Persistent recalcitrant dorsolateral foot pain after ankle sprain

NewsBot · Feb 22, 2007

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Clinical Importance of the Lateral Branch of the Deep Peroneal Nerve.
Clin Orthop Relat Res. 2007 Feb 15;
Kennedy JG, Brunner JB, Bohne WH, Hodgkins CW, Baxter DB

Persistent recalcitrant dorsolateral foot pain after ankle sprain cannot always be explained by known anatomic nerve pathways. To determine whether an impingement of a lateral branch of the deep peroneal nerve might be responsible for atypical pain, we conducted a cadaveric anatomic study to identify the anatomy and course of the nerve. Furthermore, using this information, we conducted a clinical study to determine if targeted treatment to a lateral branch of the deep peroneal nerve would resolve these symptoms. We dissected 22 cadaveric feet to identify a large lateral branch of the deep peroneal nerve. This nerve arborized into five main branches. We identified two areas of compression in the lateral branch of the deep peroneal nerve. We also performed a prospective clinical study including 11 consecutive patients with a 1-year minimum followup. Pain and clinical findings corresponded to the anatomic compression sites in all 11 patients. All patients responded to a local anesthetic injection or surgical release of the lateral branch of the deep peroneal nerve. We identified a previously unreported complex course of the lateral branch of the deep peroneal nerve that correlated with clinical impingement syndrome and responded to specifically targeted treatment.
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efuller · Feb 22, 2007

NewsBot said:

Clinical Importance of the Lateral Branch of the Deep Peroneal Nerve.
Clin Orthop Relat Res. 2007 Feb 15;
Kennedy JG, Brunner JB, Bohne WH, Hodgkins CW, Baxter DB
Click to expand...

So you cut out the nerve and the pain goes away, therefore the nerve must have been responsible for the pain? What is wrong with this logic? If you cut out the nerve (or use of local anesthetic) then there will be no more pain regardless of the cause.

I've been around this stump in other forums. When you see persistant dorsal lateral foot pain think sinus tarsi syndrome caused by compression forces between the lateral process of the talus and the floor of the sinus tarsi of the calcaneus. This explanation of pain, as far as I know, was first described by Duchenne in 1869. More recently described by Kevin Kirby in his rotational equilibrium paper.

Regards,

Eric Fuller

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efuller MVP

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