Radiating pain in the foot

Introduction Because lumbar disc herniation occurs mostly in the lumbar and lumbosacral intervertebral space, and the sciatic nerve is from the lumbar and sacral nerve roots, patients with lumbar disc herniation often have sciatica or first hips, and gradually radiate to the posterior thigh and the outside of the calf. The back of the foot and the lateral side of the plantar and toes. Central type of protrusion often causes bilateral sciatica. When the intra-abdominal pressure such as coughing, sneezing, and urination is increased, the radiation pain of the lower extremities is aggravated. Leg pain is more important than low back pain is one of the main signs of disc herniation.

Cause

There are mainly the following aspects: the localized displacement of the intervertebral disc tissue exceeds the intervertebral space. Its basic factor is the degeneration of the intervertebral disc. There are several reasons why it is easy to cause lumbar disc herniation:

1, spinal deformity.

2. The age is too large.

3. Ethnic inheritance.

4, long-term sedentary, long-term bending, long-term load.

5. Causes of trauma.

6, the waist is cold.

7, diabetes. Lumbar disc herniation symptoms are mainly low back pain and sciatica, which are manifested as lumbar pain, numbness in the buttocks and thighs, decreased feeling or pain allergy, pain in the feet, muscle atrophy, thin legs, difficulty walking, etc. Defecation and dysfunction, lower limb paralysis, prolonged bedridden can degrade the quality of life of patients, and loss of work and labor capacity.

an examination

Related inspection

CT examination of bone and joint and soft tissue EMG

Lumbar X-ray film

Simple X-ray film can not directly reflect the presence of disc herniation, but the degenerative changes such as narrowing of intervertebral space and vertebral edge hyperplasia are sometimes seen on X-ray films. It is an indirect suggestion. Some patients may have spinal deviation and spinal side. Convex. In addition, X-ray film can be found with or without bone disease, tumors and other bone diseases, with important differential diagnosis.

2. CT examination

It can clearly show the location, size, shape and nerve root and dural sac of the disc herniation. It can also show the laminar and ligamentum hypertrophy, small joint hypertrophy, spinal canal and lateral recess stenosis. In other cases, it has a great diagnostic value for this disease and has been widely used.

3. Magnetic resonance (MRI) examination

MRI has no radioactive damage and is important for the diagnosis of lumbar disc herniation. MRI can comprehensively observe whether the lumbar intervertebral disc is lesioned, and clearly show the morphology of intervertebral disc herniation and its relationship with the surrounding tissues such as dural sac and nerve root through different sagittal images and cross-sectional images of the intervertebral disc. In addition, it can be identified whether there are other space-occupying lesions in the spinal canal. However, the indication of whether the prominent intervertebral disc is calcified is not as good as CT examination.

4. Other

Electrophysiological examination (electromyography, nerve conduction velocity and evoked potential) can help determine the extent and extent of neurological damage and observe the therapeutic effect. Laboratory tests are mainly used to eliminate some diseases and play a differential diagnosis role.

Differential diagnosis

Bipedal redness and heat pain: caused by erythematous limb pain disease, under certain incentives, paroxysmal clinical manifestations of bipedal redness, swelling, heat, pain, etc., is a clinical feature of erythematous limb pain .

Foot pain: common symptoms of ankylosing spondylitis include heel pain, foot pain, intercostal muscle pain. Young men with lumbar stiffness, low back pain can not be relieved after rest, should be suspected of this disease, need to take timely high-quality pelvic orthotopic X-ray film. Many scholars believe that there is low back pain plus bilateral arthritis (X-ray findings), which can be diagnosed as this disease.

Foot swelling and tenderness: The heel of the calcaneal fracture can be extremely swollen, the posterior sulcus becomes shallow, and the entire hind foot is swollen and tender. According to the typical history of trauma, heel pain and tenderness, heel congestion, wide and flat deformity, and the outward slanting of the calcaneus, the normal sag below the lateral iliac crest, etc., it is not difficult to make a fracture judgment. The X-ray film is mainly the standard lateral position and the axial position piece. When the axial position piece is taken, the X-ray tube should be projected at an angle of 40° with the longitudinal axis of the foot. The lateral position piece draws a line from the anterior facet of the calcaneus to the posterior articular surface. Then, draw a line from the posterior articular surface to the calcaneus nodule. The two-line intersection angle is called the calcaneus nodule. The two-line intersection angle is called the calcaneus nodule angle (Böhler angle), and the normal is 20°~40°.

and foot numbness and burning sensation: numbness and foot numbness and burning sensation are a neuropsychiatric symptom of beriberi patients. The beriberi disease is vitamin B1 deficiency, and the vitamin B1, Thiamine, is a precursor of thiamine pyrophosphate (TPP). TPP is an important coenzyme for the decarboxylation of pyruvic acid and -ketoglutaric acid in the Krebs cycle, and is also a coenzyme of erythrocyte ketol transferase. In addition, there is a certain relationship between brain cell activity and nerve impulse conduction. Once lacking, it can cause a series of symptoms of the nervous system and circulatory system, called beriberi.

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