Digital Nerves of the Foot: Anatomic Variations and Implications Regarding the Pathogenesis of Interdigital Neuroma

Foot & Ankle ◽  
1993 ◽  
Vol 14 (4) ◽  
pp. 208-214 ◽  
Author(s):  
Kenneth A. Levitsky ◽  
Benjamin A. Alman ◽  
David S. Jevsevar ◽  
James Morehead
Keyword(s):  
Digital Nerve ◽  
Morphometric Data ◽  
Lateral Plantar Nerve ◽  
The Third ◽  
Communicating Branch ◽  
Mechanical Basis ◽  
The Common ◽  
Web Space ◽  
Neuroma Formation ◽  
Communicating Branches

Seventy-one cadaveric feet were dissected, with attention to communicating branches of the digital nerves, the diameters of the digital nerves, the distance between the metatarsal heads, and the presence or absence of interdigital neuromas. A communicating branch was absent in 52 feet (73.2%) and present in 19 specimens (26.8%). The communication was from the fourth to the third web space common digital nerve (i.e., from the lateral to the medial plantar nerve) in 11 specimens. A reverse communication, from the third to the fourth web space common digital nerve (i.e., from the medial to the lateral plantar nerve), was present in eight specimens. Neuromas were identified in the second web space in 26 specimens and in the third web space in 32 feet. The common digital nerve to the third web space was not thicker in feet with a contribution from the fourth to the third web space nerve. Additionally, the incidence of third web space neuroma in feet with this type of communication was not significantly greater than in those feet without an internervous communication. However, the intermeta-tarsal head distances and the ratios of the intermetatarsal head distance to the digital nerve diameter in web spaces 2 and 3 were significantly smaller in comparison to spaces 1 and 4 ( P < .05). The morphometric data lend support to theories that explain the propensity for neuroma formation in both the second and third web spaces on a mechanical basis. The data do not support those theories that explain an increased incidence of third web space neuroma formation based on a communication from the fourth to the third web space digital nerve.

scholarly journals Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Mohamed Abdelaziz ◽  
Kathryn Whitelaw ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
Anne Johnson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nerve Transection ◽  
Digital Nerve ◽  
Morton’S Neuroma ◽  
The Past ◽  
Symptom Exacerbation ◽  
Morton's Neuroma ◽  
Web Space ◽  
Neuroma Formation

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

The Superficial Anastomosis on the Palm of the Hand between the Ulnar and Median Nerves

1991 ◽  
Vol 16 (5) ◽  
pp. 511-514 ◽  
Author(s):  
G. P. FERRARI ◽  
A. GILBERT
Keyword(s):  
Median Nerve ◽  
Ring Finger ◽  
Middle Finger ◽  
The Other ◽  
Sensory Innervation ◽  
Digital Nerve ◽  
The Third ◽  
Palmar Surface ◽  
Communicating Branch ◽  
Palm Of The Hand

The communications between the median and ulnar innervated territories on the palm of the hand have been studied anatomically and microscopically. A communicating branch is well appreciated but its description has had little emphasis in anatomical or surgical literature. 50 cadaveric palms were dissected in both sexes and an anastomotic branch was found in 45 hands. In 43 of them it originated proximally from the ulnar nerve and proceeded distally to enter the third common digital nerve; in the other two hands it left the median nerve to reach the fourth common digital nerve. By microscopic dissection we have seen that the ulnar fibres of the anastomotic branch which join the median nerve may contribute to the sensory innervation of the radial half of the ring finger and ulnar side of the middle finger on its palmar surface. We have therefore described a cutaneous area on the palm where care must be taken to avoid surgical damage to this branch.

An Anatomic Basis for Recurrence after Morton's Neuroma Excision

Foot & Ankle ◽  
1992 ◽  
Vol 13 (3) ◽  
pp. 153-156 ◽  
Author(s):  
James A. Amis ◽  
Scott W. Siverhus ◽  
Boleslaw H. Liwnicz
Keyword(s):  
Digital Nerve ◽  
Morton’S Neuroma ◽  
Traumatic Neuroma ◽  
High Incidence ◽  
Fresh Frozen ◽  
Morton's Neuroma ◽  
Anatomic Basis ◽  
The Common ◽  
Distal Aspect ◽  
Neuroma Formation

Dissections of the common digital nerve and its branches were performed in the second and third web spaces in five fresh-frozen cadaveric feet. Plantarly directed nerve tetherings, which were histologically demonstrated to be nerve branches, were consistently present along the course of each common digital nerve. These plantarly directed nerve branches were found in highest concentration in the distal aspect of the common digital nerve proximal to the bifurcation into the proper digital branches. The presence of these nerve branches may contribute to the high incidence of Morton's neuroma recurrence either due to traumatic neuroma formation in the branches or to failure of proximal retraction of the more distally resected nerve stump.

scholarly journals 933 The Glass Half Full? A Case Of Cutaneous Neuroma Formation Post Laceration Of First Web-Space Of The Hand

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Barzilai ◽  
G Smith
Keyword(s):  
Peripheral Nerve Injury ◽  
Severe Pain ◽  
Cutaneous Lesion ◽  
Penetrating Trauma ◽  
Nerve Graft ◽  
Digital Nerve ◽  
Penetrating Injuries ◽  
Reduce Risk ◽  
Web Space ◽  
Neuroma Formation

Abstract Introduction neuromas are lesions resulting from abnormal nerve regeneration following a peripheral nerve injury and may cause severe pain. Method we present a case of a 54-year-old female who developed a painful cutaneous lesion over the first web-space of the hand following an untreated glass laceration 3 years previously. Results surgical resection revealed a 100% transection of ulnar digital nerve (UDN) of thumb with regeneration into the skin. A posterior interosseous nerve (PIN) nerve graft was required to bridge the resulting 15mm gap. Histopathology revealed a 12x12mm neuroma extending into dermis. Conclusions cutaneous neuroma is a rare consequence of penetrating trauma. This case highlights the need for prompt assessment of penetrating injuries to reduce risk of neuroma formation.

scholarly journals III.—Morphological Studies on the Echinoidea Holectypoida and their Allies

1917 ◽  
Vol 4 (6) ◽  
pp. 249-256
Author(s):  
Herbert L. Hawkins
Keyword(s):  
Common Origin ◽  
Normal Type ◽  
The Third ◽  
Morphological Studies ◽  
Apical System ◽  
The Common

The characters of the apical system of a series of Holectypus hemisphæricus from the same horizon at two localities in Dorsetshire are analysed and described. It is found that the average relations of the plates of the system are different at the two localities, although certain numbers of identical forms occur at both. Out of 189 specimens (from both localities), 40 show serious departures from the normal type. These abnormalities are of three classes. One, the most prevalent, consists in the presence of madreporic pores on genital 3, in addition to the normal perforation of genital 2. This is regarded as a “progressive variant” in the direction of Discoides. The second, occurring in three specimens, consists in the interpolation of a supernumerary plate within the system. It is suggested that this may be either a “regressive variant” towards Acrosalenia, or a “progressive variant” towards Nucleolites (as illustrated by N.orlicularis). In neither case would this variation coincide with actual phyletic sequence, so that it is styled “parallel variation”. The third type of variant, seen in one specimen only, combines both the first and second types, and in addition shows an absence of genital 5 and a corresponding increase in the size of the posterior oculars, which meet round the back of the system. The variation in this specimen is interpreted as being “progressive” towards Discoides, “parallel progressive” or “regressive” towards Nucleolites or Acrosalenia respectively, and “progressive” towards Conulus. There are indications of a different series of variants in the Holectypus depressus from the Cornbrash. The high percentage of variation in the composition of the apical system of Holectypus is regarded as an indication of the evolutional activity of the genus, and of its near approximation in time and phylogeny to the common origin of many of the groups of Irregular Echinoids.

The Christian character of Christian mystical experiences

1984 ◽  
Vol 20 (3) ◽  
pp. 417-427
Author(s):  
Steven Payne
Keyword(s):  
Common Elements ◽  
Third Place ◽  
Cognitive Value ◽  
The Third ◽  
Affirmative Response ◽  
The Common ◽  
Mystical Experiences ◽  
Contemporary Writers ◽  
Mystical Literature

Are mystical states essentially ‘everywhere the same’? Though this question is notoriously obscure and difficult to answer, many contemporary writers on mysticism seem to favour an affirmative response to it, for a variety of reasons. First of all, some are impressed by the undeniable similarity in the testimony of mystics from widely divergent backgrounds and cultures; like most readers of mystical literature, they are deeply struck by the degree of apparent consensus between Christian, Hindu, and Buddhist contemplatives, for example. Secondly, there is a commendable desire in recent times to adopt a more positive and open-minded approach to other religions, and to acknowledge the value of their spiritual traditions; consequently, Christian authors today tend to focus on the common elements in Christian and non-Christian spiritualities, downplaying any differences. In the third place, those who wish to defend the cognitive value of mystical experiences on the basis of the ‘universal agreement’ of mystics will naturally maintain that there is a fundamental unanimity behind their different reports.

Richard The Third, Act I, Scene 4

PMLA ◽  
1912 ◽  
Vol 27 (2) ◽  
pp. 117-141
Author(s):  
Robert Adger Law
Keyword(s):  
The Third ◽  
Common Opinion ◽  
The Common

The chief source of Shakespeare's tragedy of Richard the Third has long been acknowledged to be either Hall's or Holinshed's prose Chronicle. In addition, some echoes have been discovered in it of the Latin tragedy, Richardus Tertius, of the anonymous English True Tragedie of Richard the Third, and of Marlowe's play, Edward the Second. But for one of the longest and most impressive scenes in Shakespeare's drama, that in which Clarence in prison meets his death at the hands of two ruffians hired for the deed by his brother, the Duke of Gloucester, no source is generally known. For the basis of the entire scene, Hall's Chronicle, which is so close akin to most situations in the play, contains of Clarence's death merely the statement that “attainted was he by parliament and iudged to death, and there vpon hastely drowned in a butte of malmesey within the towre of London.” Mr. P. A. Daniel expresses the common opinion of Shakespearian scholars to-day in saying, “Shakespeare seems to have been indebted to his own imagination only, for the scene of Clarence in prison, his beautiful narrative of his dream, and the less happy dialogue of the murderers.”

Latviešu metālmūzikas albumu nosaukumi

2021 ◽  
pp. 361-369
Author(s):  
Ingars Gusāns
Keyword(s):  
Current Situation ◽  
Creative Work ◽  
Distinctive Character ◽  
Literary Works ◽  
The Third ◽  
Metal Music ◽  
Local Character ◽  
The Subject ◽  
The Common

The aim of the study is to describe the titles of Latvian metal music albums, from the perspective of content, by identifying the common and distinctive character of the metallic music tradition, and perhaps even the local one. Of 241 album titles (data on Dec. 31, 2019), most are in English, some in French, Latin, Russian, some consisting of digits, and 69 titles in Latvian. These titles are the subject of the research. The main source is Encyclopaedia Metallum (www.metal-archives.com), which still does not reflect the current situation concerning Latvian metal music. Album titles in this study are viewed separately from album designs and song titles and are analysed from the perspective of content. The album title is an important part of the work that has been issued because it is an element that makes the audience/buyer pay attention to the album because it must not be forgotten that today the album is also an item that you want to sell. In general, it can be concluded that Latvian metal musicians, with their album titles in Latvian, are mostly following world trends, as evidenced by the integration in the researcher Deena Weinstein’s classification of Dionysian discourse and discourse on chaos. Most titles are more relevant to the discourse on chaos because the thematic circle of chaos is wider. Latvian mythology, along with history, is an up-to-date source for the creative work of bands that is responsible for the local feeling of the titles. A large enough number are titles that are difficult to fit in the Weinstein’s division and form the third group with philosophical titles and simply all sorts of titles. If the philosophical titles follow the world’s trends, the simple titles include the names of the events, tributes, and the titles of literary works, which give them a local character.

scholarly journals Bias against Vitamin C in Mainstream Medicine: Examples from Trials of Vitamin C for Infections

Life ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 62
Author(s):  
Harri Hemilä ◽  
Elizabeth Chalker
Keyword(s):  
Clinical Trials ◽  
Vitamin C ◽  
Common Cold ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
The Third ◽  
Nutritional Recommendations ◽  
Mainstream Medicine ◽  
The Common ◽  
Based Medicine

Evidence has shown unambiguously that, in certain contexts, vitamin C is effective against the common cold. However, in mainstream medicine, the views on vitamin C and infections have been determined by eminence-based medicine rather than evidence-based medicine. The rejection of the demonstrated benefits of vitamin C is largely explained by three papers published in 1975—two published in JAMA and one in the American Journal of Medicine—all of which have been standard citations in textbooks of medicine and nutrition and in nutritional recommendations. Two of the papers were authored by Thomas Chalmers, an influential expert in clinical trials, and the third was authored by Paul Meier, a famous medical statistician. In this paper, we summarize several flaws in the three papers. In addition, we describe problems with two recent randomized trial reports published in JAMA which were presented in a way that misled readers. We also discuss shortcomings in three recent JAMA editorials on vitamin C. While most of our examples are from JAMA, it is not the only journal with apparent bias against vitamin C, but it illustrates the general views in mainstream medicine. We also consider potential explanations for the widespread bias against vitamin C.

scholarly journals AN ERROR ANALYSIS OF ARGUMENTATIVE ESSAY (CASE STUDY AT UNIVERSITY MUHAMMADIYAH OF METRO)

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Fenny - Thresia
Keyword(s):  
Data Analysis ◽  
Error Analysis ◽  
English Writing ◽  
The Third ◽  
The Subject ◽  
The Common ◽  
Learner Language

The purpose of this study was study analyze the students’ error in writing argumentative essay. The researcher focuses on errors of verb, concord and learner language. This study took 20 students as the subject of research from the third semester. The data took from observation and documentation. Based on the result of the data analysis there are some errors still found on the student’s argumentative essay in English writing? The common errors which repeatedly appear are verb. The second is concord, and learner languages are the smallest error. From 20 samples that took, the frequency the errors of verb are 12 items (60%), concord are 8 items (40%), learner languages are 7 items (35%). As a result, verb has the biggest number of common errors.

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