Volume 1

A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.

Date:
1893-1894
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.

    867/962 (page 847)
    There is uiiiesthesia of the outer half of the leg, the sole, and the greater por- tion of the dorsum of the foot. The muscles frequently waste and there may be trophic disturbances. In paralysis of one sciatic nerve the leg is fixed at the knee by the action of the quadriceps extensor. Pai'alysis of the small sciatic nerve is rarely seen. The gluteus maxiinus is involved, there is dif- ficulty in rising from a seat, and tliere is usually a strip of anaesthesia on the back part of the thigh in the region of distribution of the cutaneous branches. Of the branches of the sciatic nerve, the e.rtfnial popliied/ when paralyzed causes loss of power in the peronei, the long extensor of the toes, the tibialis anticus, and the extensor brevis digitorum. As a result there is a foot- drop, the ankle cannot be flexed, and, as the toes cannot be raised from the ground in walking, the whole leg is lifted, producing the characteristic step- page gait seen in so many forms of peripheral neuritis. In long-standing cases the foot is permanently extended and there is wasting of the anterior tibial and ]>eroneal muscles. The loss of sensation is in the outer half of the front of the leg and on the dorsum of the foot. Paralysis of the internal popliteal ■nerve causes loss of power in the gas- trocnemius, the plantaris, solcus, poplitcus, the tibialis posticus, the long and short flexors of the toes, and the muscles of the sole of the foot. The foot cannot be adducted nor can the patient rise on ti]>toe. In long-standing cases talipes calcaneus follows, and the toes assume a claw-like position from sec- ondaiy contracture. Among other neuralgic affections of the lumbar and sacral plexuses are the following: coccygodynia, an affection most common in women. The pain about the coccyx is greatly aggravated bv the sitting posture, and is usu- ally associated with other nervous phenomena. It is an exti'cmely intractable affection, and the condition may be so intolerable that resection of the coccyx has to be performed—an operation which, lidwever, is not always successful in relieving the pain. There are certain neuralgic affections of the nei'ves of the feet which are very troublesome. In the affection known as painful heel, the podo<lynia of S. D. Gross, the pain is usually most severe in the heel itself, sometimes in a very limited spot on the under surface, sometimes in the line of the metatarso- phalangeal joint. It is most common in women, and is not necessarily asso- ciated with any swelling, discoloration, or enlargement of tlie joint. In some instances it would appear to be a manifestation of hysteria ; in others the patients have rheumatism or gout. Some of the worst cases occur in shop- girls as a result of standing for a long time on the feet. Plantar neuralgia may be associated with a definite neuritis, and is some- times seen after the sj^ecific fevers, and has been described by Hughes in cais- son disease. The ])ain may extend along the sole of the foot or be confined to the tips of the toes, occasionally to the ball of the great toe. Numbness, tingling, hyperassthesia, and sweating mav occur with it. A curious tender- ness of the toes, possibly due to a neuritis, is not infrequently seen in typhoid fever in patients who have been subjected to the cold-bath treatment.