Superficial Peroneal and Sural Neuroma Transposition in a Case of Neuropathic Pain Following Foot Surgery 7 Mackinnon SE1 Yee A1 February 27, 2014Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Pain resulting from nerve injury can originate from the site of injury (local neuroma pain) and from the collateral sprouting of adjacent sensory territories into the deinnervated territory (hyperalgesic pain). Surgical management of neuropathic pain is controversial and typical management of neuroma pain includes excision and transposition. In our institution, management includes a proximal crush injury to facilitate an axonal injury and a period of prolonged regeneration, neuroma resection with distal end cautery cap, and proximal intermuscular transposition. In the case, the patient presented with severe neuropathic pain in the anterior/lateral region of the ankle and foot, following surgery to correct flat foot deformity. Two attempts to surgically resolve the neuropathic pain from a sural neuroma failed before being referred to our institution. Examination and provocative tests revealed involvement of the sural nerve and superficial peroneal nerve. Surgical management included exploration and transposition of the sural nerve and superficial peroneal nerve with releases of the peroneal nerve at the fibular head, lateral sural nerve, and deep peroneal nerve. The nerves releases were included due to having positive provocative tests during examination.Keywords: sural nerveneuropathic painiatrogenic nerve injurysuperficial peroneal nerveproximal crushneuroma excision and transposition You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:25 - Pre-operative Examination and Management Discussion00:01:53 - Operative Positioning and Considerations00:02:29 - Superficial Peroneal Nerve Exploration – Incision00:03:19 - Identifying and Releasing the Overlying Superficial Fascia00:03:45 - Identifying and Releasing the Transverse Crural Ligament00:04:28 - Proximal Exposure of the Superficial Peroneal Nerve00:05:34 - Peroneal Nerve Release at the Fibular Head – Incision00:07:20 - Identifying the Common Peroneal Nerve00:08:22 - Identifying and Releasing the Posterior Crural Intermuscular Septum00:09:44 - Identifying the Lateral Sural Nerve00:10:49 - Sural Nerve Exploration - Incision00:11:44 - Exposing the Sural Neuroma and Proximal Exposure of the Sural Nerve00:13:43 - Proximal Crush of Sural Nerve and Superficial Peroneal nerve00:14:04 - Neuroma Resection, Cautery Cap, and Proximal Transposition of the Sural Nerve00:15:40 - Cautery Cap and Proximal Transposition of the Superficial Peroneal Nerve00:16:28 - Deep Peroneal Nerve Release – Incision and Release You must login to view the full article and extended video on this page. 1 Comment Howard Pecker 13th May 2018 It would be helpful if the camera would occasionally pull back to show the general orientation of the leg, and for the occasional wide view. Thanks for your efforts and exquisite videos. Your name was mentioned as a reference at the recent AAOS meeting in the lecture/symposium on compression neuropathies. Log in to Reply | Leave a Comment Cancel replyYou must be logged in to post a comment.