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Review Question - QID 1391

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QID 1391 (Type "1391" in App Search)
A competitive marathoner reports 6 months of pain over the lateral distal leg and dysesthesia over the dorsum of the foot. There is a tender fullness over the distal lateral fibula with a positive Tinel's sign. There is normal motor strength, but pain with passive plantar flexion and inversion of the ankle. The most appropriate surgical treatment is:

Repair muscle herniation and closure of the fascial defect

8%

198/2360

Fascial release and superficial peroneal neurolysis

81%

1917/2360

Fascial release of all four compartments

2%

57/2360

Superficial peroneal neurectomy

7%

169/2360

Lumbar discectomy

0%

7/2360

Select Answer to see Preferred Response

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This is a case of superficial peroneal nerve entrapment by the fascial opening in the distal leg. It is classically exacerbated by plantar flexion and inversion of the foot. Treatment involves release of the fascial opening to reduce this traction phenomenon.

Sridhara et al reported on 2 cases that were successfully treated by surgical decompression of the nerve at the bulge by fasciotomy. They described the following findings: 1) a decrease in sensation on the foot dorsum over the cutaneous distribution of the nerve with sparing of the first web space; 2) a soft tissue bulge over the anterolateral leg 10 cm above the lateral malleolus; 3) a Tinel sign over the bulge; 4) an increase in the size of the bulge either with resisted ankle dorsiflexion or weight bearing; and 5) tenderness over the bulge or distally over the terminal sensory branches of the superficial peroneal nerve.

Styf et al published a more recent series of 17 patients (19 legs) with entrapment of the superficial peroneal nerve. We performed decompression of the superficial peroneal tunnel in 14 patients and local fasciectomy in three. Fourteen patients (80%) were free from symptoms or satisfied with the result.

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