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Common Peroneal Nerve and Tarsal Tunnel Release Surgery in an Adolescent Male with Hunter Syndrome: Illustrative Case
Elijah M Persad-Paisley1, Belinda Shao2, Vinay Rao1
1Warren Alpert Medical School of Brown University; Division of Plastic Surgery, Rhode Island Hospital, Providence, RI.
Insights
Children with Hunter syndrome (MPS II) can develop lower extremity nerve compression. Surgical release of peroneal and tarsal tunnel syndromes provided subjective mobility improvements in a pediatric case.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Genetics
Background:
- Hunter syndrome (Mucopolysaccharidosis II) is associated with glycosaminoglycan buildup, leading to nerve compression syndromes.
- Carpal tunnel syndrome is well-documented, but lower extremity nerve entrapments are less studied in this population.
- Orthopedic conditions like contractures are common comorbidities in Hunter syndrome.
Background:
Children with Hunter syndrome have a high prevalence of nerve compression syndromes given the buildup of glycosaminoglycans in the tendon sheaths and soft tissue structures. These are often comorbid with orthopedic conditions given joint and tendon contractures due to the same pathology. While carpal tunnel syndrome and surgical treatment has been well-reported in this population, the literature on lower extremity nerve compression syndromes and their treatment in Hunter syndrome is sparse.
Observations:
We report the case of a 13-year-old male with a history of Hunter syndrome who presented with toe-walking and tenderness over the peroneal and tarsal tunnel areas. He underwent bilateral common peroneal nerve and tarsal tunnel releases, with findings of severe nerve compression and hypertrophied soft tissue structures demonstrating fibromuscular scarring on pathology. Post-operatively, the patient's family reported subjective improvement in lower extremity mobility and plantar flexion.
Lessons:
In this case, peroneal and tarsal nerve compression were diagnosed clinically and treated effectively with surgical release and postoperative ankle casting. Given the wide differential of common comorbid orthopedic conditions in Hunter syndrome and the lack of validated electrodiagnostic normative values in this population, the history and physical examination and consideration of nerve compression syndromes are tantamount for successful workup and treatment of gait abnormalities in the child with Hunter syndrome.
