Primary Repair of Peroneus Longus Myofascial Herniation With Symptomatic Superficial Peroneal Nerve Compression

Abstract

Symptomatic myofascial herniations of the extremities occur infrequently; however, they can contribute to significant pain, weakness, and neuropathy with activity. Muscle herniation typically occurs through either a traumatic or congenital focal defect in the deep overlying fascia. Patients may present with an intermittently palpable subcutaneous mass and may have neuropathic symptoms, depending on the degree of nerve involvement. Patients are initially treated with conservative modalities, whereas surgery is reserved for patients who demonstrate persistent functional limitations and neurologic symptoms. Here, we demonstrate a technique for primary repair of a symptomatic lower-leg fascial defect.

Fig 1

Clinical images of a right leg demonstrating a myofascial herniation of the peroneus longus with the foot in plantarflexion (A), and the palpable mass more evident with the ankle dorsiflexion (B). The 4 blue arrows demonstrate the location of the herniation.

Fig 2

Dynamic ultrasound of a right lower leg demonstrating a fascial defect (green arrow) at rest without evidence of herniation (A) and muscle herniation through the fascial defect with active patient ankle dorsiflexion (B).

Fig 3

Intraoperative image of a right lower leg demonstrating placement of forceps within a fascial defect (A). Evidence of the superficial peroneal nerve within the lower-extremity fascial defect (B).

Fig 4

Intraoperative image of a right lower leg demonstrating primary closure of the crural fascial defect with suture placement through the fascial layer (A), suture knot-tying (B), and the completed primary repair (C).

Fig 5

A 6-week postoperative image demonstrating the healed surgical incision and resolution of the herniation.