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TARSAL TUNNEL SYNDROME
Tingling and numbness to the sole of the it is difficult to stop putting pressure through foot can be caused by tarsal tunnel syndrome, your feet. Shoe orthotics are recommended for although other problems can also cause similar some patients and this will often successfully symptoms to your feet. It is important to have relieve symptoms. Altering lifestyle habits the correct diagnosis and identify the level of including weight loss may be helpful in relieving compression or type of nerve disease so that symptoms of tarsal tunnel syndrome. Anti- your symptoms can be effectively treated. medications such as Neurontin may be used. condition where pressure on the tibial nerve in Conditions that may increase your symptoms the region of your ankle causes tingling and such rheumatoid arthritis, hypothyroidism, numbness to the sole of your foot and in more diabetes and other conditions that may increase severe cases changes to the small muscles in swelling to your feet should be treated to see if your foot. The tibial nerve comes off the sciatic that helps your symptoms. Other causes of nerve in the thigh and then continues behind the knee to the inside ankle (medial malleolus) peripheral neuropathy and lumbar radiculopathy where is goes through a tunnel and then divides should be ruled out. Tarsal tunnel syndrome into the calcaneal nerve and the medial and may also be associated with or confused with lateral plantar nerves. The medial and lateral plantar nerves go through separate tunnels in the foot and each tunnel can put more pressure on relieve your symptoms, surgical release of the tarsal tunnel may be recommended. The surgery requires an incision behind your ankle extending down to the arch of your foot. The ligament over the tibial nerve in the region of the tarsal tunnel is released. The nerve is followed in the foot and the tunnels for the medial and lateral plantar nerves are also released. The calcaneal branch frequently has its own tunnel which is also released. A long acting anesthetic is used to help with postoperative pain and because of this anesthetic you will likely feel more numbness following surgery. A soft bulky dressing is At first, the symptoms of tingling and/or applied and it is removed two to three days numbness may come and go and then as the following surgery. To control swelling, it is pressure on the nerve increases, these feelings important to keep your foot elevated whenever may last for longer periods of time. If untreated, possible and moving your toes will help to over time your symptoms will likely increase decrease swelling. When you are walking, you with increased pressure on the nerve through the may put as much weight through your foot as you feel comfortable with. A cane or crutches may be used at first to help decrease weight Non-operative Treatment
compression involves decreasing the pressure on Postoperative Management
the posterior tibial nerve. Because you weight bear through your feet when you walk or stand, begin range of motion exercises of your ankle and an ace wrap may be used to help control from surgery include injury to the small sensory swelling in your foot. Also you may shower and wash over the stitches with soap and water. The stitches are removed 2 to 3 weeks following Recovery
surgery depending on your wound healing. You Initially after surgery, you may notice an may progess to full weight bearing as you feel improvement in the tingling into your foot. If comfortable and may use crutches or a cane for you have had numbness for a long period of time your comfort. In some cases with delayed before surgery, it may take many weeks or wound healing, prolonged swelling or decreased months before you notice improvement in the ankle strength/range of motion, you may be sent sensation in your foot. The nerve grows back slowly at the rate of an inch a month and as the feeling comes back you may feel more burning Complications
tingling into your foot. Similar to when the feeling is coming back after your foot has bleeding, infection and delayed wound healing. “fallen asleep”, you may have those kinds of As the feeling comes back to your foot, you may feelings as the nerve is regenerating and the feel more tingling or burning sensations as normal sensation returns. Other complications Written by: Susan E. Mackinnon, MD & Christine B. Novak, PT, MS Washington University School of Medicine, St. Louis, Missouri March, 2001

Source: http://nerve.wustl.edu/TARSALTUNNELSYNDROME.pdf

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Appendices Chapter 19 Appendices APPENDIX 1: BASELINE HEALTH DATA TABLE 23: POPULATION, NUMBER OF MEDICAL INSTITUTIONS AND PHARMACIES IN THE TERRITORY OF MUNICIPAL ENTITIES IN THE SAKHALIN REGION Municipal entity Population in thousands *Number of Number of Number of outpatient pharmacies institution clinics and obstetrics *Health institutions as legal en

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Chronologie einer Krankheit von Gerhard Klein * *DI: Gerhard Klein ist seit 1998 bei der Aids Hilfe Wien als Mitarbeiter für ProjektPrävention beschäftigt. 1981 Ein Drogentechniker am Center for Disease Control in den USA bemerkt eine ungewöhnlich hohe Anfrage nach Pentamidine -eine Droge, die in der Behandlung von Pneumocystis Carinii Pneumonia (PCP) verwendet wird. Sp

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