Early Results of Optimized Nerve Management With Electrical Stimulation for Lower Extremity Neuroma

Nerve injury is the most common complication following foot and ankle surgery, with painful neuroma reported in up to 10% of procedures. Current treatment often yields varying degrees of pain relief. Electrical stimulation (ES) through peripheral neuromodulation is an emerging technology associated with improvement in nerverelated pain and acceleration of neural regeneration. This study assessed the short-term outcomes of combining nerve reconstruction techniques with ES in providing early pain relief for patients with symptomatic lower extremity neuromas.

We describe a single-institution, prospective, cohort study including adult patients with lower extremity neuroma subjected to a nerve management procedure (neurolysis, targeted muscle reinnervation, or nerve allograft reconstruction) with concomitant peripheral nerve stimulator placement. Patients were treated postoperatively with ES (phase duration: 100 μs, pulse rate: 80 Hz) for 4 hours daily. Patient demographics, surgical details, and outcomes data were evaluated.

Eight female patients (mean age: 49 ± 13 years) were included. Peripheral nerve injuries were identified at the following locations: sural nerve (n = 5), medial plantar nerve (n = 1), tibial nerve (n = 1), superficial peroneal nerve (n = 2), and saphenous nerve (n = 1). Mean Brief Resilience Scale (BRS) was 3.11 ± 0.61. At 3 months postintervention, NRS Pain scores decreased from a mean of 8.5 ± 1.2 to 1.5 ± 1.2, PROMIS Pain Interference scores decreased from 61.5 ± 3.4 to 53.7 ± 4.9, and PROMIS Pain Behavior scores decreased from 65.8 ± 3.5 to 56.1 ± 4.2.

Early results of optimized neurotherapy with electrical stimulation demonstrate improved short-term pain relief for patients with symptomatic lower extremity neuromas.