Der neuropathische Fußschmerz und seine Differenzialdiagnosen

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

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