Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Foot Ankle Int. 2019 Oct;40(10):1209-1213. doi: 10.1177/1071100719858143. Epub 2019 Jul 23.
Dorsal pain from osteoarthritic midfoot joints is thought to be relayed by branches of the medial and lateral plantar, sural, saphenous, and deep peroneal nerves (DPN). However, there is no consensus on the actual number or pathways of the nervous branches for midfoot joint capsular innervation. This study examined the DPN's terminal branches at the midfoot joint capsules through anatomic dissection and confirmation of their significance in a clinical case series of patients with midfoot pain relief after DPN block.
Eleven cadaveric lower leg specimens, 6 left and 5 right, were dissected using operative loupe magnification. We preserved the terminal branches and recorded their paths and branching patterns. Joint capsular innervations were individually noted. To confirm our hypothesis of significant dorsal midfoot joint capsular innervation by the DPN, we also performed an institutional review board-approved retrospective chart review of 37 patients with painful dorsal midfoot osteoarthritis who underwent diagnostic local anesthetic injection block of the DPN. The percentage of temporary pain relief after the injection was recorded.
Terminal innervation of the DPN branches showed distribution of the second and third tarsometatarsal joints in all specimens. Inconsistent innervation of the naviculocuneiform (9/11), fourth (7/11), first (6/11), and fifth (4/11) tarsometatarsal and calcaneocuboid joints (1/11) were observed. The retrospective review of pain relief in patients with dorsal midfoot pain due to arthritis after diagnostic injection demonstrated a mean of 92.1% improvement.
Innervation of the dorsal midfoot joint capsule appears to follow a consistent distribution across 3 joints: second and third tarsometatarsal joints and the naviculocuneiform joint. Acute relief of dorsal midfoot arthritic pain after diagnostic injection suggests that dorsal midfoot nociceptive pain is at least partly transmitted by the DPN.
Level IV, case series.
骨关节炎性中足关节的背侧疼痛被认为是由内侧和外侧足底、跗骨、隐神经和深腓浅神经（DPN）的分支传递的。然而，对于中足关节囊的神经分支的实际数量或途径，尚无共识。本研究通过解剖学解剖检查了 DPN 在中足关节囊的终末分支，并通过对接受 DPN 阻断后中足疼痛缓解的患者的临床病例系列进行确认，证实了它们的重要性。
使用手术放大镜解剖了 11 个小腿标本，6 个左侧，5 个右侧。我们保留了终末分支，并记录了它们的路径和分支模式。单独记录关节囊的神经支配。为了证实我们关于 DPN 对中足背侧关节囊有重要神经支配的假设，我们还对 37 例患有疼痛性中足背骨关节炎的患者进行了机构审查委员会批准的回顾性图表审查，这些患者接受了 DPN 的诊断性局部麻醉注射阻滞。记录注射后暂时缓解疼痛的百分比。
DPN 分支的终末神经支配显示所有标本的第二和第三跖骨间关节的分布。观察到足舟状骨-楔骨（9/11）、第四（7/11）、第一（6/11）和第五（4/11）跖骨间和跟骰关节（1/11）的神经支配不一致。对因关节炎导致中足背侧疼痛的患者进行诊断性注射后疼痛缓解的回顾性研究显示，平均改善率为 92.1%。
中足关节囊的神经支配似乎在 3 个关节中具有一致的分布：第二和第三跖骨间关节以及足舟状骨-楔骨关节。诊断性注射后急性缓解中足关节炎性疼痛表明，中足痛觉疼痛至少部分通过 DPN 传递。
IV 级，病例系列。
