Peripheral Nerve Stimulator for Treating Sural and Posterior Tibial Neuralgias – Case Report

Abstract

BACKGROUND: Sural neuralgia is persistent pain in the distribution of the sural nerve that provides sensation to the lateral posterior corner of the leg, lateral foot, and fifth toe. Sural neuralgia is a rare condition, but can be challenging to treat and cause significant limitations. Posterior tibial neuralgia, also known as tarsal tunnel syndrome, is an injury or stretch affecting the tibial nerve at the medial border of the ankle and heel. We present one case of sural neuralgia complicated by superimposed posterior tibial neuralgia resistant to conservative management that were effectively treated with a peripheral nerve stimulator placement. CASE REPORT: A 60-year-old man developed sural and posterior tibial neuralgias after a motorcycle accident resulting in severe injury of his left lower extremity. He underwent surgery for his open left distal tibia fracture. The patient continued to have pain which was not alleviated with physical therapy and conservative management. Six years after the initial injury and failing conservative management, he underwent successful sural and posterior tibial nerve blocks followed by placement of a peripheral nerve stimulator with improvement in pain and daily function. CONCLUSIONS: Peripheral nerve stimulators may be a safe and effective treatment for both sural and posterior tibial neuralgias that do not respond to conservative therapy. However, large scale studies are needed to elucidate its effectiveness and safety profile. KEY WORDS: Peripheral nerve stimulator, posterior tibial neuralgia, sural neuralgia