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Other medications that are used to reduce pain include gabapentin, carbamazepine, or tricyclic antidepressants such as amitriptyline. Whenever if possible, patients need to avoid or limit the use of medication to reduce the risk of side effects. If the pain is severe, a pain specialist can help patients to explore all options to relieve the pain.
The ankle joint consists of the talus resting within the mortise created by the tibia and fibula as previously described. Since the talus is wider anteriorly (in the front) than posteriorly (at the back), as the front of the foot is raised (dorsiflexed) reducing the angle between the foot and lower leg to less than 90°, then the mortise is confronted with an increasingly wider talus.
The common fibular nerve is the smaller terminal branch of the sciatic nerve. The common fibular nerve has root values of L4, L5, S1, and S2. It arises from the superior angle of the popliteal fossa and extends to the lateral angle of the popliteal fossa, along the medial border of the biceps femoris.
The fibula is ossified from three centers, one for the shaft, and one for either end. Ossification begins in the body about the eighth week of fetal life, and extends toward the extremities. At birth the ends are cartilaginous. Ossification commences in the lower end in the second year, and in the upper about the fourth year.
Patients generally do not report pain near the proximal fibula, so physical examination such as palpation along the fibula is effective for differentiating a Maisonneuve fracture from an isolated syndesmotic injury. [4] Feeling pain near the proximal fibula during palpation is a positive indication of a Maisonneuve fracture. [12]
It is important to evaluate the exact location of the pain, the range of motion of the ankle, and the condition of the nerves and blood vessels. It is also important to palpate the calf proximally (near the knee) because there may be an associated high fibula fracture [citation needed] (Maisonneuve fracture).
The deep fibular nerve (also known as deep peroneal nerve) begins at the bifurcation of the common fibular nerve between the fibula and upper part of the fibularis longus, passes infero-medially, deep to the extensor digitorum longus, to the anterior surface of the interosseous membrane, and comes into relation with the anterior tibial artery above the middle of the leg; it then descends with ...
The fibularis longus arises from the head and upper two-thirds of the lateral, or outward, surface of the fibula, from the deep surface of the fascia, and from the connective tissue between it and the muscles on the front and back of the leg. It occasionally is also connected by a few fibers from the lateral condyle of the tibia.