Hardware-Associated Superficial Peroneal Nerve Entrapment Following Syndesmotic Stabilization: A Case Report.
- 1Mayo Clinic Florida, Jacksonville, Florida.
Abstract
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. 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. 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.
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BibTeX
@article{meli2026hardwareassociated,
title = {{Hardware-Associated Superficial Peroneal Nerve Entrapment Following Syndesmotic Stabilization: A Case Report.}},
author = {Gabrielle M Meli and Adam P Henderson and Taylor Rakauskas and Jeffrey B Strohecker and Steven R Clendenen and Edward T Haupt},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8422},
url = {https://europepmc.org/article/MED/42997067},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Hardware-Associated Superficial Peroneal Nerve Entrapment Following Syndesmotic Stabilization: A Case Report.
AU - Gabrielle M Meli
AU - Adam P Henderson
AU - Taylor Rakauskas
AU - Jeffrey B Strohecker
AU - Steven R Clendenen
AU - Edward T Haupt
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8422
UR - https://europepmc.org/article/MED/42997067
AB - 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. 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. 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.
SN - 2250-0685
SN - 2321-3817
ER -