Meralgia paresthetica (lateral femoral cutaneous nerve entrapment) in Diabetes

                                                                     S.Bamila

SeenaRajsekar

Dept. of Podiatry

Meralgia paresthetica is a condition that have the following symptoms.
•    Burning, stinging or “pins and needles” sensation in the outer thig
•    Numbness & tingling in the outer (lateral) part of your thigh
•    Less commonly, dull pain in your groin area or across your buttocks
These symptoms commonly occur only on one side of the body and may increase after walking or standing.

How does this happen?

•    The lateral femoral cutaneous nerve is entrapped as it passes under the inguinal ligament.
•    Obesity
•    Diabetes mellitus
•    Old age
•    Large  bulging abdomen

•    Tight belts or garments around the waist

    

    
 •    Scar tissue near the lateral aspect of the inguinal ligament
•    Pregnancy
•    Injury during local or regional surgery
•    Seat belt injury following motor vehicle accident
•    Meralgia has also been reported after long-distance walking and cycling.

Risk factors:
The following conditions may increase your risk of meralgia paresthetica:

•    Extra weight - Being overweight or obese may increase the pressure on your lateral femoral cutaneous nerve.
•    Pregnancy - A growing belly adds extra pressure on the groin, through which the lateral femoral cutaneous nerve passes.
•    Diabetes - Diabetes-related nerve injury can lead to Meralgiaparesthetica.
•    Age - People between the ages of 40 and 60 are at a higher risk.

Treatment:

There are several categories of treatment for Meralgia paresthetica according to the cause  and severity of the problem.

•    The most immediate response to Meralgia paresthetica should be rest.
•    Conservative management- Wearing loose clothing and losing weight.
•     Making lifestyle changes.
•    Medicines
•    Creams containing capsaicin.
•    A mainstay of treatment (which could be curative) are nerve blocks.

Rehabilitation Program: Physical Therapy

•    Fitness program to assist in weight reduction to reduce abdominal girth, as well as proper biomechanics and postural re- education
•    Heat application
•    Transcutaneous electrical nerve stimulation
•    Interferential current
•    Low-intensity phonophoresis.
•    Soft-tissue techniques (e.g, trigger point therapy) also may be beneficial for pain and tightness in the hip and thigh muscle
•    Deep tissue massage/myofascial release
•    Joint mobilization/Joint manipulation
•    Exercise programs to stretch, self- treat and improve proprioception, balance, strength and core stability
•    Neural mobilisation
•    Activity modification advice
•    Taping

Outer Thigh Meralgia paresthetica Exercises:
         
Hip Exercises:

Bridging consists of lying flat on the floor and lifting your bottom up while tightening your gluteal muscles.

  Hip extensions involve lying on your belly and lifting your leg up while tightening the gluteals.

Standing hip abduction requires standing upright while slowly lifting each leg to one side, keeping the knee straight.Reducing hip tightness is one way to reduce the symptoms of Meralgia Paresthetica by improving flexibility and building strength.
Such exercises should not cause any thigh pain.

Quadriceps Stretches:



Quad stretch involves pulling the heel of your foot back toward your buttocks while standing, stretching the length of the upper thigh. Stretching should cease if pain occurs.

Lunges:

Lunges strengthen both the hips and quadriceps muscles to help prevent thigh pain. Stand upright and step forward with one foot, lowering the body until the opposite knee touches the ground at a right angle.

Summary:

The simplest treatment is to get the pressure off the nerve by losing weight and/or not wearing tight fitting pants or belts. If there is pressure on the nerve, decreasing that pressure in any manner will improve symptoms.

If the pain is severe, operative decompression should be considered.