Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, 53226, USA.
Arch Phys Med Rehabil. 2010 Dec;91(12):1948-51. doi: 10.1016/j.apmr.2010.08.022.
Two patients with recalcitrant unilateral heel pain and plantar fasciitis were referred for electrodiagnostic evaluation. They both reported constant, sharp, unilateral medial heel pain, with nocturnal symptoms, as well as exacerbation by weight-bearing activities. Examination of both patients demonstrated focal medial heel tenderness and a Tinel sign over the tarsal tunnel on the affected side. Neither patient had weakness or sensory deficits in the affected foot. In both patients, findings on nerve conduction studies were normal in the affected foot, including the first branch of the lateral plantar nerve (FBLPN), as well as the medial and lateral plantar motor and sensory (ie, mixed nerve) responses. Needle electromyographic (EMG) abnormalities were found only in the abductor digiti quinti pedis (ADQP), an intrinsic foot muscle that is exclusively innervated by the FBLPN, but there were no EMG abnormalities noted in the medial or lateral plantar-innervated muscles studied, nor the contralateral ADQP. Both patients then underwent surgical decompression of the FBLPN. Postoperative follow-up (patient 1 at 10 months, patient 2 at 21 months) revealed excellent outcomes, as defined by symptom resolution, in both patients. Electrodiagnostic evaluation was useful in diagnosing isolated first branch lateral plantar neuropathy.
两位患有顽固性单侧足跟痛和足底筋膜炎的患者被转来进行电诊断评估。他们都报告说有持续的、尖锐的单侧足跟内侧疼痛，夜间症状加重，且负重活动时加重。对两位患者的检查都显示出患侧跟骨内侧局部压痛和跟骨隧道处 Tinel 征阳性。受影响的脚都没有无力或感觉缺失。在两位患者中，受影响的脚的神经传导研究结果均正常，包括足底外侧神经第一分支（FBLPN）以及内侧和外侧足底运动和感觉（即混合神经）反应。仅在 FBLPN 独家支配的内在足部肌肉——小趾展肌（ADQP）中发现针极肌电图（EMG）异常，但在研究的内侧或外侧足底支配的肌肉以及对侧 ADQP 中未发现 EMG 异常。然后，两位患者均接受 FBLPN 减压手术。术后随访（患者 1 为 10 个月，患者 2 为 21 个月）显示，两位患者的症状均完全缓解，结果均为优。电诊断评估对诊断孤立的第一分支足底外侧神经病很有用。
