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TIBIAL NERVE

Anatomy Origin : Sciatic nerve Supplies Post. Muscle of leg Gastocnemius Popliteus Soleus Tibialis post. Flexor Hallucis Longus Flexor Digitorum Longus Knee joint

TIBIAL NERVE INJURY


Rarely injured Causes except in open wound Injuries around the ankle (distal part) Clinical features: Unable to plantar-flex the ankle Or flex the toes Sensation absent over the sole + part of the calf Later trophic ulcer may develop

Treatment
Complete nerve division sutured as soon as possible While recovery awaited orthosis is worn (prevent excessive dorsiflexion) Sole is protected against pressure ulceration Hindfoot fusion or transfer tibialis ant to the back of the foot

COMMON PERONEAL (FIBULAR) NERVE


Anatomy Origin : sciatic nerve Supplies : Skin on the lateral part of post leg Knee joint

COMMON PERONEAL INJURY


Causes :
Common damaged at level of the fibular neck by Severe traction when the knee forced into varus e.g. Lat ligament inj, # around the knee, during operative correction of gross valgus By pressure splint @ cast By skin traction By intraneural ganglion @ wound

Clinical features
Foot drop can neither dorsiflex nor evert the foot Gait : high stepping gait avoid cratching the toes Sensation : lost over the front and outer half of the leg and dorsum of the foot Pain (intraneural ganglion @ wound)

SUPERFICIAL FIBULAR NERVE


Anatomy Origin : common fibular nerve Supplies
Fibularis longgus Fibularis brevis Skin on distal of ant surface of the leg Dorsum of foot

SUPERFICIAL FIBULAR NERVE INJURY


Causes Lateral compartment syndrome ( mascular part) Cuteneous branches trapped, stretched by severe inversion inj. Clinical features Pain at lateral part of the leg Numbness @ paraesthesia of the foot Weakness on eversion Sensory loss dorsum of the foot Pain + sensory loss without muscle weakness (cut. Branches)

DEEP FIBULAR NERVE


Anatomy Origin : common fibular nerve Supplies:
Anterior muscle of the leg Dorsum of the foot Skin of 1st interdigital cleft Joint it cross

DEEP FIBULAR NERVE INJURY


Causes
Anterior compartment syndrome

Clinical features
Pain Weakness of dorsiflexion Sensory loss

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