Percutaneous Tibial Nerve Stimulation

Stimulator Unit

Needle Electrode

Grounding Electrode

Lead Wires

Gel or Conductive Paste

Disposable Covers/Needles

Patient preparation

Medical History and Assessment:

Review of Medical History: Ensure the patient is medically stable and assess for any contraindications, such as active infections or conditions that may interfere with the procedure (e.g., pregnancy, deep vein thrombosis).

Evaluate for Sensitivity to Electrical Stimulation: Every patient could have some skin sensitivity issues or other complications that might hinder successful or safe treating.

Informed Consent: The procedure should be described to the patient, what can be expected from the treatment, possible complications, and how many sessions are required.

Consent is then obtained.

Pre-Procedure Instructions:

Hydration: For bladder related issues, the patient should be encouraged to take a lot of water before the procedure.

Avoidance of Skin Lotions/Creams: The area of the ankle should be devoid of lotions, cream or oils as they might hinder the placement of the electrodes.

Clothing: To access the ankle area the patient should wear comfortable clothing that is soft, or the patient may be requested to wear a gown.

Patient position

Seated Position: The patient should be comfortably seated in a chair with their legs relaxed and uncrossed. The legs should be supported, usually with a footrest or by placing the feet flat on the floor.

Ankle in Neutral Position: The specific position of the affected leg (which is most often the left one) should be chosen to make the ankle straight. The foot, in turn, may be placed on a foot pedal or slightly raised to ensure comfort and optimal access to the tibial nerve.

Step 1-Preparation:

Patient Education: The patient is informed about the procedure, its benefits, and possible risks. Written consent is obtained.

Positioning: The patient is positioned comfortably, typically sitting or lying down with the leg to be treated extended.

Skin Preparation: The area on the ankle, just above the medial malleolus (bony prominence on the inner side of the ankle), is cleaned and disinfected with an antiseptic solution.

Step 2-Placement of Needle Electrode:

Needle Insertion Site: The clinician locates the tibial nerve at the level of the medial malleolus (inner ankle) of the patient’s lower leg.

Needle Insertion: A fine, thin needle electrode is inserted just above the medial malleolus, at a point where the tibial nerve can be located. The needle is inserted at an angle of about 60 degrees to the skin surface.

Confirmation of Nerve Location: The clinician may use a stimulator to ensure that the needle is correctly placed near the tibial nerve. A motor response (such as a small twitch of the foot) confirms correct placement.

Step 3-Connection to the Stimulator:

Electrode Connection: The needle is connected to a PTNS stimulator device that delivers low electrical pulses to the tibial nerve.

Stimulation Settings: The clinician sets the appropriate parameters on the stimulator, which usually involves pulse frequency, intensity, and duration.

Step 4-Stimulation:

Treatment Duration: The patient typically receives 30-minute sessions of stimulation, once a week for about 12 weeks.

Monitoring: The clinician monitors the patient for any discomfort or adverse reactions during the stimulation. The intensity can be adjusted to ensure the patient feels a mild tingling or muscle contraction, but not pain.

Muscle Response: The stimulation may cause slight muscle twitching or movement in the foot or ankle, which is expected and indicates proper stimulation of the tibial nerve.

Step 5-Completion and Removal:

End of Session: After the stimulation time is complete, the needle is carefully removed.

Post-Treatment Care: The treatment site is cleaned again, and the patient is monitored briefly for any immediate side effects or reactions.

Aftercare Instructions: The patient is given instructions on possible side effects (like mild bruising or tingling) and what to do if they experience any discomfort after the session.

Complications

Pain or Discomfort: The procedure requires inserting a needle close to the tibial nerve at the ankle, some patients may experience discomfort or mild pain during the procedure. Discomfort at the site of needle insertion is common.
Infection: As with any invasive procedure, there is a small risk of infection at the site where the needle is inserted.
Bruising or Bleeding: Some patients may experience bruising or minor bleeding at the site of needle insertion. This is usually mild and resolves quickly.
Nerve Injury: Though rare, there is a small risk of nerve injury, leading to numbness or tingling in the leg or foot. This can sometimes be temporary, but in rare cases, it may be permanent.
Muscle Twitching or Spasms: During treatment, electrical impulses may cause muscle twitching or spasms in the foot or leg. These are usually temporary and resolve after the procedure.
Skin Irritation or Allergic Reaction: The adhesive used to fix the electrodes on the skin may cause irritation or allergic reactions in sensitive people.