Neuralgia refers to a severe, sharp pain occurring along the course of a nerve. This diagnostic code refers to the posterior tibial nerve which is a sensory and motor nerve. This nerve innervates the muscles of the lower leg. Motor branches are distributed to the intrinsic foot muscles.

Neuralgia may be caused by pressure on nerve trunks, faulty nerve nutrition, toxins or inflammation. Etiologic factors associated with the condition include: osteoarthritis; compression (tarsal tunnel syndrome); tight fitting shoes; tenosynovitis; and post-traumatic deformities at the ankle.

Manifestations of the condition include burning pain and tingling in the sole of the foot (paresthesias). There may be muscle wasting, paralysis of the intrinsic muscles of the foot, loss of plantar flexion and ankle inversion, as well as loss of sensation in the sole of the foot.

Peripheral nerve examination may include: nerve conduction tests; needle electromyography (EMG); computed tomography (CT) scan; magnetic resonance imaging (MRI); muscle-strength testing; deep tendon reflexes (DTR); sensory testing; and gait examination.

Generally, the nerve in mild stretch or in compression injuries recovers. Patients should be cautioned against extended leg-crossing positions, prolonged sitting on a toilet, or assuming unusual positions, such as yoga sitting. The usual treatment consists of a splint that supports the ankle and the foot, and range of motion (ROM) exercises. Local injection of steroids may provide temporary relief. If the nerve does not show signs of regeneration, it may have to be explored and freed from adhesions. Analgesics may also be of benefit.

Splinting, should be used as long as voluntary activity is impaired.

• If the Veteran is a former prisoner of war and was interned or detained for not less than 30 days, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309(c) Disease subject to presumptive service connection].

• If the Veteran was exposed to an herbicide agent during active military, naval, or air service, this disease shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.309(e). Disease subject to presumptive service connection.

• This disability shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied.  38 CFR 3.309(a)

• Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis.  38 CFR 4.123 Neuritis, cranial or peripheral.

• With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves] 38 CFR 4.124a Schedule of ratings—neurological conditions and convulsive disorders