Hardware-Associated Superficial Peroneal Nerve Entrapment Following Syndesmotic Stabilization: A Case Report
Year: 2026
Type: article
Abstract: Introduction: Persistent neuropathic pain following syndesmotic stabilization should prompt consideration of superficial peroneal nerve (SPN) entrapment. The authors report a rare case of hardware-associated SPN entrapment after syndesmotic stabilization for chronic ankle instability following a triplane ankle fracture and highlight the diagnostic value of ultrasound-guided injection when metallic hardware limits direct nerve visualization. Case Report: A 13-year-old female underwent arthroscopic debridement, syndesmotic stabilization, and lateral ligament reconstruction for persistent pain and instability following a triplane ankle fracture. Her pre-operative mechanical symptoms resolved; however, she subsequently developed dorsal foot paresthesias and electric shock-like pain in the distribution of the SPN. Ultrasound evaluation was limited by acoustic shadowing from syndesmotic hardware, but ultrasound-guided diagnostic injection and hydrodissection resulted in complete but transient symptom relief, supporting the diagnosis of hardware-associated SPN entrapment. Surgical exploration demonstrated the SPN immediately adjacent to the syndesmotic fixation construct. SPN decompression and hardware removal resulted in complete resolution of neuropathic symptoms. Conclusion: Patients who develop new dorsal foot paresthesias, allodynia, or electric shock-like pain following syndesmotic fixation should be evaluated for SPN entrapment. When metallic hardware limits direct nerve visualization, ultrasound-guided diagnostic injection can provide valuable functional information to establish the diagnosis and guide definitive surgical management.
Institution: Mayo Clinic in Florida
Language: English
Topic: Peripheral Nerve Disorders
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $250
OpenAlex ID: W7225598248
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