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Thread: Lower Thoracic, Conus, and Cauda Equina Injuries: Diagnosis & Treatment

  1. #51
    Senior Member Kaprikorn1's Avatar
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    Duge...I don't feel like walking on glass...just the constant burning like feet are in boiling oil up to about my ankles.

    Metro...my Merrell sandals are the "High Tide" model. They have a pretty good "air cushion" sole. What are MBT's? I'm not familiar with them. Are they Merrells?

    Kap

    accept no substitutes

  2. #52
    mbt pic

    kap this site has good closeup pictures, do a goggle search for MBT or Masai barefoot technology.

    the brown sandals i recently purchased and they do not have a adjustable heel strap,(fine tuning AFO heel pocket) the black ones i bought last year and they had a adjustable heel strap and a neoprene stretch at the toe box(which i cut)
    your best bet is to find a store that sells them to try them on , since they fit a bit different.
    i have no s1 basically, so i have no calf muscle , and these work great with the AFO to give a roll forward , since they have a huge rocker bottom.
    my ankle weakness require me to wear a AFO or at least a brace as the height of the shoe will cause my ankle to roll out evert badly,
    they are expensive , but i really cant walk far without them, the pain reduction for me is night and day
    insurance may pay for them , i have had workers comp pay for mine and the VA ordered me a pair from a local shoe store and mailed them to me. i have the docs make out the prescription for MBT custom rocker bottom shoe, they have stiff non flexing sole bed also that helps.

  3. #53
    Here is a redrawn/relabeled picture of the dermatomes
    Last edited by Wise Young; 09-28-2006 at 04:18 AM.

  4. #54
    Dear Wise, Thank you for your info. What dermatomes innervate the bottom of the foot?

    [This message was edited by diane2 on 05-31-05 at 02:36 AM.]

  5. #55
    Diane2,

    The L4 dermatome covers the medial bottom of the foot, the L5 dermatome covers the mid-bottom of the feet, and the S1 dermatome covers the lateral bottom edge of the foot. By the way, in another topic, I show pictures of dermatome maps that i think are wrong from textbooks of neurology and anatomy. Both the Netter and the Duke U dermatome maps (that is where the middle set of charts comes from) appear to have depicted the bottom of the foot relatively accurately. However, the dermatomes of the leg and particularly the coverage of the knee (patella) are inaccurate in both the Netter and Wash U. maps.

    Wise.

    [This message was edited by Wise Young on 05-31-05 at 05:03 PM.]

  6. #56
    Thanks a lot. Do you think there are individual differences in dermatome distribution that adds to the confusion?

    On another topic, do you discuss "post polio syndrome",esp for those that are exercising quite a bit and seem to be getting gradual peripheral nerve re-growth? Seems esp relevant for conus and cauda equina injuries.

  7. #57
    Wise, Perhaps there are individual differences in dermatomes that contributes to maps being slightly different?

    Have you commented on "post polio syndrome" for those who are cauda equina/conus and seem to be getting peripheral nerve regrowth?

  8. #58
    Diane2,

    There are of course individual differences at the edges of the dermatomes. That is one of the reasons why the ASIA classification guidelines ask clinicians to test the dermatomes at the specified points. These are the points that everybody should share.

    The Netter picture (linked to http://www.backpain-guide.com/Chapte...culopathy.html from Atlas of Human Anatomy by Frank Netter, MD) is very pretty and is widely used by many people for teaching dermatomes. As I pointed out in my earlier post, Netter made at least 15 errors that are consequential for the neurological examination.

    The concern of the ASIA committee was to provide specific points for the neurological examination so that if there is sensation at that specific point, you can say with a reasonable degree of certainty that that particular spinal cord segment and root is intact. You can imagine the discussion that went on when we found all the conflicting charts from all the textbooks.

    As it turns out, due to the high prevalence of lumbosacral disc herniations and an abundance of clinical experience mapping the sensory loss in the foot, maps of the foot are reasonably accurate. But, you can see that there are discrepancies between the Netter chart and the Duke chart (linked to http://www.regionalabc.org/lower/ana...ermatomes.php:)



    Netter shows L4 covering only the medial side of the great toe whereas the Duke image shows the L4 dermatome covering the entire medial side of the foot. Netter also wrongly shows S2 extending to the bottom of the foot; the S2 dermatome stops midcalf and does not extend into the foot.

    The Duke University dermatome maps are wrong concerning the L2, L3, and L4 dermatomes. As shown above, the Duke map shows the L2 dermatome covering the front of the upper thigh from the inguinal ligament to the upper midthight, the L3 dermatome covering the front midthigh and the the medial thigh and part of the back of the leg, the L4 dermatome covering the entire lateral aspect of the thigh and spiraling in the front to cover the patella (the bump of the knee). According to the ASIA map, L2 covers the front and medial aspect of the upper thigh, L3 covers the front lower thigh and knee, L4 the the medial lower leg, L5 the lateral lower leg, and S1 the back of the lower leg and heel and lateral aspect of the foot.

    By the way, the above images are simply links to images on internet... If you want to find the URL of the images, just right-click or control-click (on Apple) the image in your browser to open the image in a new window and look for the URL address. The Netter image is displayed at www.backpain-guide.com. What I call the Duke images is a link from www.regionalabc.org which is hosted by Duke University Medical Center.

    Wise.

    [This message was edited by Wise Young on 05-31-05 at 06:36 PM.]

  9. #59
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    Back to the subject of cure-Dr. Young, deep down in my black heart i honestly feel that if anything were to arise ( likely not ) that nothing would work.

    sherman brayton

  10. #60
    Sherman, I still don't have a good idea of your injury level. Wise.

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