A 35-year-old reporter presents to your office for evaluation of back pain and weakness in his left leg. He was play-wrestling with his nephew and hurt his back 2 weeks ago. He states that he has noticed tingling in his left leg as well. He has not noticed incontinence of bowel or bladder function. You perform a physical examination and confirm that he is dragging his left foot when he walks and that his Achilles reflex is diminished. You diagnose him with a herniated disc. Which nerve root are you testing with the Achilles reflex?

S1

Explanation:

When the S1 nerves is numb, you would feel it on the outside of your foot. It is the main supplier of innervation to the ankle, and one experiences a loss of reflex on the foot when the achilles tendons are tapped, then this signifies that there is an impingement to the S1 nerve, even though there is actually no loss of function.

Faced with this situation that the patient suffered, we deduce that his herniated disc generated a compressive neuropathy of the tibial nerve

Explanation:

The tibial nerve provides sensitivity to the plant

foot; comes from the sciatic nerve and then

The tarsal tunnel is divided into three branches:

medial plantar branch, lateral plantar branch and medial calcaneal nerve. Although compression of these is not common, it is a cause of failure in the diagnosis and chronic pain of the patient. Compression of the lateral plantar nerve causes pain and paresthesia in the external part of the foot, unlike the medial plantar nerve that does it in the middle area, while the lateral calcaneal nerve, especially in the heel.

Physical examination and medical history are

which mainly guides us towards

diagnosis; however, complementary tests, such as driving studies, can be useful. Treatment will always start conservatively, with changes in biomechanical abnormalities, use of shoes, etc., and can be supplemented with local application of corticosteroids. In some cases, when this treatment fails, surgical management with exploration and release is required.