Sural nerve injury - iatrogenic

Case contributed by Maulik S Patel
Diagnosis almost certain

Presentation

Numbness along the lateral foot. Lateral ankle surgery 4 months ago.

Patient Data

Age: 55 years
Gender: Female
ultrasound

Discontinuity of the sural nerve under the lateral ankle scar with a gap of about 12 mm between two ends of the nerve. The proximal torn nerve end shows a hypoechoic nodule (7 x 5 x 4 mm), a traumatic neuroma.

Ankle joint anterior recess effusion. Intact anterior inferior tibiofibular, anterior talofibular and calcaneofibular ligaments. Normal peroneal tendons.

Large protrusion from the lateral surface of the talus.

Cine-loops are aligned to the short axis of the sural nerve. The first two loops run from the proximal to the distal direction. The 3rd loop runs from the distal to the proximal direction.

Case Discussion

A female had ankle surgery to excise the lateral talus bony protrusion a few months ago. Post-surgery she developed numbness along the lateral foot. Lateral ankle pain was persistent.

The ultrasound shows an iatrogenic sural nerve injury under the scar region. The lateral talar bony protrusion is still visible.

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