Patients often come to the CELT Pain Clinic with complaints that their sciatic nerve hurts. The cause of this phenomenon is sciatica: inflammation of the sciatic nerve, which can occur even in absolutely healthy people. The sciatic nerve is a paired nerve of the sacral plexus, which is the thickest and longest in the human body. It begins in the lumbar region, passes through the tailbone, the back of the pelvis, along the legs and reaches the feet.
That is why, when the sciatic nerve hurts, pain symptoms spread to the lower back and lower limbs. Sciatica is not a separate disease; as a rule, it occurs as a result of other diseases. If you have sciatic nerve pain and don't know what to do, contact our Pain Clinic. It is very important to promptly identify the cause of such symptoms and begin treatment of the primary disease.
At CELT you can get advice from a specialist algologist.
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Reasons why the sciatic nerve hurts
Sciatica (or, as it is also called, sciatic neuralgia) occurs due to the following diseases:
- Osteochondrosis of the lumbosacral spine. Pathological changes in the intervertebral discs cause a decrease in the distance between the vertebrae and lead to compression of the sciatic nerve;
- Intervertebral hernia of the lumbar region. In this case, compression of the sciatic nerve is caused by protrusion of the hernia towards the spinal canal;
- Spondylolisthesis. Instability of the spine in this disease leads to displacement of the vertebrae, and consequently to pinching of the sciatic nerve with the development of inflammatory processes;
- Dislocation or subluxation of the sacroiliac joint;
- Lumbar spinal canal stenosis. Excessive formation of soft tissue leads to a narrowing of the canal through which the spinal cord passes. All this leads to excessive pressure of the intervertebral discs on the nerve roots;
- Piriformis syndrome. The sciatic nerve passes under or through the piriformis muscle, which can cause irritation and inflammation.
Nerve diseases of the foot and ankle
Compression of the deep peroneal nerve was first described by Thompson in 1960, and in 1968 Marinacci named the condition anterior tarsal tunnel syndrome.
How does nerve compression occur?
The deep peroneal nerve may be compressed at several levels. The most common is anterior tarsal tunnel syndrome, which is compression of the deep peroneal nerve under the inferior extensor retinaculum. Compression by dorsal osteophytes of the talonavicular joint and the intermetatarsal bone (an accessory bone located between the bases of the 1st and 2nd metatarsals) has previously been described in runners.
Causes of nerve compression
The cause of the syndrome is often trauma. Many patients have a history of multiple injuries to the ligamentous apparatus of the ankle joint. Wearing tight shoes or ski boots is considered a provoking factor. Recreational runners may sometimes hide their house key in their shoe lacing when leaving the house; this key can become a source of external compression on the deep peroneal nerve. External compression of the nerve can be observed in athletes performing abdominal exercises while fixing their feet under a metal bar. Pressure on the nerve can be exerted by bone fragments from fractures or osteophytes of the distal end of the tibia, talus, scaphoid, cuneiform, or base of the metatarsals. The source of neuropathy of the deep peroneal nerve may be swelling of the surrounding tissues or the articular ganglion.
Finally, recently there has been an increase in the number of cases of deep peroneal nerve injuries associated with total ankle replacement, which uses an anterior approach, which involves significant mobilization of the neurovascular bundle and subsequent suturing of deep tissue layers, incl. over the deep peroneal nerve.
Who is predisposed to peroneal neuralgia?
Compression of the deep peroneal nerve is most often seen in runners, but can also occur in dancers and people whose feet are subject to compression or hyperextension for one reason or another.
Symptoms of nerve damage
Patients with deep peroneal neuralgia complain of pain in the dorsum of the foot, which can be reflected in the first interdigital space. As with other nerve compression syndromes in the foot and ankle area, it is necessary to exclude other causes of this pain syndrome, in particular, radicular syndrome emanating from the spine. When collecting anamnesis, attention should be paid to such provoking factors as wearing tight shoes or certain types of physical activity (for example, abdominal exercises, in which patients rest the front surface of the ankle joints against a metal stop). A history of foot and ankle injuries or chronic instability is important. When a nerve is compressed, patients often describe increased pain at night.
Conservative treatment
Conservative treatment includes modification of footwear to relieve external pressure on the dorsum of the foot and ankle, and modification of physical activity to activities that do not cause or worsen existing symptoms. As with superficial peroneal neuralgia, ankle braces can be used to relieve pain associated with joint instability. Local administration of glucocorticosteroids may be effective.
Surgery
The operation is performed under regional anesthesia at the level of the ankle joint.
The level of nerve compression is usually located at the anterior aspect of the ankle joint, the dorsal surface of the talonavicular joint, or the first metatarsophalangeal joint. A skin incision is made at the required level.
Once the source of compression is identified, it is resected.
In cases where the main factor in the development of neuralgia of the deep peroneal nerve is instability of the ankle joint, one should think about appropriate reconstructive interventions on the ligamentous apparatus. If the patient is diagnosed with anterior compartment syndrome, fasciotomy is indicated.
Postoperative period
During the first 4-5 days after surgery, the patient moves using crutches and gradually, as tolerated, begins to put weight on the operated leg. With extended interventions, immobilization of the ankle joint continues for 2 weeks, after which the plaster splint is replaced with an orthopedic boot for another 2-4 weeks.
Results of the operation
Patients with compression of the deep peroneal nerve who underwent surgical decompression achieved satisfactory results in 80% of cases. Unsatisfactory results were usually associated with intrinsic nerve damage or neuropathies that contributed to or aggravated the manifestations of nerve compression and for which neurolysis was usually ineffective. The best treatment results can be expected in patients with nerve compression from underlying bony structures or osteophytes. If the cause of the disease is a foot injury associated with foot compression, the results will be less favorable.
Clinical manifestations of sciatica
In most cases, one of the sciatic nerves is affected, so the pain is localized on one side, but damage to both nerves also occurs. When the sciatic nerve hurts, treatment is primarily aimed at reducing pain. They can be so strong that the patient cannot move not only the limbs, but also the torso, since each of them (including deep inhalations/exhalations) increases the pain. It has a shooting or burning character and radiates to the buttock and leg. In addition, the following clinical manifestations are observed:
- impaired skin sensitivity in the lumbar and gluteal regions, as well as legs;
- muscle weakness in the groin, lower extremities and fingers, paralysis;
- the patient is forced to take a position in which pain is reduced;
- attacks of pain occur due to stress, hypothermia, sudden movements;
- sexual disorders and fecal and urinary incontinence in the most severe cases.
Peroneal nerve neuropathy - how to recognize and treat
The human body is vulnerable to mechanical damage. Most of them are treatable, but in some cases there may be negative consequences. This is not a recurrence of damage, but a new problem. Such consequences include ligament rupture and muscle tissue damage. We are talking about problems with the peroneal nerve - neuropathy. This disease is rare, but takes on a chronic form and has periods of remission accompanied by acute pain. The results of treatment for neuropathy are not always satisfactory - the patient receives temporary relief, but the treatment process is long-term.
It has been noted that a large percentage of patients who develop neuropathy are people:
- Professionally or forcibly spending a lot of time in one position.
- Having fractures of the leg bones, which leads to a long stay of the limbs in a cast.
Both cases are characterized by muscle atrophy, which can result in nerve neuropathy.
Common causes of the disease
The main cause of the disease is trauma to the fibula: bruise, pearl or crack. Nerve damage occurs where it presses against the bone. The length of the affected area varies between a few millimeters and centimeters. This is how tunnel syndrome is formed.
By disrupting blood circulation in damaged tissues, this causes atrophy of muscle tissue and the development of formations in the affected areas. There are known cases of the appearance of neuropathy of the tibial nerve as side effects of intoxication, alcoholism, and drug addiction. It is possible that a cancerous tumor may appear in areas of nerve damage or damage to a ligament called the talofibular ligament.
The danger is that in many cases it all starts with a minor injury, which is paid little attention to and no help is sought. This makes neuropathy difficult to recognize in its early stages.
How to recognize
The following are considered symptoms of neuropathy:
- The area in which the affected nerve is located (lower leg and foot) loses sensitivity to the effects of temperature fluctuations.
- The appearance of pain in a wide range: from mild to severe. Worsened by walking, jumping or squatting.
- The toes become unbendable. This leads to inconvenience in wearing shoes.
- The foot loses its ability to move. This may result in the use of crutches and, in some cases, a wheelchair.
- At the site of disease development (locally), the temperature may rise and the skin may turn red.
The appearance of such symptoms after a leg injury should force a person to consult a doctor and begin treatment if necessary. Inactivity can cause poor posture and, in worst cases, cause neuropathy (compression-ischemic). This will mean that the nerve endings are compressed to such an extent that they begin to die. It is no longer possible to restore such tissue in any way.
How to cure
Patients who develop peroneal nerve neuropathy are treated in a stepwise manner. First you need to relieve the patient of pain and discomfort in general. Then the level of inflammatory processes is localized and reduced. Most often, such measures are sufficient.
Non-hormonal anti-inflammatory drugs are used as the main drugs for treatment: ketorol, diclofenac or nimesulide.
Despite the apparent simplicity of therapy, medications can only be taken with a prescription prescribed by a doctor and after clearly reading the contraindications for their use.
The rapid restoration of nerve tissue is greatly helped by a course of vitamin B. Such drugs are sold in pharmacies, and the course of treatment consists of twenty injections. The most effective are B1, B6, B12. The full course will consist of 60 injections. In addition to restoring nerve tissue, it is necessary to establish blood circulation at the site of inflammation. This can be achieved by taking the medications Trental, Cavinton. After completion of the inflammatory process, the patient is recommended to undergo exercise therapy, massage, gymnastics, and physiotherapy. Folk remedies: lotions and compresses have a beneficial effect on the restoration of areas affected by peroneal nerve neuropathy.
Folk remedies
Here are some simple recipes:
- One way to combat inflammation is goat milk. They moisten gauze and apply it to the inflamed area for two to three minutes. This needs to be done several times during the day until recovery.
- Thoroughly mix two tablespoons of turpentine with three tablespoons of water, pour the resulting solution onto a piece of bread and apply to the sore spot for seven minutes. The procedure should be done before bedtime so that the sore leg is immediately placed in a warm place. You need to complete the course once every two days until recovery. The effect lies in the warming property of turpentine.
It is necessary to clearly understand that folk remedies do not replace medical care provided by doctors, but only supplement it after consultation with the treating doctor.
Surgical intervention
In advanced cases, the treatment methods described above will not lead to the patient’s recovery.
This can happen if the pain occurs frequently and is very severe. For treatment, a plaster splint is applied and orthoses are even prescribed to fix the joint. Failure to achieve a positive result after using these methods will lead to surgery. In such severe cases, only surgery will eliminate the cause of inflammation and restore blood conduction in the muscle tissue, which will contribute to the rehabilitation of the peroneal nerve. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Diagnosis of sciatic nerve pain
Is your sciatic nerve hurting and you don’t know how to treat it? Seek medical help! Specialists at the CELT Pain Clinic will find out the cause that caused this disease and prescribe its effective treatment. Before starting it, our doctors examine the patient, check reflexes and determine skin sensitivity and collect anamnesis. In addition, it is prescribed:
- X-ray examination;
- CT scan;
- Magnetic resonance imaging.
If the presence of a tumor in the spine is suspected, a radioisotope diagnostic study is prescribed.
Symptoms
Neuropathy is accompanied by a clinical picture of severity, which depends on the degree of damage to the nerve fibers.
Nerve dysfunction can be recognized by impaired flexion of the foot and motor ability of the fingers. When walking, the foot is placed incorrectly - the emphasis is on the heel. The muscular system of the lower leg and foot shows signs of obvious atrophy and deformation.
In the case of traumatic origin of neuropathy, swelling forms in the ankle area, blood flow is disrupted, tissue sensitivity increases, and there is severe pain, which intensifies when the damaged areas are touched.
If the cause of nerve neuropathy is endocrine disorders or infectious lesions, the patient loses sensation in the lower extremity area of the leg and foot. The pain syndrome persists and can have a different nature and severity. The pain intensifies with walking and physical activity. The patient may experience involuntary contractions of individual muscles or a convulsive syndrome involving the lower limbs.
In addition, the patient is concerned about neurotrophic disorders, such as dryness of the epidermis in the lower legs and feet, keratinization of the upper layer of the dermis, brittle nails, pallor of the skin and a decrease in local temperature, increased sweating.
Treatment of sciatic nerve pain
To successfully treat sciatic nerve pain, the CELT Pain Clinic uses modern techniques:
- Physiotherapy - aimed at reducing pain, improving blood circulation and relieving swelling and may include: UHF therapy, electrophoresis, laser and magnetic therapy, paraffin applications;
- Systemic therapy involves the use of non-steroidal anti-inflammatory drugs. Their use should be regulated by a doctor, since they have a number of side effects. In addition, anticonvulsants can be prescribed, which are extremely effective in treating neuralgia. In addition, drugs are used that relieve pain symptoms quickly. They can be prescribed either as tablets or as injections. Our Pain Clinic uses only modern, effective means.
- Blockades aimed at the affected area. Depending on the problem causing the pain, different medications may be used to block the pain. To control the accuracy of delivery of the medicine to the problem area, we use an X-ray unit or ultrasound machine.
Do you want to be healthy and eliminate pain attacks from your life? Contact the CELT Pain Clinic!
Make an appointment through the application or by calling +7 +7 We work every day:
- Monday—Friday: 8.00—20.00
- Saturday: 8.00–18.00
- Sunday is a day off
The nearest metro and MCC stations to the clinic:
- Highway of Enthusiasts or Perovo
- Partisan
- Enthusiast Highway
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Diagnostics
Tibial nerve neuropathy belongs to the group of mononeuropathy of the extremities. The clinical picture of the pathology is characteristic of dysfunctions of the musculoskeletal system and is of a traumatic nature, and therefore is subject to joint observation and control by specialists in the field of neurology and traumatology.
The first step in making a diagnosis is to question the patient about injuries to the lower extremities, working conditions, as well as the characteristics of the clinical picture and the presence of other diseases that may affect the normal functioning of the nervous system. After this, the patient is examined to identify atrophic and neurotrophic changes in the lower leg and foot.
Based on the data obtained, an initial diagnosis is made, which is confirmed by instrumental studies using one of the following methods:
- ultrasound diagnostics of the lower extremities;
- electromyography is a research method that allows you to determine the performance of the muscular system of the lower leg and foot;
- X-ray diagnostics if indicated, for example, for fractures;
- trigger point blockade is a therapeutic and prophylactic method that involves administering a medication to the affected areas of the lower extremities, which makes it possible to determine the degree of nerve damage;
- CT and MRI are used as additional diagnostic methods when using other methods there is insufficient data to make a diagnosis.