Terman. Terapia Manualna. Fizjoterapia

28/04/2025

Trochę czasu minęło zanim odzyskaliśmy kontrolę motoryczną po wielokrotnym skręceniu stawu skokowego 💪🙂

02/02/2025

Uwięźnięcie nerwu Baxtera 🦶🧐

Baxter’s nerve entrapment 🦶

🦶 Plantar heel pain is one of the most prevalent and recalcitrant podiatric conditions. Previous studies have estimated that 10–15% of the population experiences this condition during their lifetime (https://pubmed.ncbi.nlm.nih.gov/17400020/, https://pubmed.ncbi.nlm.nih.gov/18574754/). However, making a correct diagnosis is challenging because of numerous etiologies, including plantar fasciopathy, heel pad atrophy, and nerve entrapment, which produce overlapping symptoms (https://pubmed.ncbi.nlm.nih.gov/1600660/, https://pubmed.ncbi.nlm.nih.gov/24860133/)

🦶 Among these etiologies, entrapment of the first branch of the lateral plantar nerve, also known as Baxter’s nerve (BN) or inferior calcaneal nerve, is thought to be one of the main causes of neuropathy, accounting for approximately 20% of chronic heel pain (https://pubmed.ncbi.nlm.nih.gov/23980227/).

🦶 Initially described in 1984 by Baxter and Thigpen, it is often overlooked as a cause of medial heel pain, particularly in athletes, where it may coexist with plantar fasciopathy (https://doi.org/10.29328/journal.aceo.1001012).

🦶 Usually emerging from the lateral plantar nerve (LPN) just distal to its origin from the tibial nerve, the BN is a mixed motor and sensory nerve. The nerve has a motor branch to the abductor digiti minimi muscle (ADM) and a sensory branch (also known as calcaneal branch of the inferior calcaneal nerve) to the periosteum of medial calcaneal tuberosity and long plantar ligament (https://pubmed.ncbi.nlm.nih.gov/17400020/).

👉 There are two well-known entrapment sites of the BN (https://pubmed.ncbi.nlm.nih.gov/32500156/).

1️⃣ The first site is where the nerve crosses the deep fascia of the abductor hallucis between the abductor hallucis and medial caudal margin of the quadratus plantae (https://pubmed.ncbi.nlm.nih.gov/22526881/); contributory factors include altered biomechanics such as pes cavus or excessive pronation as well as muscle hypertrophy.

2️⃣ The second is where the nerve passes just anterior to the medial calcaneal tuberosity. Contributory factors include plantar fasciopathy or a plantar calcaneal spur (https://pubmed.ncbi.nlm.nih.gov/23980227/, https://pubmed.ncbi.nlm.nih.gov/28369929/).

👉 Clinically, patients with Baxter's nerve entrapment complain of plantar heel pain, but there are subtle differences between these patients’ symptoms and those with plantar fasciitis.

✅ Patients with Baxter's nerve entrapment describe the pain as located more medially than the pain in plantar fasciopathy.

✅ Additionally, the pain is often described as a burning pain on the medial side of the heel, and it is worse in the evenings and after activities rather than during the patients’ first steps in the morning (typically described in plantar fasciopathy, (https://pubmed.ncbi.nlm.nih.gov/29763043/, https://doi.org/10.1016/j.otsm.2021.150854).

✅ A positive Tinel sign and maximal tenderness of nerve entrapment can be elicited at the two points mentioned above (https://www.ncbi.nlm.nih.gov/books/NBK499868/). Patients may report numbness or paresthesias on the lateral aspect of their foot especially in chronic cases (https://doi.org/10.1016/j.jbspin.2016.02.005).

✅ Examining these nerve entrapments should include a biomechanical exam to evaluate the contribution of hindfoot varus/valgus position, equinus, or pes planus.

💡 A combination of load management, non-steroidal anti-inflammatory medication (NSAIDs), orthoses, and physical therapy (strengthening of the foot intrinsics, neural mobilization, https://doi.org/10.1016/j.eujim.2022.102201, https://pubmed.ncbi.nlm.nih.gov/21875518/, https://pubmed.ncbi.nlm.nih.gov/17400020/) is recommended in the initial management of Baxter's neuropathy (https://pubmed.ncbi.nlm.nih.gov/24860133/), based on very weak evidence.

📸 https://pubmed.ncbi.nlm.nih.gov/39773256/: Gross dissection of the Bn, which diverges from the lateral plantar nerve. it travels vertically and turns horizontally (red arrowhead) towards the abductor digiti minimi muscle. Bn: Baxter nerve, lPn: lateral plantar nerve, MPn: medial plantar nerve, fHl: flexor hallucis longus muscle, fdl: flexor digitorum longus muscle.

17/01/2025

Ukrwienie łąkotek :)

08/01/2025

08/01/2025

Anatomia rozcięgna podeszwowego 🦶

🎊🌲Between the years, we traditionally announce our "Best-of series" of the most influential posts of 2024 on FB.

📣 today 🥇 2

Anatomy of the Plantar Fascia 🦶

👉 The plantar aponeurosis (PA) originates from the calcaneal tubercle and extends to the forefoot. The aponeurosis consists of a medial, central and lateral part. The medial and lateral parts attach to the abductor hallucis and the musculus abductor digiti quinti pedis, respectively. These parts are usually categorized as “fascia”. The central part is thicker and is considered an “aponeurosis” (https://www.ncbi.nlm.nih.gov/books/NBK526043/).

👉 As the central aponeurosis extends towards the forefoot, it divides into five separate bundles. These bundles radiate towards and attach through the plantar plates to the proximal phalanges (https://pubmed.ncbi.nlm.nih.gov/12831690/, https://pubmed.ncbi.nlm.nih.gov/13129168/). Most anatomic studies of the PA have focused on its attachment to the calcaneus. Detailed descriptions of each central PA bundle are rare.

👉 There is dorsiflexion of the metatarsophalangeal (MTP) joints during walking. The PA tightens via a windlass mechanism first described by Hicks (https://pubmed.ncbi.nlm.nih.gov/13129168/). All five bundles contribute to raising the foot arch. It is not known whether dysfunction of only one central bundle could affect this mechanism.

📸 Picture: Great view of a dissection of the sole of the foot showing the anatomy of the plantar aponeurosis (PA).

1. Longitudinal digital tracts of the PA.

2. Abductor digiti quinti muscle.

3. Lateral component of the PA.

4. Central component of the PA.

5. Medial component of the PA.

📘 Source: https://www.sciencedirect.com/science/article/pii/S1268773121000023

09/11/2024

Pozostał tydzień do walki o pas KSW 💪.
Cieszymy się że mogliśmy dołożyć cegiełkę w przygotowaniach. Trzymamy kciuki ✊
za wygraną 🏆

02/10/2024

Kontuzje na rowerze to częsta rzecz 🤔. Warto po wyleczeniu poprawić stabilizację centralną i wzmocnić obręcz barkową 💪, aby zminimalizować późniejsze ryzyko urazów. Pacjent po złamaniu wyrostka łokciowego oraz urazie Collesa 🧐

29/06/2024

Intensywny tydzień szkoleniowy za mną 🧐👌.
Diagnostyka USG level wyżej 💪.

21/06/2024

Kontrolna wizyta 💪🙂👊, wszystko idzie w dobrą stronę 🧐 Formela Fight Team Władysławowo

09/05/2024

Działamy pełną parą 💪🙂👊, a dla naszych pacjentów zajęcia grupowe Movement Stabilization, aby przedłużyć efekt terapii 🙂.

08/05/2024

Z niecierpliwością czekamy na debiut Kacper Formela 💪🙂👊 w KSW, to już w sobotę 😜. Trzymam kciuki i czekam na fajerwerki 💥. Formela Fight Team Władysławowo

04/05/2024

Możliwe miejsca bólu przy problemach z narządami wewnętrznymi 🧐

Common visceral pain referral patterns 💡

👉 Referred pain is defined as pain perceived in a region innervated by nerves other than those that innervate the source of the pain (https://link.springer.com/referenceworkentry/10.1007/978-3-540-29805-2_4801). Visceral referred pain is explicitly visceral nociception and pain that becomes referred.(

👉 Visceral pain is not perceived locally. Viscera are diffusely innervated, and the central pathways of visceral pain are poorly organized somatotopically. This means that the nervous system is not “wired” in a manner to localize visceral pain accurately. Therefore, visceral symptoms are most often experienced as a diffuse, generalized, and poorly defined pain within the abdominal region. However, pain from different visceral sources can refer to various somatic locations.

👉 Thought to be a response to viscerosomatic convergence (s. penultimate post), this can help explain some common pain referral patterns that are seen in visceral pain conditions.

📘 Klineberg et al. (https://pubmed.ncbi.nlm.nih.gov/18183841/) described examples of some visceral pain referral patterns that can be seen in patients presenting with back pain. For example, patients with aortic aneurysms can report mid-thoracic back pain that can be severe and described as tearing.

👉 Acute pancreatitis is another cause of thoracolumbar back pain (https://pubmed.ncbi.nlm.nih.gov/15549456/) Inflammation of the pancreas occurs after obstruction of the pancreatic duct and can be triggered by binge drinking or gallstones. Abdominal and back pain with a history of drinking should raise one’s suspicion, as should a history of pancreatitis, as the pain may represent residual disease.

👉 Patients with gallbladder or liver pathology can have referred pain in the posterior scapular and shoulder region. This can be especially important in patients with spinal cord injury when there is sensation impairment below the level of injury and referred pain may be the only presenting symptom suggesting the underlying pathology.

👉 Ectopic pregnancy, kidney stones, and prostatitis may also present with referred pain to the back region. Pain and tenderness at McBurney point, located one-third the distance from the anterior superior iliac spine to the umbilicus, can suggest underlying appendicitis.

📘 Illustration: https://www.sciencedirect.com/book/9780323722162/pain-care-essentials-and-innovations