The Addition of a Nerve Transfer to the Treatment of Peroneal Neuropathy Secondary to Intraneural Ganglion Case Series

Peroneal intraneural ganglia are rare, and their management is controversial. Presently, the accepted treatment of intraneural ganglia is decompression and ligation of the articular nerve branch. Although this treatment prevents recurrence of the ganglia, the resultant motor deficit of foot drop in the case of intraneural peroneal ganglia is unsatisfying. Foot drop is classically treated with splinting or tendon transfers to the foot. We have recently published a case report of a peroneal intraneural ganglion treated by transferring a motor nerve branch of flexor hallucis longus into a nerve branch of tibialis anterior muscle in addition to articular nerve branch ligation and decompression of the intraneural ganglion to restore the patient's ability to dorsiflex. We have since performed this procedure on 4 additional patients with appropriate follow-up. Depending on the initial onset of foot drop and time to surgery, nerve transfer from flexor hallucis longus to anterior tibialis nerve branch may be considered as an adjunct to decompression and articular nerve branch ligation for the treatment of symptomatic peroneal intraneural ganglion.

Automated summary

The management of peroneal intraneural ganglia is controversial, with decompression and ligation of the articular nerve branch being the accepted treatment. However, this may result in unsatisfactory motor deficit of foot drop. A new treatment approach involves transferring a motor nerve branch of flexor hallucis longus to a nerve branch of tibialis anterior muscle to restore dorsiflex function in patients with symptomatic peroneal intraneural ganglia.