Have you ever just looked at your foot, moving, flexing your toes, being amazed at how easily they move? Ever wondered which nerves makes it move?
The body is full of muscles, behind those muscles are the nerves which controls them and makes it possible for us to move.
There are many different nerves throughout the leg. You will find sensory nerves, balance controlling, and action nerves.
We are going to be looking at the little nerve that runs down and into our big toe, the medial plantar nerve.
What Is the Medial Plantar Nerve?
The medial plantar nerve is a small, but very important nerve in our foot. It controls the balance and movement of our big toe. Without it, it would be really difficult for us to walk or move around. Have you ever thought about what would happen if we didn't have the big toe? Many people don't realize just how important it actually is to our balance.
Just like our thumb is vital for our hand functions, to grab and hold onto items. The big toe is important for our leg movements and balance. Otherwise we would just be tipping over all the time.
If you have ever looked at a baby trying to sit and keep its balance you might notice those cute little toes. The big toe often looks very “concentrated” or flexed. This is because they need it to keep their balance. They aren’t even standing but it still keeps them from falling over. It’s amazing.
Where Is It Located?
The medial plantar nerve is part of one of the largest nerves in the body; the sciatic nerve. This nerve starts at the back of the pelvis and runs all the way down through the thigh. It then gets divided into smaller nerves which run to the knee and others that run down to the feet and into the toes.
The tibial nerve is one of the two that connects to the huge sciatic. It runs down to the foot where the common plantar nerve takes over. The common plantar nerve is what controls the other toes. The medial then parts from the common and runs down into the big toe. It then helps us balance and move around.
This nerve can get strained. It can cramp up. But these are things that are easy to fix and shouldn't cause too much pain in the long run.
There is one very common injury to the medial plantar nerve; medial plantar neuropraxia or medial plantar entrapment.
What is Medical Plantar Neuropraxia?
Medial plantar neuropraxia, or nerve entrapment, is when the nerve gets squeezed between bones or other ligaments close to the nerve. It can cause it to get stuck in that position and then it gets difficult for it to deliver signals to and from it destination.
This can cause a great amount of pain when trying to do different movements with the foot. Putting on shoes can become virtually impossible because of the pain.
You will most likely feel the pain throughout the ankle and heel, then out in the toe. Additional pressure on the foot will make the pain worse, so try to keep still.
It can happen to the medial nerve itself but it can also happen to the lateral plantar nerve at the same time. Then its called medial plantar and lateral plantar entrapment. The lateral plantar nerve runs down into the smallest toe, and is what controls all the movements and feelings in that area.
What Causes Medical Plantar Neuropraxia?
This injury is mostly seen in long distance runners and athletes. This is because running puts a lot of continuous pressure on the medial plantar nerve. This can cause it to become damaged or broken. Many athletes choose to ignore the pain, since this starts as a very dull pain underneath the foot. But this will only worsen the pain and the outcome.
Medial plantar neuropraxia is also seen in other, more rare cases such as:
- Bone spurs
- Hypertrophic muscles
A few cases have reported that a cyst caused the neuropraxia. In one of the cases it was caused by a ganglion cyst in the leg.
The patient had been complaining of a dull pain in the sole of his foot for 6 months.
The 5.5 cm long cyst was discovered through an MRI scan. It was then removed through surgery.
The gigantic cyst had been pressing down on the nerve causing the neuropraxia.
Bone spurs is often seen around the edges of the bones. Usually where the bones meet each other. It will create small "splinters". It's nothing dangerous, but it is normally connected to osteoarthritis.
Bone spurs in the heel can cause the nerve to become trapped, leaving you with neuropraxia.
Muscle hypertrophy happens when a muscle increases in size rather quickly.
This can happen to any muscle in the body, but is often seen in the legs and arms.
It can put pressure on the nerve, hence; causing the nerve entrapment.
Medial plantar neuropraxia can be extremely painful to deal with. But other than being very painful, it doesn't share the same typical symptoms of other nerve entrapments. Those symptoms are usually numbness, and burning tingling sensation in the affected area.
Some of the symptoms include:
- Tender feeling from inside the foot.
- Difficulty walking, sometimes even standing.
- Burning feeling throughout the foot starting at the heel.
- Pain in the heel.
This is usually diagnosed through a doctors examination. The doctor will base the diagnosis of off two factors:
- The patient's symptoms.
- Through a neurological test.
During the examination, the doctor will look at the symptoms the patient is describing. They will most likely search for the source of the pain, which typically in this case would be the heel. Afterwards they will look at the patient’s physical and medical history. This injury is seen most often in long distance runners, where there's a lot of pressure put on this nerve.
The doctor will then most likely run a neurological test. This will test the senses in the foot, if they are working properly, or if the nerves in the foot are broken or damaged.
The doctor will then make his or hers diagnosis.
Some patients actually go a very long time without knowing what is causing the pain. Sometimes applying a cold or warm compression can help manage the pain. But it won't fix the problem.
Medial plantar neuropraxia is usually treated by keeping the foot and ankle very still. The doctor might apply a splint to the foot which will keep it from moving. Physiotherapy may also help heal the injury.
Another way to treat this injury is through cryotherapy. This will expose the nerve to extreme colds, which will dull its irritation and help healing.
If none of these treatments are successful. A surgical procedure might be the only option to free the "trapped" nerve.
Long Term Effects of Medical Plantar Neuropraxia
If the neuropraxia isn't detected and treated in the proper time, the long term effects may be more extreme. Neuropraxia in this area can be very difficult to treat. It needs a lot of rest followed by careful rehabilitation.
Some long term effects can be pain in the foot or heel. A dull burning feeling in the heel may also be present.
An athlete who gets this injury may never fully recover to perform at the same level without pain being present.
If pain or tenderness is present after treatment, applying a cold or warm compression may help ease the pain.
The medial plantar nerve is one of the most important nerves in our feet. It helps us to balance and move our toes. Without it it would be very difficult, maybe even impossible for us to walk around without losing our balance.
The medial plantar originates from the sciatic nerve that starts at the back of the pelvis. It is also connected to the common plantar nerves and tibial nerve.
The most common injury of the medial plantar is called a neuropraxia. This happens when the nerve becomes stuck or “trapped” between bones or other ligaments in the foot. It can also be caused by cysts, bone spurs, and muscle hypertrophy. All are linked to putting pressure on the nerve which causes the entrapment.
Neuropraxia is most often seen in athletes. Running can put hard continuous pressure on the muscle and nerve.
Symptoms can be hard to distinguish. It’s often just a dull pain or burning feeling starting at the heel or ankle. Many people often go a long time with this injury not knowing it’s there.
As the injury gets worse, so will the pain. Eventually it will become very excruciating and hard to deal with. Exposing the injury to further strain is the worst you can do in this instance. If medial plantar neuropraxia is suspected, keeping the ankle and foot still, is the best thing to do.
Physiotherapy is a great way to treat the injury. And sometimes a combination of physiotherapy and cryotherapy can fix the problem. But if the injury is still there, surgery might be the only option.