A Case of Posterior Tibial Nerve Injury After Arthroscopic Calcaneoplasty

J Foot Ankle Surg. 2018 May-Jun;57(3):587-592. doi: 10.1053/j.jfas.2017.10.004. Epub 2018 Jan 5.

Abstract

We report the first case of distal posterior tibial nerve injury after arthroscopic calcaneoplasty. A 59-year-old male had undergone right arthroscopic calcaneoplasty to treat retrocalcaneal bursitis secondary to a Haglund's deformity. The patient complained of numbness in his right foot immediately after the procedure. Two years later and after numerous assessments and investigations, a lateral plantar nerve and medial calcaneal nerve lesion was diagnosed. In the operating room, the presence of an iatrogenic lesion to the distal right lateral plantar nerve (neuroma incontinuity involving 20% of the nerve) and the medial calcaneal nerve (complete avulsion) was confirmed. The tarsal tunnel was decompressed, and both the medial and the lateral plantar nerve were neurolyzed under magnification. To the best of our knowledge, our case report is the first to describe iatrogenic posterior tibial nerve injury after arthroscopic calcaneoplasty. It is significant because this complication can hopefully be avoided in the future with careful planning and creation of arthroscopic ports and treated appropriately with early referral to a nerve specialist if the patient's symptoms do not improve within 3 months.

Keywords: Haglund's deformity; arthroscope; calcaneus; complication; neuroma-in-continuity.

Publication types

  • Case Reports

MeSH terms

  • Arthroscopy / adverse effects*
  • Arthroscopy / methods
  • Bursitis / diagnostic imaging
  • Bursitis / surgery*
  • Calcaneus / diagnostic imaging
  • Calcaneus / surgery*
  • Follow-Up Studies
  • Foot Deformities / diagnostic imaging
  • Foot Deformities / surgery*
  • Humans
  • Iatrogenic Disease
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Recovery of Function
  • Risk Assessment
  • Tibial Neuropathy / etiology*
  • Tibial Neuropathy / physiopathology
  • Tibial Neuropathy / surgery
  • Treatment Outcome