Index of Day 4 Lower Extremity Lecture 1

Summary

• Foot Neuropathies and Peripheral Neuropathy Overview (0:03)

◦ Dr. Richard Hazel introduces the topic of foot neuropathies, focusing on the dorsal foot and drop foot.

◦ Peripheral neuropathy is explained as damage to nerves outside the brain and spinal cord, causing weakness, numbness, and pain in hands and feet.

◦ The condition can affect other body functions like digestion and urination and is often caused by diabetes, infections, metabolic problems, inherited causes, and toxins.

◦ Symptoms of peripheral neuropathy include stabbing, burning, and tingling sensations, which can improve with treatable conditions.

• Common Causes and Symptoms of Peripheral Neuropathy (2:43)

◦ Dr. Richard Hazel discusses the common causes of neuropathy, including diabetes, traumatic injuries, infections, and metabolic problems.

◦ Medicines like Gabapentin are mentioned as ineffective for treating the root cause of neuropathy, only hiding the pain.

◦ The sciatic nerve pathway, including the tibial and peroneal nerves, is explained, with a focus on the superficial peroneal nerve.

◦ The superficial peroneal nerve is described as sensory, while the deep peroneal nerve has motor functions, and their roles in causing drop foot are discussed.

• Anatomy and Pathways of the Peroneal Nerve (3:06)

◦ Dr. Richard Hazel explains the anatomy of the peroneal nerve, including its division into deep and superficial branches.

◦ The deep peroneal nerve's motor function and the superficial peroneal nerve's sensory function are detailed.

◦ The pathway of the superficial peroneal nerve from the knee to the top of the foot is described, including its innervation areas.

◦ The overlap between the superficial peroneal and sural nerves is mentioned, with a focus on the sensory part of the deep peroneal nerve.

• Entrapment Zones and Treatment of Peroneal Nerve Issues (7:08)

◦ Dr. Richard Hazel discusses the entrapment zones of the superficial peroneal nerve, including the peroneus brevis and extensor digitorum longus.

◦ The treatment of peroneal nerve issues is described, emphasizing the importance of treating the peroneus brevis and extensor digitorum longus muscles.

◦ The use of electric stimulation for treating peroneal nerve issues is recommended, with a success rate of one to two sessions.

◦ The impact of sports injuries, ballet, and tight footwear on the superficial peroneal nerve is discussed.

• Sural Nerve Entrapment and Its Symptoms (20:57)

◦ Dr. Richard Hazel introduces the sural nerve, which branches from the sciatic nerve and innervates the outer part of the foot.

◦ The common entrapment sites of the sural nerve, including the gastrocnemius and Achilles junction, are described.

◦ The symptoms of sural nerve entrapment, such as pain, numbness, tingling, and burning, are detailed.

◦ The treatment of sural nerve entrapment involves addressing the entrapment zones and using motor points and trigger points.

• Impact of Cipro on Neuropathy and Myofascial Pain (28:15)

◦ Dr. Richard Hazel shares a case study of a patient with sural nerve entrapment caused by Cipro, a strong antibiotic.

◦ The patient experienced leg cramps, burning sensations, and restless leg syndrome, which improved after treatment.

◦ The correlation between Cipro and myofascial pain is discussed, with a recommendation to use AI tools for research.

◦ The importance of addressing myofascial restrictions caused by Cipro is emphasized.

• Drop Foot and Its Treatment (31:02)

◦ Dr. Richard Hazel explains the concept of drop foot, which occurs after sciatica or other nerve damage.

◦ The importance of treating drop foot within the first year for better recovery is highlighted.

◦ The muscles involved in drop foot, including the deep peroneal nerve muscles, are detailed.

◦ The use of electric stimulation and motor points for treating drop foot is recommended.

• Roll Sprains and Their Impact on Foot Muscles (36:14)

◦ Dr. Richard Hazel discusses the impact of roll sprains on foot muscles, including the deep peroneal nerve muscles.

◦ The reflex hypertonia of foot muscles after a roll sprain is explained.

◦ The treatment of roll sprains involves addressing the hypertonic muscles to improve recovery.

◦ The use of electric stimulation and motor points for treating roll sprains is recommended.

• Anatomy Review and Motor Points for Foot Neuropathies (39:25)

◦ Dr. Richard Hazel reviews the anatomy of the deep peroneal nerve muscles involved in foot neuropathies.

◦ The motor points for treating these muscles, including the tibial anterior, extensor digitorum longus, and peroneus tertius, are detailed.

◦ The importance of treating both the motor and sensory aspects of foot neuropathies is emphasized.

◦ The use of electric stimulation and motor points for treating foot neuropathies is recommended.

• Assessment and Treatment Strategies for Foot Neuropathies (42:17)

◦ Dr. Richard Hazel outlines the assessment and treatment strategies for foot neuropathies, including palpation and stretch tests.

◦ The importance of considering previous sciatica and postural issues in treatment is highlighted.

◦ The use of electric stimulation and motor points for treating foot neuropathies is recommended.

◦ The impact of footwear and tight laces on foot neuropathies is discussed.