Outcomes of Surgical Treatment for Sural Nerve Pain

CATEGORY: Ankle; Hindfoot INTRODUCTION/PURPOSE: Somatic neuropathy is a common complication following foot and ankle surgery, trauma, or compression due to entrapment. Symptoms can be intense and debilitating. The Sural nerve is commonly affected and is at risk due to the location and proximity to frequently used surgical approaches. The purpose of this study is to investigate the outcomes of sural nerve neurolysis and neurectomy with intramuscular burial for sural neuritis. METHODS: IRB approval was obtained, and patients were identified who underwent operative treatment by two foot and ankle specialists for sural nerve related pain. Exclusion criteria included patients under the age of 18, prisoners, those who underwent concomitant osseous procedures, and less than 6-week follow-up. Demographics and preoperative outcomes including FFI, SF-36, FAAM, and VAS were recorded. Final follow-up questionnaires using PROMIS measures and FAAM were administered using REDCap. RESULTS: The 25 patients meeting inclusion criteria for this study had a median age of 47 (interquartile range [IQR], 43 to 49) and had median follow-up of 33.7 months (IQR, 4.5 -73.2). Median FAAM ADL improved from 40.8 (IQR 38.1-51.3) preoperatively to 59.5 (IQR 47.6-76.2) postoperatively, p=0.032. FAAM Sports scores improved from 15.6 (IQR 9.4-21.9) to 31.3 (IQR 25.0-56.3) postoperatively, p=0.002. VAS scores improved from a median of 9.0 (IQR 7.0-9.0) to 4.5 (3.0-6.0), p<0.0001. At final follow-up patients reported PROMIS lower extremity function score median of 46.7 (IQR 36.7-51.2), PROMIS neuropathic pain quality score of 51.5 (IQR 45.5-60.2), and PROMIS pain interference of 55.7 (IQR 41.1-63.7). Patients with current or recent nicotine use, depression, anxiety, and complex regional pain syndrome (CRPS) prior to surgery reported poorer outcomes. CONCLUSION: Neurectomy with burial or neurolysis can significantly improve symptoms for sural neuritis secondary to neuroma or nerve entrapment. Tobacco use, depression and anxiety are associated with poorer outcomes following surgery. Further research is needed to More clearly identify patients at risk for worse outcomes and perioperative factors that could allow interventions to optimize patient outcomes.