» In the development of podiatric foot and ankle surgery training, much emphasis was initially placed on musculoskeletal deformities and trauma. ...
Consideration for treating peripheral nerve injuries was generally considered outside of the realm of podiatric care. Over the last 25 years, significant emphasis has been placed on the development of integrating principles of peripheral nerve diagnosis and treatment algorithms into the training of podiatric surgeons. With this new field of lower extremity peripheral nerve surgery, the armamentarium of care has been greatly increased to help patients with both acute and chronic lower extremity pathologies.
This edition of Foot and Ankle Quarterly features outstanding leaders in podiatric peripheral nerve surgery as reviewing editors. These surgeons have been at the forefront of the development of training for podiatric surgeons in the field of lower extremity peripheral nerve surgery. They have also contributed significantly to peer-reviewed academic journals, with dozens of articles related to peripheral nerve topics. I was also happy to be able to have Mark Schuenke PhD, a clinical anatomist at the University of New England Osteopathic Medical School as a reviewer. He is the society anatomist for the Association of Extremity Nerve Surgeons, and is instrumental in our training in both the fundamental and advanced peripheral nerve surgery training courses for podiatric surgeons.
As surgeons, we are anatomists at heart, and all understanding of lower extremity peripheral nerve pathologies revolve around a thorough understanding of the three-dimensional anatomy of the musculoskeletal system. Sural and tibial nerve branching patterns were highlighted in this issue because these are two of the most commonly injured and subsequently operated-on nerve systems encountered by the lower extremity peripheral nerve surgeon. Variations in treatment from neuroplastic procedures to denervation are covered, and the audio lectures delineate well-thought-out treatment algorithms for the surgeon to follow.
Lastly, looking forward into the future, new research is demonstrating that in metabolic diseases such as diabetes, neuroplastic decompression of compressed lower extremity nerves can reduce the recurrence rate of diabetic neuropathic foot ulcerations to well below 5%. In 2025, Dwayne Yamasaki, PhD and Scott Nickerson, MD will be publishing an article looking at the vascular reasons for this recurrence in diabetic ulceration rates. This work is now being looked at by major academic centers at vascular surgery departments, and potentially more level I studies will be performed on this exciting application of peripheral nerve surgery.
I hope that this edition, through the knowledge and passion of each of our authors, will excite the reader to consider looking into adding lower extremity peripheral nerve diagnostic skills and peripheral nerve surgery skills to their own personal armamentarium of care for their patients.
James P. Wilton, DPM, FAENS, FACFAS
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Article Authors and Lecturers
Julie Abboud (n)
James C. Anderson (n.)
Steven L. Barrett (n.)
Christopher G. Browning (n.)
Damien M. Dauphinee (n.)
D. Scott Nickerson (3. Association of Extremity Nerve Surgeons)
Andrew Rader (n.)
Edgardo R. Rodriguez-Collazo (1. Data Trace Publishing Co.)
Mark Schuenke (n.)
James P. Wilton (1. Data Trace Publishing Co.; 3. Association of Extremity Nerve Surgeons)
Dwayne S. Yamasaki (n.)
FAQ Journal Planning Committee
Chrissy Wesolowski (n.)
Lauren Molander (n.)
Stephanie Wu, DPM, MSc (n.)
Foot and Ankle Quarterly 35-3 Contributors
Guest Editor
James P. Wilton, DPM, FAENS, FACFAS
Cottage Hospital, Woodsville, NH; Valley Regional Hospital, Clarement, NH; Fellow, Vice Chair Board of Trustees, Director of Basic and Advanced Peripheral Nerve Surgery Course, Association of Extremity Nerve Surgeons, San Antonio, TX; Fellow, American College of Foot and Ankle Surgeons; Member, American Society of Peripheral Nerve; Surgical Missions Director, Fundacion Padre Damien , Guayaquil, Ecuador
Contributors
Julie Abboud, DPM, MS, FAENS Private practice, Greenville, WI; Fellow, President (2022-2023) and Faculty of Basic Peripheral Nerve Surgery Course, Association of Extremity Nerve Surgeons, San Antonio, TX; Member, American Society of Peripheral Nerve; Diplomate, American Board of Podiatric Medicine; Certified Wound Specialist, American Board of Wound Management
James C. Anderson, DPM, FAENS, FACFAS, FASPS Fellow, Association of Extremity Nerve Surgeons; Fellow, American College of Foot and Ankle Surgeons; Author, A Perfect Night’s Sleep; Eliminate Restless Legs Syndrome; Past President and Board of Trustees Member, Association of Extremity Nerve Surgeons; President, Anderson Podiatry Center, Fort Collins, CO; President, Foot Surgery Center of Northern Colorado, Fort Collins, CO
Steven L. Barrett, DPM, MBA, FAENS Chairman of the Board of Trustees, Association of Extremity Nerve Surgeons
Christopher G. Browning, DPM, FACFAS, FACFAOM, FAENS, CWSP Podiatry Residency Program Director, Baylor Scott & White Health Care, Baylor College of Medicine, Temple, TX
Damien M. Dauphinee, DPM, FACFAS, FAENS, CWS-P President and Managing Partner, Complete Foot and Ankle Care of North Texas, PA; Fellow and Past President, Association of Extremity Nerve Surgeons; Board-Certified, Reconstructive Foot and Ankle Surgery and Wound Management; Author, Saving Limbs Saving Lives: Advanced Treatments for Preventing Amputations in Diabetic Populations; Co-host, The Pod Doctors podcast
Scott Nickerson, MD, FAAOS Member, retired, Sheridan Orthopedic Associates, Sheridan, WY; Consultant, Wound Clinic, Sheridan Memorial Hospital, Sheridan, WY; Fellow, American Academy of Orthopaedic Surgeons; Fellow, Association of Extremity Nerve Surgeons
Andrew Rader, DPM, FAENS, FACPM, FASPS, FAPWCAc, FAPWH Medical Director, Memorial Hospital Wound Center; Board of Trustees, Association of Extremity Nerve Surgeons
Edgardo R. Rodriguez-Collazo, DPM Director of OutreachStrategies, Dean’s Office, William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL; Board Member and Fellow, Association of Extremity Nerve Surgeons; Founder and Advisory Board Member, American Microsurgical Orthoplasty Society; Adult and Pediatric Ilizarov Limb Deformity Correction, Peripheral Nerve Reconstruction Microsurgery, Department of Surgery, Ascension St. Joseph – Chicago, Chicago, IL
Mark Schuenke, PhD Professor and Associate Chair, Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME
Dwayne S. Yamasaki, PhD Founder and President, Enso Medical Technologies, Inc., St. Augustine, FL
35-4 In this issue:
FEATURE ARTICLE: Peripheral Nerve Surgery: Updates 2024
James P. Wilton, DPM, FAENS, FACFAS
CONDENSATIONS and COMMENTARIES
Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery
Commentary by Andrew Rader, DPM, FAENS, FACPM, FASPS, FAPWCAc, FAPWH
Imaging the Nerve “Allograft to Muscle Target” Technique in Neuroma Management
Commentary by Julie Abboud, DPM, MS, FAENS
Predicting Nerve Course Variations to Prevent Iatrogenic Lesions: A Surgical Perspective on Sural Nerve Variations
Commentary by Damien M. Dauphinee, DPM, FACFAS, FAENS, CWS-P
Tibial Nerve Branching Pattern and Compatibility of Branches for the Deep Fibular Nerve
Commentary by Mark Schuenke, PhD
Anatomical Patterns of the Sural Nerve: A Meta-Analysis with Clinical and Surgical Considerations
Commentary by Mark Schuenke, PhD
Objective Evidence That Nerve Decompression Surgery Reduces Neuropathic DFU Recurrence Risk to Less than 5%
Commentary by Steven L. Barrett, DPM , MBA, FAENS
Surgical Algorithm for Neuroma Management: A Changing Treatment Paradigm
Commentary by James C. Anderson, DPM, FAENS, FACFAS, FASPS
A Method for Entubulating Exposed Nerve Ends following Neurectomy Using a Porcine Extracellular Matrix Nerve Cap
Commentary by Christopher G. Browning, DPM, FACFAS, FACFAOM, FAENS, CWSP
Nerve Decompression for Diabetic Peripheral Neuropathy with Nerve Entrapment: A Narrative Review
Commentary by Dwayne S. Yamasaki, PhD
The Peripheral Nerve Surgeon’s Role in the Management of Neuropathic Pain
Commentary by D. Scott Nickerson, MD, FAAOS
AUDIO LECTURE 1: Diagnosis of Peripheral Nerve Pathology and Treatment Algorithms Part 1: History and Anatomy
Edgardo R. Rodriguez-Collazo, DPM
AUDIO LECTURE 2: Diagnosis of Peripheral Nerve Pathology and Treatment Algorithms Part 2: Surgical/Treatment Options
Edgardo R. Rodriguez-Collazo, DPM