Surgical Treatment of Superficial Peroneal Neuroma With Intramuscular Transposition

Abstract

Peripheral nerve injury with neuroma formation is a painful consequence of surgical interventions and acute trauma. The superficial peroneal nerve (SPN) is susceptible to damage, and neuroma formation is common following lateral ankle surgery. Conservative treatments often fail to provide relief, leading to surgical intervention decisions. Surgical techniques for managing SPN neuromas vary, including nerve excision, transposition, and grafting. This report discusses a technique involving neuroma excision, cauterization, and burial into the peroneus brevis muscle. A 29-year-old male experienced pain and paresthesia months after a lower leg injury. Examination and ultrasound confirmed an SPN neuroma. Initial conservative treatments were ineffective, leading to surgical considerations. A 4 to 5 cm incision was made proximal to the lateral malleolus, exposing the SPN. Dissection released the SPN from the crural fascia, and the peroneus brevis muscle was split to accommodate nerve burial. The neuroma was excised, and the terminal SPN stump was cauterized. The proximal nerve was secured within the peroneus brevis muscle, and wound closure was performed. The procedure was executed without complications. The patient reported significant improvement in pain and paresthesia following surgery. Over a 3-year follow-up period, the patient experiences no recurrence of symptoms related to the neuroma. Transection, cauterization, and intramuscular transposition of the proximal nerve stump offer reliable treatment for symptomatic superficial peroneal neuromas. Cauterizing the terminal nerve end with a bipolar device is a simple adjunctive procedure that warrants consideration for similar cases.