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Postoperative sural nerve entrapment following lateral heel surgery: a case report
Nicola Piras1, Marcello Dante2, Fabiana Altamore2
1Via dei ponderanesi 2, asl Biella, Ponderano, 13875, Italy. nicola.piras@aslbi.piemonte.it.
Background:
Sural nerve injury is an uncommon complication following foot and ankle surgery, including procedures performed for Haglund deformity. Postoperative sural nerve entrapment remains rarely reported and may be challenging to diagnose.
Case Presentation:
A 56-year-old woman presented with persistent lateral ankle pain and paraesthesia 12 months after open lateral heel surgery for Haglund deformity. Clinical examination revealed a trigger point at the distal portion of the surgical scar associated with a positive Tinel's sign. A diagnostic local anaesthetic injection provided temporary complete symptom relief. Magnetic resonance imaging showed signal asymmetry of the sural nerve compared with the contralateral side. Surgical exploration demonstrated entrapment of the sural nerve within fibrotic scar tissue. Neurolysis was performed, and oxidized regenerated cellulose (ORC) was applied as an adjunctive anti-adhesion barrier. Symptoms progressively resolved, with complete recovery at 3 months and no recurrence at 24-month follow-up.
Conclusions:
This case highlights postoperative sural nerve entrapment as a rare complication after lateral heel surgery. Diagnosis relies primarily on clinical evaluation supported by imaging and diagnostic injections. Although ORC was used as an adjunct during neurolysis, its contribution to the clinical outcome remains uncertain, and further studies are needed to clarify its role in peripheral nerve surgery.
