The role of fasciae in Civinini–Morton's syndrome

Abstract

This study evaluates the pathogenetic role of the perineural connective tissue and foot fasciae in Civinini-Morton's neuroma. Eleven feet (seven male, four female; mean age: 70.9 years) were dissected to analyse the anatomy of inter-metatarsal space, particularly the dorsal and plantar fasciae and metatarsal transverse ligament (DMTL). The macrosections were prepared for microscopic analysis. Ten Civinini-Morton neuromas obtained from surgery were also analysed. Magnetic resonance images (MRIs) from 40 patients and 29 controls were compared. Dissections showed that the width of the inter-metatarsal space is established by two fibrous structures: the dorsal foot fascia and the DMTL, which, together, connect the metatarsal bones and resist their splaying. Interosseous muscles spread out into the dorsal fascia of the foot, defining its basal tension. The common digital plantar nerve (CDPN) is encased in concentric layers of fibrous and loose connective tissue, continuous with the vascular sheath and deep foot fascia. Outside this sheath, fibroelastic septa, from DMTL to plantar fascia, and little fat lobules are present, further protecting the nerve against compressive stress. The MRI study revealed high inter-individual variability in the forefoot structures, although only the thickness of the dorsal fascia represented a statistically significant difference between cases and controls. It was hypothesized that alterations in foot support and altered biomechanics act on the interosseous muscles, increasing the stiffness of the dorsal fascia, particularly at the points where these muscles are inserted. Chronic rigidity of this fascia increases the stiffness of the inter-metatarsal space, leading to entrapment of the CDPN.

Role of fasciae around the median nerve in pathogenesis of carpal tunnel syndrome: microscopic and ultrasound study

“…A similar organization was found by Reina & Sala-Blanch (2015) in an anatomic study of the sciatic nerve. This microscopic organization corroborates the hypothesis of Macchi et al (2007) and Stecco et al (2015) regarding the musculo-cutaneous nerve, which proposed a telescopic model for nerve sliding. The nerve with its connective components is organized in concentric layers which act as gliding interfaces between each other and between the nerve and adjacent tissues.…”

Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica

“…reported that, in 59% of cases, the sartorius muscle had a medial aponeurotic expansion from its tendinous origin to the ASIS, which ensheathes the LFCN, and attached to the inferior border of the inguinal ligament . Minimal dissection referring to the sartorius muscle would be helpful for preventing excessive injury to the connective tissue surrounding the LFCN with scar tissue formation, which may impair normal sensation and the mobility of the thigh …”

“…5 Minimal dissection referring to the sartorius muscle would be helpful for preventing excessive injury to the connective tissue surrounding the LFCN with scar tissue formation, which may impair normal sensation and the mobility of the thigh. 23,24 The symptoms of MP are known to be aggravated by prolonged standing or repetitive hip extension, and relieved by sitting. 2,9 In a few of the specimens in this study the LFCN directly entered the fascia of the tensor fascia lata muscle.…”

Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the pelvis and lower extremity: Diagnosis and treatment. Part 3

“…Эта патология чаще возникает на фоне плоскостопия и ПФ, как последствие травм плюсны («маршевый перелом»), а также при ношении узкой обуви на высоком каблуке, значительно нарушающей биомеханику свода стопы. Синдром Мортона проявляется жжением, покалыванием и парестезиями в области пальцев стопы, чаще среднего и безымянного, возникающими или усиливающимися при ходьбе и значительно уменьшающимися в состоянии покоя [36,42].…”

“…В ряде случаев полезную информацию дает рентгенография, при которой определяются в первую очередь кальциноз мягких тканей как косвенный признак энтезопатии таза, а также «пяточная шпора» при ПФ [35,37]. Для точной диагностики туннельных синдромов может потребоваться и проведение электромиографии [36,41,42].…”