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2023 Workshop Handout Bundle
Needle EMG of the Foot
Needle EMG of the Foot
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Pdf Summary
Needle electromyography (EMG) examination of the foot is a valuable tool in the evaluation of neurogenic disorders affecting the foot. It is commonly underutilized due to misconceptions about the procedure. Several studies have reported prolonged insertional activity in the foot muscles of normal subjects, but this has been refuted by later studies that found true abnormal spontaneous activity in only a small percentage of healthy individuals. Many electromyography (EDX) consultants believe that examination of the foot muscles is too painful for the patient, but the discomfort is similar to that experienced during examination of hand muscles. Additionally, there is limited education and training dedicated to this topic, contributing to discomfort and reluctance among EDX consultants. This workshop aims to address these concerns and provide a comprehensive understanding of the anatomic principles, electrophysiologic approach, technique, and clinical interpretation of needle EMG examination of the foot.<br /><br />The intrinsic muscles of the foot receive their nerve supply from the medial plantar nerve (MPN), lateral plantar nerve (LPN), and Baxter's nerve, all branches of the tibial nerve. These muscles are affected by various neurogenic disorders, including peripheral polyneuropathy, lumbosacral radiculopathy/plexopathy, and entrapment/compression mononeuropathies. The tibial nerve can be compressed within the tarsal tunnel, upper and lower calcaneal chambers, and abductor canal.<br /><br />The workshop provides guidance on the needle EMG examination of specific foot muscles, including the first and fourth dorsal interosseus pedis, flexor digiti minimi brevis, abductor digiti quinti pedis, extensor digitorum brevis, and abductor hallucis. Needle electrode placement techniques for each muscle are described, as well as the expected innervation patterns. The authors emphasize the importance of needle EMG examination of multiple foot muscles, as symptoms may be caused by entrapment of different nerves or individual nerve branches.<br /><br />Conclusion: Needle EMG examination of the intrinsic foot muscles is an essential part of the evaluation of neurogenic disorders affecting the foot. Despite misconceptions and limited training, this technique provides valuable diagnostic information when performed correctly and interpreted in conjunction with the patient's clinical presentation.
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