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Candida Overblown
Candida is normally inoffensive yeast, an organism that lives naturally inside our bodies in small populations within the intestines. Sometimes, however, under certain conditions is can mutate into a fungal infection. The aggressive fungal form...
Consider The Facts Before Taking Weight Loss Pills
Are you struggling with weight loss? If diet and exercise have left you scratching your head, have you considered weight loss pills to help you lose weight? You are not alone. National Health and Nutrition Examination Survey reported that nearly...
Obesity and Weight Loss Explained
What is Obesity?
Obesity means an excessively high proportion of body fat.
Overweight refers to an excess of body weight, but not
necessarily body fat. Health professionals use a measurement
called body mass index (BMI) to classify an...
Waking Up to the Benefits of Sleep
Copyright 2005 Linda Slater Dowling
At one time or another, we've all wished that there were 48
hours in a day. Sometimes it feels like we need at least that
long just to get everything, from work to studying to
socializing and relaxing,...
Why You Should Stop Snoring -
If you or your sleeping partner snores, you may think of snoring as merely an irritant. But, snoring can have serious social and health consequences. So, there is every reason why one should attempt to stop snoring.
Snoring can cause severe...
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Peroneal Neuropathy: Waiting for the Other Foot to Drop
A "foot-drop" is a medical term which--thankfully--does not mean
that the foot suddenly disconnects from the leg. Rather, it
means that when the leg is lifted from the ground, the foot
droops downward at the ankle. The muscles that are supposed to
prop up the foot have become so weakened that they cannot
overcome gravity's downward pull. When people with this problem
try to walk, they have to either hike the leg higher to clear
their drooping toes or else risk tripping over them.
What is to blame for this inconvenient symptom? In truth, there
are multiple possible causes, but one of the most common
culprits is injury to a nerve-bundle in the leg known as the
peroneal nerve. To understand how this nerve-bundle can get in
trouble, a quick review of the bones of the leg is helpful.
There is just one bone, a big one, that connects the hip to the
knee, and that is the femur. There are two bones that connect
the knee to the ankle. The tibia is the larger one and lies more
to the inside, while the fibula is the thinner one and lies more
to the outside. That's the extent of the bony anatomy we need to
know.
The nerve-fibers constituting the peroneal nerve travel with the
huge sciatic nerve that runs behind the femur from the buttock
to the lower thigh. That's where the "common peroneal nerve"
splits out from the pack and runs along the outside of the knee,
tucking behind the head of the fibular bone (a knobby protrusion
just beyond the knee) and then snaking around the neck of the
fibula just below its head. The neck of the fibula forms the
floor of the fibular tunnel that the common peroneal nerve must
pass through. Within this tunnel the common peroneal nerve is
particularly vulnerable to injury.
Also within this tunnel the common peroneal nerve splits into
two branches, the "deep peroneal nerve" (farther from the leg's
surface) and the "superficial peroneal nerve" (closer to the
leg's surface). Because the two branches have different
connections to muscles and skin, injury to one produces
different impairments than are produced by injury to the other.
The deep peroneal nerve is responsible for cocking up the ankle
and toes, so injury to this branch produces weakness or
paralysis of the muscles responsible for these actions. There is
just a tiny patch of skin, located between the big toe and the
toe next to it, connected to the deep peroneal nerve, so damage
to this branch produces numbness limited to this small area.
The superficial peroneal nerve, by contrast, is responsible for
skin sensation on most of the outside of the calf and top of the
foot, so these areas can become numb when the superficial
peroneal nerve is injured. This branch is also responsible for
lifting the outside edge of the foot, so this action is gone
when the superficial peroneal nerve is not functioning properly.
Impairments due to injury of the common peroneal nerve (the
parent of the two branches) are the sum of the impairments
associated with each of the branches. So this means that the
ankle and toes cannot cock upwards, the outside edge of the foot
cannot lift, and there is numbness on the outside of the calf
and top of the foot.
"Peroneal neuropathy" means impairment of the peroneal nerve.
Peroneal neuropathies are the most common neuropathies (of the
kind that affects just one nerve at a time) in the lower
extremities. Investigators at the Louisiana State University
Health Sciences Center recently collected a series of 318
patients with peroneal neuropathy who required
surgery, while
Italian researchers collected another 69 cases that included
those who didn't need surgery. From these two tabulations of
cases a good picture emerges of the more common causes of
peroneal neuropathy.
Many were due to physical traumas. Some of the traumas were
severe enough to break or dislocate bones, while others involved
deep cuts in the soft tissues, and still others involved just a
stretch or bruise. Another common cause was surgical operations.
Some of the surgeries were to the nearby knee, but others were
performed on more distant structures, like the hip, the abdomen
or even the chest.
Many cases were due to excessive external pressure being applied
to the nerve. This occurred in different ways. For example, in
prolonged leg-crossing the knee of the bottom leg pushes
steadily against the peroneal nerve of the crossing leg.
Peroneal neuropathies seen in bedridden patients were presumably
due to lying on the fibular tunnel for too long without a shift
in position. Other patients had entrapment or pinching of the
nerve within the fibular tunnel unrelated to external pressure.
A surprisingly large group of patients had peroneal neuropathy
due to weight loss, also known as "slimmer's paralysis." More
than one factor might have been at play in these cases,
including lack of nutrients, pressure on the nerve, or both.
Researchers and clinicians find that in some people an
apparently isolated peroneal neuropathy is actually the leading
edge of a more widespread polyneuropathy. "Polyneuropathy" means
that peripheral nerves are impaired in a more diffuse
pattern--not just single nerves in single places. So in some
cases of apparent peroneal neuropathy further investigations
turn up polyneuropathy due to other causes, for example,
diabetes, excessive alcohol consumption or genetic factors.
How are cases evaluated? The physician's evaluation starts with
the time-honored methods of history-taking and physical
examination. As part of the physical examination the doctor
inventories which muscles are weak (and which are not) and maps
out areas of numbness affecting the skin. Additional testing
with electromyography and nerve conduction studies, which check
on electrical functions of the muscles and nerves, often
provides valuable information, including whether additional
nerves are affected and how bad the impairments are.
How about treatment? Treatment varies according to what caused
the peroneal neuropathy in the first place, but let's consider a
typical case unrelated to severe trauma. Nonsurgical approaches
are usually tried first, including avoidance of further pressure
on the peroneal nerve, improved nutrition and supplementation of
the diet with vitamins. A simple brace applied to the ankle
improves walking. In many cases the nerve recovers without
anything more drastic being done. But if these conservative
treatments fail (and the peroneal neuropathy is not part of a
more widespread polyneuropathy) then surgical exploration of the
fibular tunnel is often indicated. If the nerve is pinched, then
the surgeon frees up the nerve from whatever was pinching it.
(C) 2005 by Gary Cordingley
About the author:
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and
researcher who works in Athens, Ohio. For more health-related
articles see his websites at: http://www.cordingleyne
urology.com and http://www.neurologyartic
les.com
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