Download PDF
Nervenheilkunde 2017; 36(08): 634-345
DOI: 10.1055/s-0038-1627508
Übersichtsartikel
Schattauer GmbH

Der neuropathische Fußschmerz und seine Differenzialdiagnosen

Eine klinische und pathophysiologische ÜbersichtThe neuropathetic foot pain and its differential diagnosesA clinical and pathophysiological review
W. Hermann
1   Universität Leipzig, Klinik und Poliklinik für Neurologie
,
C. Tinta
2   Neurologie, SRO AG Langenthal, Schweiz
› Author Affiliations
Further Information

Publication History

eingegangen am: 26 April 2017

angenommen am: 08 May 2017

Publication Date:
20 January 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Der menschliche Fuß hat sich zu einem Stützfuß entwickelt. Dafür bilden seine Strukturen ein elastisches Gewölbe, das ausdauernd Stand und Gang ermöglicht. Nerval wird der Fuß vom Plexus sacralis über den N. ischiadicus versorgt. Dieser teilt sich in den N. peronaeus communis für die dorsalen und den N. tibialis vorrangig für die plantaren Strukturen. Erkrankungen wie Polyneuropathie, Erythromelalgie, CRPS und RLS sind mit Schmerzen verbunden. Reizungen bei Engpasssyndromen, Morton-Metatarsalgie, Baxter-Neuralgie, Joplin-Neurom und L5/S1-Syndrom führen zu neuropathischen Beschwerden. Störungen muskulärer und nervaler Strukturen können durch Dystonie, Spastik und Krampi ebenfalls Fußschmerzen verursachen. Nicht neurologische Ursachen betreffen primär Hautund Nagelläsionen, Sehnenund Perioststörungen, Knochenund Gelenkerkrankungen sowie Gefäßprozesse. Die Kenntnis der nervalen Topografie ist für die Differenzialdiagnostik notwendig sowie Grundlage für die Untersuchungsplanung und Befundinterpretation. Neben einer speziellen Therapie muss die rasche Diagnostik gefährliche Erkrankungen hinsichtlich drohendem Mobilitätsverlust oder Lebensgefahr erkennen.

Summary

The human foot has developed into a support foot. To accomplish this, its structures form an elastic arch which allows permanent stance and gait. Nerve supply comes from the plexus lumbosacral via the sciatic nerve. This divides into the common peroneal nerve for the dorsal and the tibial nerve predominantly for the plantar structures. Disorders like polyneuropathy, erythromelalgia, CRPS and RLS are associated with pain. Irritations with impingement syndromes, Morton’s neuroma, Baxter-neuralgia, Joplin-neuroma, and L5/S1 syndrome lead to neuropathic pains. Disorders of muscular and neural structures can also lead to foot pain through dystonia, spasticity, and muscle cramps. Nonneurological causes primarily relate to skin and nail lesions, tendon and periosteum disorders, bone and joint diseases as well as vascular processes. The knowledge of neural topography is required for differential diagnosis and is the basis for examination planning and interpretation of the findings. Besides a special therapy the quick diagnosis must also recognize dangerous disorders with regard to an impending loss of mobility or mortal danger.

Schlüsselwörter

Fußschmerz - Nn. tibialis et peronaeus communis - Engpasssyndrome - Erythromelalgie - Polyneuropathie

Keywords

Foot pain - tibial and peroneal nervus - impingement syndromes - erythromelalgia polyneuropathy
 

  • Literatur

  • 1 Bramble DM, Lieberman DE. Endurance running and the evolution of Homo. Nature 2004; 432: 345-352.
    CrossrefPubMedSearch in Google Scholar
  • 2 Bertolini R, Leutert G, Rother P. et al. Systematische Anatomie des Menschen, 3. Aufl. Berlin: VEB Verlag Volk und Gesundheit; 1987
    Search in Google Scholar
  • 3 Clara M. Das Nervensystem des Menschen. 2. Aufl. Leipzig: Johann Ambrosius Barth-Verlag; 1953: 188-200.
    Search in Google Scholar
  • 4 Antoniadis G, Scheglmann K. Hinteres Tarsaltunnelsyndrom. Deutsches Ärzteblatt 2008; 105 (45) 776-781.
    Search in Google Scholar
  • 5 Sommer C. Painful neuropathies. Curr Opin Neurol 2003; 16: 623-8.
    CrossrefPubMedSearch in Google Scholar
  • 6 Baron R. Diagnostik und Therapie neuropathischer Schmerzen. Deutsches Ärzteblatt 2006; 41: A2720-A2729.
    Search in Google Scholar
  • 7 Stengel M, Maag R, Baron R. Krankheitsmechanismen neuropathischer Schmerzen: ein Ausblick. J Neurol Neurochir Psychiatr 2006; 02: 9-15.
    Search in Google Scholar
  • 8 Lai J, Hunter JC, Porreca F. The role of voltage-gated sodium channels in neuropathic pain. Curr Opin Neurobiol 2003; 13: 291-7.
    CrossrefPubMedSearch in Google Scholar
  • 9 Doppler K, Sommer C. Neuropathische Schmerzen durch Nav 1.7-Mutationen. Nervenarzt 2013; 12: 1428-1435.
    Search in Google Scholar
  • 10 Davis JB, Gray J, Gunthorpe MJ. et al. Vanilloid receptor-1 is essential for inflammatory thermal hyperalgesia. Nature 2000; 405: 183-7.
    CrossrefPubMedSearch in Google Scholar
  • 11 Sommer C, Doppler K. Gene und Schmerz. Akt Neurol 2016; 43: 242-248.
    Thieme ConnectSearch in Google Scholar
  • 12 Coull JA, Boudreau D, Bachand K. et al. Trans-synaptic shift in anion gradient in spinal lamina I neurons as a mechanism of neuropathic pain. Nature 2003; 424: 938-42.
    CrossrefPubMedSearch in Google Scholar
  • 13 Hermann W. Polyneuropathie – eine pathophysiologisch-anatomische und klinische Übersicht. Nervenheilkunde 2016; 1–2: 50-58.
    Thieme ConnectSearch in Google Scholar
  • 14 Layzer RB. Hot feet: erythromelalgia and related disorders. J Child Neurol 2001; 16 (03) 199-202.
    CrossrefPubMedSearch in Google Scholar
  • 15 Yang Y, Wang Y, Li S. et al. Mutations in SCN9A, encoding a sodium channel alpha subunit, in patients with primary erythermalgia. J Med Genet 2004; 41: 171-174.
    CrossrefPubMedSearch in Google Scholar
  • 16 Goh EL, Chidambaram S, Ma D. Complex regional pain syndrome: a recent update. Burns & Trauma 2017; 05: 2.
    CrossrefPubMedSearch in Google Scholar
  • 17 Krumova E, Maier C, Tegenthoff M. Neues aus der Forschung zum komplexen regionalen Schmerzsyndrom (CRPS). Akt Neurol 2013; 40: 478-485.
    Thieme ConnectSearch in Google Scholar
  • 18 Legrain V, Bultitude JH, De Paepe AL. et al. Pain, body, and space: what do patients with complex regional pain syndrome really neglect?. Pain 2012; 153: 948-951.
    CrossrefPubMedSearch in Google Scholar
  • 19 Mutso AA, Radzicki D, Baliki MN. et al. Abnormalities in hippocampal functioning with persistent pain. J Neurosci 2012; 32: 5747-5756.
    CrossrefPubMedSearch in Google Scholar
  • 20 Park JY, Ahn RS. Hypothlamic – pituitary – adrenal axis function in patients with complex regional pain syndrome type 1. Psychoneuroendocrinology 2012; 37: 1557-1568.
    CrossrefPubMedSearch in Google Scholar
  • 21 Parkitny L, McAuley JH, Di Pietro F. et al. Inflammation in complex regional pain syndrome: a systematic review and meta-analysis. Neurology 2013; 80: 106.
    CrossrefPubMedSearch in Google Scholar
  • 22 Harden RN, Oaklander AL, Burton AW. et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines. 4th edition. Pain Med 2013; 14: 180-229.
    CrossrefPubMedSearch in Google Scholar
  • 23 Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007; 08 (04) 326-331.
    CrossrefPubMedSearch in Google Scholar
  • 24 Gerhold K. Das komplexe regionale Schmerzsyndrom bei Kindern und Jugendlichen. arthritis + rheuma 2013; 33: 393-400.
    Search in Google Scholar
  • 25 Fogel W. Aktueller Stand von Diagnostik und Therapie des Restless-legs-Syndroms (RLS). Akt Neurol 2005; 32 (Suppl. 03) 94-96.
    Thieme ConnectSearch in Google Scholar
  • 26 Allen RP, Picchietti D, Hening WA. et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003; 04: 101-119.
    Search in Google Scholar
  • 27 Winkelmann J, Muller-Myhsok B, Wittchen HU. et al. Complex segregation analysis of restless legs syndrome provides evidence for an autosomal dominant mode of inheritance in early age at onset families. Ann Neurol 2002; 52: 297-302.
    CrossrefPubMedSearch in Google Scholar
  • 28 Trenkwalder C, Allen R, Högl B. et al. Restless legs syndrome associated with major diseases: A systematic review and new concept. Neurology 2016; 86 (14) 1336-43.
    CrossrefPubMedSearch in Google Scholar
  • 29 Connor JR, Wang XS, Patton SM. et al. Decreased transferrin receptor expression by neuromelanin cells in restless legs syndrome. Neurology 2004; 62: 1563-1567.
    CrossrefPubMedSearch in Google Scholar
  • 30 Gupta R, Dhyani M, Kendzerska T. et al. Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment. Acta Neurol Scand 2016; 133 (05) 320-9.
    CrossrefPubMedSearch in Google Scholar
  • 31 Wurzinger B, König P. Eisenmangel, Fatigue und Restless-Legs-Syndrom. Wien Med Wochenschr 2016; 166 13–14 447-452.
    CrossrefPubMedSearch in Google Scholar
  • 32 Winkelmann J, Schormair B, Xiong L. et al. Genetics of restless legs syndrome. Sleep Med 2017; 31: 18-22.
    CrossrefPubMedSearch in Google Scholar
  • 33 Adams RD, Victor M, Ropper AH. Prinzipien der Neurologie. 6. Aufl. New York: McGraw-Hill; 1997: 207-237.
    Search in Google Scholar
  • 34 Tackmann W, Richter HP, Stöhr M. Kompressionssyndrome peripherer Nerven. Heidelberg: Springer; 1989
    Search in Google Scholar
  • 35 Pecina MM, Krmpotic-Nemanic J, Markiewitz AD. Tunnel syndromes – peripheral nerve compression syndromes. CRC Press Boca Raton Florida 2001; 267-74.
    Search in Google Scholar
  • 36 Stöhr M. Klinische Elektromyogrphie und Neurographie – Lehrbuch und Atlas. 5. Aufl. Stuttgart: Kohlhammer; 2005: 217-224.
    Search in Google Scholar
  • 37 DiDomenico LA, Masternick EB. Anterior tarsal tunnel syndrome. Clin Podiatr Med Surg 2006; 23: 611-620.
    CrossrefPubMedSearch in Google Scholar
  • 38 Gani N, Khan HA, Kamal Y. et al. Anterior tarsal tunnel syndrome with thrombosed dorsalis pedis artery: A case report. Arch Trauma Res. 2015 04. 01
    Search in Google Scholar
  • 39 Reed SC, Wright CS. Compression of the deep branch of the peroneal nerve by the extensor hallucis brevis muscle: a variation of the anterior tarsal tunnel syndrome. Can J Surg 1995; 38 (06) 545-6.
    PubMedSearch in Google Scholar
  • 40 Tennant JN, Rungprai C, Phisitkul P. Bilateral anterior tarsal tunnel syndrome variant secondary to extensor hallucis brevis muscle hypertrophy in a ballet dancer: A case report. European Foot and Ankle Surgery 2014; e56-e58.
    Search in Google Scholar
  • 41 Waizy H, Plaass C, Stukenborg-Colsman C. Die Mortonsche Neuralgie. Fuß & Sprunggelenk 2010; 08 (04) 231-239.
    CrossrefSearch in Google Scholar
  • 42 Kuhn H, Küster HH, Esken M. Die intermetatarsale Neuropathie – Civinini-Durlacher, genannt Morton Metatarsalgie. Fuß & Sprunggelenk 2003; 01 (04) 273-282.
    CrossrefSearch in Google Scholar
  • 43 Maronde B. Schmerzen im Fuß: Ein kniffliger Fall und der Weg zur Diagnose. Medical Tribune 2013; 05: 3.
    Search in Google Scholar
  • 44 Sarrafian SK. Anatomy of the foot and ankle: descriptive, topographic, functional. 2nd ed. Philadelphia: Lippincott; 1993
    Search in Google Scholar
  • 45 Rodrigues RN, Lopes AA, Torres JM. et al. Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging. Radiol Bras 2015; 48 (06) 368-372.
    CrossrefPubMedSearch in Google Scholar
  • 46 Schon LC, Baxter DE. Neuropathies of the foot and ankle in athletes. Clin Sports Med 1990; 09 (02) 489-509.
    Search in Google Scholar
  • 47 Rondhuis JJ, Huson A. The first branch of the lateral plantar nerve and heel pain. Acta Morphol Neerl Scand 1986; 24: 269-279.
    PubMedSearch in Google Scholar
  • 48 Ngo KT, Del Toro DR. Electrodiagnostic findings and surgical outcome in isolated first branch lateral plantar neuropathy: A case series with literature review. Arch Phys Med Rehabil 2010; 91: 1948-1951.
    CrossrefPubMedSearch in Google Scholar
  • 49 Rosenbaum AJ, DiPreta JA, Misener D. Plantar heel pain. Med Clin N Am 2014; 98: 339-352.
    CrossrefPubMedSearch in Google Scholar
  • 50 Still GP, Fowler MB. Joplin’s neuroma or compression neuropathy of the plantar proper digital nerve to the hallux: clinicopathologic study of three cases. The Journal of foot and ankle surgery 1998; 37 (06) 524-530.
    CrossrefPubMedSearch in Google Scholar
  • 51 Merritt GN, Subotnick SI. Medial plantar digital proper nerve syndrome (Joplin’s neuroma)-typical presentation. The Journal of foot surgery 1982; 21 (03) 166-169.
    PubMedSearch in Google Scholar
  • 52 Volkmann J. Dystonie. In: Oertel WH, Deuschl G, Poewe W. Parkinson-Syndrome und andere Bewegungsstörungen. Stuttgart: Thieme; 2012: 229-266.
    Search in Google Scholar
  • 53 Hufschmidt A, Lücking CH, Rauer S. Neurologie compact, 6. Aufl. Stuttgart: Thieme; 2013: 348.
    Search in Google Scholar
  • 54 Muller U. The monogenic primary dystonias. Brain 2009; 132 (08) 2005-2025.
    CrossrefPubMedSearch in Google Scholar
  • 55 Miller TM, Layzer RB. Muscle cramps. Muscle Nerve 2005; 32: 431-442.
    CrossrefPubMedSearch in Google Scholar
  • 56 Butler JV, Mulkerrin EC, O’Keeffe ST. Nocturnal leg cramps in older people. Postgrad Med J 2002; 78: 596-598.
    CrossrefPubMedSearch in Google Scholar
  • 57 Harper CM. Muscle pain, cramps, and fatigue. In: Engel AG, Franzini-Armstrong C. Myology Basic and Clinical. New York: McGraw-Hill; 2004: 1739-1754.
    Search in Google Scholar
  • 58 Schwellnus MP. Cause of exercise associated muscle cramps (EAMC) – altered neuromuscular control, dehydration or electrolyte depletion?. Br J Sports Med 2009; 43: 401-408.
    CrossrefPubMedSearch in Google Scholar
  • 59 Bentley S. Exercise-induced muscle cramp. Proposed mechanisms and management. Sports Med 1996; 21: 409-420.
    PubMedSearch in Google Scholar
  • 60 Lindemuth R, Czaplinski A, Dillmann U. et al. Crampi/Muskelkrampf. In: Diener HC, Weimar C. Leitlinien für Diagnostik und Therapie in der Neurologie. Stuttgart: Thieme; 2012: 807-809.
    Search in Google Scholar
  • 61 Dunn JE, Link CL, Felson DT. et al. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Epidemiol 2004; 159 (05) 491-8.
    Search in Google Scholar
  • 62 Menz HB, Gill TK, Taylor AW, Hill CL. Age and gender differences in disabling foot pain using different definitions of the Manchester Foot Pain and Disability Index. BMC Musculoskelet Disord 2011; 12: 243.
    CrossrefPubMedSearch in Google Scholar
  • 63 Butterworth PA, Menz HB, Urquhart DM. et al. Fat mass is associated with foot pain in men. The Journal of Rheumatology January 2016; 43 (01) 138-143.
    Search in Google Scholar
  • 64 Butterworth PA, Landorf KB, Smith SE, Menz HB. The association between body mass index and musculoskeletal foot disorders: a systematic review. Obes Rev 2012; 13: 630-42.
    CrossrefPubMedSearch in Google Scholar
  • 65 Menz HB, Morris ME. Determinants of disabling foot pain in retirement village residents. J Am Podiatr Med Assoc 2005; 95: 573-9.
    CrossrefPubMedSearch in Google Scholar
  • 66 Gorter KJ, Kuyvenhoven MM, de Melker RA. Nontraumatic foot complaints in older people. A population-base survey of risk factors, mobility and wellbeing. J Am Podiatr Med Assoc 2000; 90: 397-402.
    CrossrefPubMedSearch in Google Scholar
  • 67 Awale A, Dufour AB, Katz P. et al. Link between foot pain severity and prevalence of depressive symptoms. Arthritis Care Res 2016; 68: 871-876.
    CrossrefPubMedSearch in Google Scholar
  • 68 Menz HB, Morris ME. Footwear characteristics and foot problems in older people. Gerontology 2005; 51: 346-51.
    CrossrefPubMedSearch in Google Scholar
  • 69 Altmeyer P, Paech V. Enzyklopädie Dermatologie, Allergologie, Umweltmedizin. Heidelberg: Springer; 2011
    Search in Google Scholar
  • 70 Alexander IJ. Der Fuß Untersuchung und Diagnostik. Berlin: Springer; 1991
    Search in Google Scholar
  • 71 Chou LB, Ho YY, Malawer MM. Tumors of the foot and ankle: experience with 153 cases. Foot Ankle Int 2009; 30: 836-841.
    CrossrefPubMedSearch in Google Scholar
  • 72 Bouysset M. Bone and joint disorders of the foot and ankle. Heidelberg: Springer; 1998
    Search in Google Scholar
  • 73 Rammelt S, Schneiders W, Fitze G, Zwipp H. Frakturen des kindlichen Sprunggelenks und Fusses. Orthopäde 2013; 42 (01) 45-54.
    CrossrefPubMedSearch in Google Scholar
  • 74 Olms K. Frakturen und Luxationen am Fuß. Trauma Berufskrankh 2015; 17 (01) 40-44.
    CrossrefSearch in Google Scholar
  • 75 Krumova EK, Frettlöh J, Klauenberg S. et al. Longterm skin temperature measurements – a practical diagnostic tool in complex regional pain syndrome. Pain 2008; 140: 8-22.
    CrossrefPubMedSearch in Google Scholar
  • 76 Trenkwalder C, Benes H, Buschmann H. et al. Restless-legs-symdrom (RLS) und Periodic LImb Movement Disorder (PLMD). In: Diener HC, Weimar C. Leitlinien für Diagnostik und Therapie in der Neurologie. Stuttgart: Thieme; 2012: 89-106.
    Search in Google Scholar
  • 77 Bhaskaranand K, Nacadgi BC. Glomus tumour of the hand. J Hand Surg (Br) 2002; 27: 229-31.
    CrossrefPubMedSearch in Google Scholar
  • 78 Herold G. Innere Medizin. Fellbach: Herold; 2017
    Search in Google Scholar