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Case Reports
. 2024 Nov 25;16(11):e74420.
doi: 10.7759/cureus.74420. eCollection 2024 Nov.

Traction Sural Neuropathy Following Nonoperative Management of Acute Achilles Tendon Rupture: A Case Report

Katherine J Kim  1 , Isabella V Cuturrufo  1 , Kenneth Vitale  1
Affiliations
Case Reports

Traction Sural Neuropathy Following Nonoperative Management of Acute Achilles Tendon Rupture: A Case Report

Katherine J Kim et al. Cureus. .

Abstract

Achilles tendon ruptures are prevalent among physically active adults and can lead to sural nerve injuries (SNIs) due to the anatomical proximity of the sural nerve to the Achilles tendon. While SNIs are well-recognized in surgical contexts, their occurrence following nonoperative treatments, which are often preferred for their lower risk of surgical complications, remains less documented and poorly understood. This report describes a case of a 30-year-old active male who developed chronic traction sural neuropathy after opting for nonoperative treatment of an acute complete Achilles tendon rupture. Despite adhering to a rehabilitation protocol, he experienced persistent symptoms of sural nerve damage, which were confirmed as chronic sensory neuropathy through nerve conduction studies. Here, we discuss the proposed pathophysiology and review the literature on SNIs in Achilles injuries. This case highlights the importance for clinicians to accurately diagnose and remain aware of the potential for SNIs in the nonoperative management of Achilles tendon ruptures.

Keywords: achilles tendon rehabilitation; achilles tendon rupture; mechanical traction injury; nonoperative management; sports medicine; sural neuropathy; tendon healing.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. MRI without contrast of the right foot/ankle
T2-weighted fat-suppressed MRI showing a complete tear of the Achilles tendon. A: sagittal section; B: coronal section; C: axial section
Figure 2
Figure 2. Sample NCS waveform recording showing a right and left comparison of the sural nerve responses
The right sural nerve amplitude potential was reduced (3.2 µV) compared to a normal left amplitude (13.0 µV).
Figure 3
Figure 3. Ultrasound findings of the right ankle
A: Short-axis view of Achilles tendon (yellow), small saphenous vein (solid blue), sural nerve (dotted blue), and peroneus brevis (green); B: Transverse view showing a thickened Achilles tendon (dotted blue) PB, peroneus brevis
See this image and copyright information in PMC

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