Hagiwara Yusuke, Natsume Yumiko, Wagatsuma Tomomi, Hasegawa Tetsuya, Yoshida Ryu
Orthopaedic Surgery, Toho Kamagaya Hospital, Chiba, JPN.
Orthopaedic Surgery, Oshima Medical Association Hospital, Kagoshima, JPN.
Cureus. 2024 Jul 26;16(7):e65405. doi: 10.7759/cureus.65405. eCollection 2024 Jul.
Non-specific low back pain without identifiable causes on imaging is a common and frustrating problem for both patients and physicians. While proximal symptoms such as shoulder pain from distal upper extremity neuropathies such as carpal tunnel syndrome are well-known, peripheral neuropathy of the foot or ankle is rarely considered in the differential diagnosis for low back pain. This study aims to highlight the potential link between chronic ankle instability (CAI) and low back pain. We present three cases: a 32-year-old woman with chronic low back pain for over 10 years, a 59-year-old woman with transient low back pain after long drives, and a 42-year-old woman with acute low back pain while gardening. All patients had normal imaging studies but exhibited CAI on examination. Diagnostic modalities included the ankle anterior drawer test, application of ankle brace, superficial peroneal nerve (SPN) blocks, and assessment of the active straight leg raise (aSLR) angle. In the first case, low back pain disappeared after SPN neurolysis and ankle ligament reconstruction. The second case showed significant improvement in aSLR and pain reduction with SPN block and ankle brace. The third case experienced substantial pain relief with the use of an ankle brace. These findings suggest that addressing ankle instability and associated traction neuropathy can significantly alleviate low back pain symptoms. CAI may be an underrecognized cause of non-specific low back pain. Interventions such as ankle brace, SPN blocks, SPN decompression, and ankle ligament reconstruction can be effective for diagnosis and treatment, potentially offering relief for patients with chronic low back pain.
影像学检查未发现明确病因的非特异性腰痛，对患者和医生来说都是一个常见且令人沮丧的问题。虽然像腕管综合征等上肢远端神经病变引起的近端症状如肩部疼痛已为人熟知，但足踝部周围神经病变在腰痛的鉴别诊断中很少被考虑。本研究旨在强调慢性踝关节不稳（CAI）与腰痛之间的潜在联系。我们呈现三个病例：一名32岁女性，慢性腰痛超过10年；一名59岁女性，长时间开车后出现短暂性腰痛；一名42岁女性，园艺时突发急性腰痛。所有患者影像学检查均正常，但检查时表现出CAI。诊断方法包括踝关节前抽屉试验、应用踝关节支具、腓浅神经（SPN）阻滞以及评估主动直腿抬高（aSLR）角度。在第一个病例中，SPN神经松解术和踝关节韧带重建术后腰痛消失。第二个病例中，SPN阻滞和踝关节支具使aSLR显著改善且疼痛减轻。第三个病例使用踝关节支具后疼痛大幅缓解。这些发现表明，解决踝关节不稳及相关的牵引性神经病变可显著减轻腰痛症状。CAI可能是未被充分认识的非特异性腰痛病因。踝关节支具、SPN阻滞、SPN减压及踝关节韧带重建等干预措施对诊断和治疗可能有效，有望为慢性腰痛患者缓解疼痛。
