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INJURY TO SCIATIC NERVE, At a glance Sciatic nerve is the thickest…

- - - - Causes have been already mentioned,
        
        the important one being leprosy as a cause of foot-drop
    - - Causes are seen along the course of the nerve
        
        At the spine
        
        Spina bifida
        
        Tumors
        
        Disk prolapse, etc.
        
        At the hip
        
        Posterior dislocation of the hip .
        
        Fractures around the hip.
        
        Fracture acetabulum.
        
        At the glutei region
        
        Deep intramuscular injections.
        
        At the thigh
        
        Fracture shaft femur.
        
        Penetrating injury and gunshot injury
        
        At the knee
        (Common causes)
        
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    - - high lesion
        (above knee)
        
        spared
        
        Peroneus longus and brevis.
        
        lost
        
        Both tibial nerve and
        
        common peroneal nerve is paralyzed.
      - low lesion
        (below knee)
        
        Type I
        
        ant tibial nerve injury
        
        lost
        
        tibialis ant
        
        ext hallucis longus
        
        ext digitorum longus
        
        peroneus tertius
        .
        
        sensation over 1st web space is lost
        
        Type II
        
        Musculocutaneous
        nerve injury
        
        lost
        
        peroneus longus & brevis
        
        sensation over outer leg & foot
        
        spared
        
        all the above ms innervated by the ant tibial nerve
      - Clinical Features
        
        foot drop
        .
        This could either be
        
        complete (in sciatic nerve or lateral popliteal nerve injury)
        
        or incomplete (injury to either superficial or deep peroneal nerve).
        
        in high lesions,
        
        it is a total foot-drop
        
        in low lesions
        
        the foot-drop is usually incomplete
        
        In low
        type I
        
        the patient cannot dorsiflex & invert the foot
        
        but eversion is possible,
        
        front of the leg is wasted.
        
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        In low type II
        
        the patient cannot evert
        
        but can dorsiflex and invert the foot.
        
        There is wasting of the outer half of the leg
        
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        The gait typical of foot-drop is a high stepping gait.
        
        Treatment of Early Foot-drop
        
        The lesions show a high incidence of recovery. Hence,
        conservative treatment with a view to encourage
        recovery (at least for 1 year) should be carried out
        
        Splintage
        
        for night-time
        
        of knee in 20° of flexion and ankle in 90°
        
        In the daytime,
        
        walking is allowed
        by using a “Foot-drop appliance”.
        
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        Steroids
        
        are also known to help
        
        Common peroneal nerve
        stripping
        
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        Treatment of established foot-drop
        (More than one year)
        
        complete foot drop
        
        common peroneal nerve palsy
        
        operation of choice is
        
        tibialis posterior transplant
        
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        incomplete foot drop
        
        commonest variety is
        
        tibial nerve injury
        (loss of dorsiflexors & presence of evertors)
        
        method of correction is
        
        anterior transportatio of tibialis posterior
        ( fixed to extensor Hallucis longus combined with
        peroneus brevis transfer to prevent excessive valgus due to strong evertors)