Incidence and Management of Sural Neuritis Post-Peroneal Tendon Repair – Case Series
Background Sural neuritis is a recognized and common complication resulting from iatrogenic injury, postsurgical or posttraumatic fibrosis, traction injury, or chronic nerve compression. Previously in a case series by Stockton and Brodsky, sural neuritis was reported as a complication in 16.6% of the patients who underwent peroneal tendon repair. Patients with sural neuritis often report pain and tingling in the distribution of the sural nerve along the lateral posterior leg, lateral foot, and the fifth digit. Symptoms of sural neuritis could be intense and debilitating, necessitating prompt recognition and treatment. Method Patients who underwent peroneal tendon repair between January 2022 to January 2024 by a single surgeon were included in this retrospective case series. Medical charts of the patients included in the study were reviewed. Demographics for all patients included in the study were recorded. Time to onset of sural neuritis, time to resolution, and management of the condition were recorded for patients who developed sural neuritis. Results A total of 39 patients were retrospectively reviewed, of which three patients (7.69%) developed symptoms attributed to sural neuritis post-peroneal tendon repair. Diagnosis of sural neuritis in the three patients ranged from 130 to 191 days post-peroneal tendon repair. Time to resolution of neuritis symptoms in the three patients who developed sural neuritis were 113 to 574 days after the onset. Successful management of sural neuritis were observation, serial injection of a mixture of 1 ml 1% lidocaine, 1 ml 0.5% bupivacaine, and 1 ml dexamethasone (4 mg/mL), and sural neurectomy. Conclusion While conservative treatments may be effective to manage sural neuritis, surgical options may be necessary for patients who fail to respond adequately. Patients suffering from sural neuritis often experience intense and debilitating symptoms that significantly impact their quality of life, highlighting the critical importance of early identification and appropriate management to mitigate long-term disability and ensure optimal outcomes.