Interactive Transcript
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All right, let's take on
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the lateral plantar nerve.
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This is scary.
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Let's start easy.
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We've got our friends Tom, Dick, and Harry.
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Tom, Dick, and Harry.
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And then the vascular and the
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nerve bundle, the tibial nerve.
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Now let's follow the tibial nerve high.
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There it is.
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Now let's follow it low.
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The tibial nerve is going to
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bifurcate into two nerves.
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The one in the front is the medial plantar nerve,
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and we're interested this time in the lateral
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plantar nerve, which sits the lateral plantar
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right next to the posterior tibial artery in
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what's called the talocalcaneal canal region.
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And then it's gonna course medially between
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the medial and lateral plantar arteries.
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So let's look at this artery
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and watch it separate.
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There it is.
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This artery's splitting into two right here.
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Split into two and there is the lateral
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plantar nerve directly adjacent to that split.
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Sorry, here's one part of the artery.
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Here's the other part of the artery.
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One, two, there's the nerve right next to it.
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Let's keep going down now and follow the
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course of the lateral plantar artery.
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See, it's headed laterally.
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Well, that makes total sense.
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Now, right at this location, like the
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medial plantar nerve, it's seen between the
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abductor hallucis and the quadratus plantae.
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That's fine.
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And now let's continue following it.
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Here it is right here, between the tibial
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arteries, that's the nerve right in between,
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and now we have the flexor digitorum brevis.
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So now it's sitting between the flexor
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digitorum brevis and the abductor hallucis.
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Let's keep following it.
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As you might expect, it should be
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heading laterally, that's why it's
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called the lateral plantar nerve.
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Let's see if we can keep following it.
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There it is.
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I've got my arrow right on it.
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Stare at it for one second.
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Now let's keep following it.
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Keep following it.
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It's headed laterally.
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There it is.
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Oh my, we still see it.
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We still see it buried in this muscle.
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We perhaps still see it right here
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as an area of subtle linearity.
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We still see it headed off to the side.
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And perhaps we see it right here.
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That may be part of it right there.
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And we are right next to
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the abductor digiti minimi.
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So we're between the abductor digiti minimi
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and the flexor digitorum brevis, and this most
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likely is the best candidate for the lateral
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plantar nerve, which is now going to divide
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into two terminal branches, which are a little
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small for us, the superficial and deep branches.
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The superficial branch divides into a proper
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digital branch and a common digital branch.
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Now on MRI, let's look at our medial and
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lateral plantar nerve, but in the coronal
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projection, using a fat-suppressed, water-
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water-emphasized image, just to show you how
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these two nerves compartmentalize from
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proximal to distal, or high and low.
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So if I put a cursor on my medial plantar
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nerve, you can see on the right where it
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is relative to the coronal projection.
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I'm even going to draw on it for emphasis.
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So here is my medial plantar nerve and right
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below it, I should put another color on it.
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Just again, for emphasis, let's go with orange.
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Right there is my lateral plantar nerve.
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Now let's scroll.
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I'm going to make it even bigger just to
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really kind of put it right in your face.
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There's the medial plantar nerve.
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You can even see the little bundles of
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it and there's the lateral plantar nerve.
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Now, that goes back.
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Now let's go forward.
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And they're separating.
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Medial plantar nerve, lateral
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plantar nerve below it.
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Medial, lateral.
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Medial, lateral.
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And now the lateral, which, which was
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initially between just the abductor, in the
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quadratus plantae, now it's starting to assume
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a position right underneath and alongside,
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snuggling next to the flexor digitorum brevis.
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Now we start to lose it, but it's still in
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there, and this is where it starts to give
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off its calcaneal branches, and it's going
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to head over to the other side, towards
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the abductor digiti minimi, and it's these
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calcaneal branches that are given off.
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That will produce Baxter's neuropathy.
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Again, if we go backwards a little bit, you
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can see that the medial plantar nerve is always
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going to sit a little bit higher than the
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lateral plantar nerve, even as we scroll down.
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Medial, lateral, medial, lateral.
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I think that really shows it optimally.
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