We celebrate with this young man who is doing much better after removal of a sural nerve, a sensory nerve branch, that travels down the back of the calf and then goes into the outer heel. This young man had a previous traumatic rupture of his achilles tendon. Unfortunately, despite a successful repair of the tendon which has allowed him to walk normally again, the patient had terrible sharp, intense, electrical shocking pain that would radiate right from his scar into the outside of his foot. Almost any movement of the heel would put a stretch on the nerve and cause it to “fire off.” Even light touch to the scar or outer ankle and Achilles tendon was intensely painful.
We suspected a traumatic neuroma or a “stump” neuroma that can occur from any surgical procedure essentially anywhere on the body. We have sensory nerves everywhere. Essentially any operation that cuts the body (which is all of them) has the potential to injure nerves. The patient’s pain completely resolved temporarily when we performed diagnostic blocks on this nerve with local anesthetic. He could move his ankle and after the injection had no pain – until the medication wore off. This gave us the information that we needed to make the decision to go to the operating room. In the operating room, the sural nerve was stuck in the surgical scar, as we suspected he did have a true neuroma of the sural nerve.
There are several options that could be considered to improve this patient’s pain. In this particular case we moved forward with a resection or removal of the nerve and we implanted this nerve upstream in a location that would be far less likely to be traumatized and placed a “cap” on the end of the nerve with a small piece of the patient’s own muscle to prevent the nerve from trying to regrow into another painful neuroma. Our goal was to allow him to get back to his normal activity levels and get back to walking, running, sitting, and even sleeping significantly improved levels of pain.