Deep peroneal neuropathy diagnosed by musculoskeletal ultrasound after ankle arthrodesis with an anterior plate: a case report

Abstract

Anterior tarsal tunnel syndrome is a unique diagnosis that is not encountered with the same frequency as other entrapment neuropathies, especially in relation to anterior plating for ankle arthrodesis. To our knowledge, there are no published reports of anterior tarsal tunnel syndrome as a complication of ankle fusion via anterior plating. The location of the deep peroneal nerve within the anterior tarsal tunnel makes it susceptible to potential injury when utilizing anterior ankle incisional approaches. Appropriate evaluation is vital for proper diagnosis and surgical planning. While MRI is the most common imaging modality used today, high frequency ultrasound has distinct advantages for assessing neuropathies about the foot and ankle. This includes higher spatial resolution and capabilities for dynamic and vascular assessments. The primary aim of our study is to raise awareness of deep peroneal nerve injury with anterior approach and plating to ankle arthrodesis, as there is limited literature discussing the risk of this complication. As anterior ankle plating has gained popularity, it is important to note potential injury or complications to the deep peroneal nerve given the proximity to the arthrodesis site. The secondary aim of our study is to discuss the diagnostic approach to evaluating nerve entrapments by utilizing high frequency musculoskeletal ultrasound.