid can be increased during the attack period. If the calcium urate crystal is found in the joint puncture fluid, the diagnosis can be confirmed. The X-ray film of the chronic patient can see the worm-like shadow near the joint surface.

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