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Dermatology · Leprosy: posterior tibial nerve involvement
Sample itemA man with long-standing leprosy has an anaesthetic, dry sole and clawing of the toes from paralysis of the small muscles of the foot. Which nerve is mainly involved?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Posterior tibial nerve
The posterior tibial nerve passes behind the medial malleolus and divides into the medial and lateral plantar nerves. Its damage causes plantar anaesthesia, anhidrosis and clawing of the toes, and makes the sole prone to painless ulcers.
Option by option
A. Sural nerve
The sural nerve is purely sensory over the lateral foot and does not paralyse intrinsic muscles.
B. Posterior tibial nerve (correct)
Correct. Plantar sensory loss with paralysis of the intrinsic foot muscles points to the posterior tibial nerve.
C. Common peroneal nerve
Common peroneal damage causes foot drop and sensory loss over the dorsum of the foot and lateral leg.
D. Saphenous nerve
The saphenous nerve is a sensory branch of the femoral nerve over the medial leg and does not supply the sole.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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