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Neurological Rehabilitation

Sural Neuropathy following Achilles Tendon Repair: A Case Report

Sural Neuropathy Following Achilles Tendon Repair: A Case Report

Thursday, November 16, 2023

    Primary Author(s)

  • Yanni G. Kevas (he/him/his)

    Medical Student
    University of Maryland School of Medicine
    Baltimore, Maryland

    • Co-Author(s)

  • JK

    Jay Karri, MD

    Assistant Professor
    University of Maryland
    Baltimore, Maryland

  • Idris Amin, MD

    Assistant Professor
    University of Maryland School of Medicine
    Laurel, Maryland

Case Diagnosis: A 26-year-old recreational soccer player with right sural neuropathy following Achilles tendon repair.

Case Description or Program Description: The patient suffered a ruptured Achilles tendon and then underwent surgical repair 3 days following the injury. He had no immediate complications from the procedure. When the nerve block wore off following surgery, he noticed burning pain in the lateral portion of his right ankle. He described severe, shooting pain that was extremely sensitive to light touch. The patient was prescribed gabapentin and duloxetine for pain management, but both were stopped due to sedation and dizziness, respectively. Approximately 4 months following the onset of his symptoms, he completed an electromyography (EMG) study, which showed right sural nerve mononeuropathy. A subsequent ultrasound found the sural nerve entrapped in underlying scar tissue.

Setting: Interventional pain medicine clinic

Assessment/Results: Sural nerve ultrasound guided peripheral nerve block and hydrodissection with 1% lidocaine and saline provided complete resolution of pain for 2 days. Peripheral nerve stimulation of the sciatic and/or peroneal nerve was offered for long term treatment but was deferred at this time. The patient was started on pregabalin and will follow up with his neurologist for medical management.

Discussion (relevance): Sural nerve entrapment can be difficult to treat, cause severe discomfort and impede function. Early, goal directed treatment of sural neuropathy is helpful to optimize functional outcomes and participation with post operative physical therapy. Ultrasound guided hydrodissection is a safe and effective treatment for patients with sural nerve entrapment that fail conservative management. Musculoskeletal ultrasound can be a useful adjunct to nerve conduction studies and/or EMG for diagnosing entrapment neuropathies and directing diagnostic injections.

Conclusions: Sural neuropathy should always be considered with discrete neuropathic pain following Achilles’ tendon repair.