35-4: Peripheral Nerve: Updates 2024

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EDITORIAL

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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Description

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
  • CME QUESTIONAIRE