» Chronic pain is a common and unfortunate complaint in patients with lower extremity pathology.
Peripheral nerve pathology can often be perplexing and go undiagnosed. These patients may have a sudden onset of symptoms after a new exercise routine, motor vehicle collision, history of trauma or a prior surgery. Neuropathic symptoms are debilitating to patients, affecting their activities of daily living and quality of life. Patients are looking for answers to the cause of their pain and the treatment options available to them. Consults to other services are often necessary to determine the etiology of the pain. A multidisciplinary, interprofessional approach is needed in order to ensure that the provider has all the pertinent information required to address the peripheral nerve injury. The condensations and commentaries within this issue take a close look at some of the cutting-edge surgical options currently available.
Podiatric literature has historically focused on orthopedic pathology, in which patients have an abundance of musculoskeletal abnormalities. As a result, the peripheral nerve and plastic surgery literature does not have as large of a presence within the podiatric journals, although patients can have concomitant orthopedic and lower extremity peripheral nerve pathology diagnoses.
I am honored to be the Guest Editor for this issue of Foot and Ankle Quarterly on Microneurosurgery, and am immensely grateful for the support from the Editor-in-Chief, Dr. Stephanie Wu and my colleagues at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, for contributing their time and input to this important subject. Our goal is to bring awareness to lower extremity peripheral nerve pathology, tips and pearls to clinically assess, identify and address a peripheral nerve injury, and to introduce knowledge of the surgical options available.
The ideas and opinions expressed in Foot and Ankle Quarterly are those of the authors and do not necessarily reflect those of the Editor or the Publisher. Publication of an advertisement or other product mentioned in Foot and Ankle Quarterly should not be construed as an endorsement of the product of the manufacturer’s claims. Readers are encouraged to contact the manufacturer with any questions about the features or limitations of the products mentioned. The Publisher does not assume any responsibility for any injury and/or damage to any persons or property arising out of or related to any use of the material contained in this periodical. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device or of each drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other healthcare professionals, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient.
Data Trace Publishing Company Continuing Education Mission Statement
Data Trace Publishing Company is committed to providing high-quality print and internet-based enduring continuing education programs, including lectures, feature articles, and condensations and commentaries on current clinical podiatric topics and medical risk management topics which lead to improved delivery of patient care and help reduce the potential for medical errors. These programs are provided to meet the educational needs of the podiatric medical profession and thereby enhance the quality of patient care.
Foot and Ankle Quarterly (FAQ) is a unique program designed to help today’s podiatric physician manage an ever-increasing flow of information. After completing the Foot and Ankle Quarterly, Volume 34 program, the learner should be better able to: develop and refine a perspective on current treatment recommendations, updates, and advances pertinent to podiatric practice; evaluate the implications of the learned information as it pertains to the diagnosis and treatment of podiatric disorders and societal issues and barriers, and; apply current trends, standards, and best practices into learner’s own practice.
Data Trace Publishing Company Continuing Education Accreditation Statement
Data Trace Publishing Company is approved by the Council on Podiatric Medical Education (CPME) as a provider of continuing education in podiatric medicine. Data Trace Publishing Company has approved this activity for a maximum of 6 continuing education contact hours (CECHs). Physicians should claim only the contact hours commensurate with the extent of their participation in the activity.
Estimated time to complete activity: 6 hours Date of release: April 28, 2023 Expiration Date: April 28, 2026 (unless further validated and extended by provider). For amended dates of activity expiration, please see FAQ Activity Effective Dates at www.datatrace.com).
Commercial Interests No commercial interest provided financial support for this continuing education activity.
CECH Note Participants of Volume 34, Issue 1 will receive a maximum of 6 CECHs for a correctly-completed CME Answer Form. In order to qualify for CECHs, a score of 70% or more must be achieved on the written examination material. Any participant who does not pass the first time may take the exam one additional time (within 90 days of receipt of results). One retake test may be taken for a fee of $15. You will be responsible for notifying your state of the number of contact hours you have received.
Participants are required to complete a course evaluation for use in developing future issues and to meet the unique educational needs of podiatric physicians.
FINANCIAL DISCLOSURE INFORMATION
It is the policy of Data Trace Publishing Company to ensure balance, independence, objectivity, and scientific rigor in all of its educational programs. All faculty, presenters, speakers, authors, and reviewers participating in any programs provided by Data Trace Publishing Company are expected to disclose any relevant financial relationships with CPME-defined commercial interests to the program audience. “Relevant financial relationships” are financial relationships of the individual (including those of the individual’s spouse or partner) in any amount occurring within the past 12 months that create a conflict of interest. A commercial interest is any organization manufacturing, producing, marketing, re-selling, or distributing healthcare goods or services consumed by or used on patients. The CPME mandates that the content of accredited activities be objective and independent of commercial bias. The intent of this policy is that readers may form their own judgements about the presentations, using independent review to resolve all identified conflicts of interest.
In addition to disclosing commercial relationships, faculty are advised of the following policies:
Each continuing education planner and author has submitted a Conflict of Interest Disclosure in order to identify relevant financial relationships and resolve conflicts.
Limitations on Data: Presenter will ensure, to the extent possible, meaningful disclosure of limitations on data (e.g., ongoing research, interim analyses, preliminary data, or unsupported opinion).
Discussion of Unapproved Uses: If unapproved (unlabeled) uses are discussed during the continuing education activity, the presenter will disclose when a product is not approved in the United States (and/or the nation where the activity takes place) for the use under discussion.
Data Trace Publishing Company has identified the option to disclose as follows:
The following authors have disclosed whether they or a member of their immediate family:
Will be receiving an honorarium for this activity
Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they willrefer as speaker or author:
Received monetary or other significant research support
Are or had been a paid consultant
Are or had been a full-time or part-time employee
Are or had been a paid or unpaid member of an advisory or similar board
Are or had been a member or on the Board of Trustees
Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they will refer as speaker or author, BUT will not be recommending any of their products over similar competitor products
Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they willrefer as speaker or author, AND will be recommending one or more of their products over similar competitor products. Recommendation will be based on:
Exclusively on data and/or clinical experience not generated by the manufacturer or derived from manufacturer-sponsored studies
Data and/or clinical experience most of which were not generated by the manufacturer or derived from manufacturer-sponsored studies
Data and/or clinical experience, most of which were generated by the manufacturer or derived from manufacturer-sponsored studies
Exclusively on data and/or clinical experience generated by the manufacturer or derived from manufacturer or derived from manufacturer-sponsored studies
Have no conflicts to disclose
Article Authors and Lecturers
Sitong Chen, DPM (n.)
Edgardo R. Rodriguez-Collazo, DPM (n.)
Leland Jaffe, DPM (n.)
Erin Klein, DPM (n.)
Darrell R. Latva, DPM (n.)
Prathiba Patel, DPM (n.)
Lauren L. Schnack, DPM (1. Data Trace Publishing Co.)
Ashka Trivedi, DPM (n.)
Qeena C. Woodard, DPM (n.)
FAQ Journal Planning Committee
Chrissy Wesolowski (n.)
Lauren Molander (n.)
Stephanie Wu, DPM, MSc (n.)
Foot and Ankle Quarterly
Lauren L. Schnack, DPM, MS, AACFAS, FACPM Assistant Professor, Fellowship Trained Podiatric Surgeon, Department of Podiatric Medicine and Surgery, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL
Sitong (Tom) Chen, DPM Fellow, Complex Deformity Correction and Limb Reconstruction, Department of Surgery, Ascension Saint Joseph Hospital Chicago, Chicago, IL; Associate, American College of Foot and Ankle Surgeons
Leland Jaffe, DPM, FACFAS, CWSP Associate Dean, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
Erin E. Klein, DPM, MS
Clinical Instructor, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL; Fellow, American Board of Foot and Ankle Surgery; Fellow, American Board of Podiatric Medicine; Physician Owner and Associate Director of Research, Weil Foot and Ankle Institute; Chicago, IL
Darrell R. Latva, DPM
Associate Professor, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL; Diplomate, American Board of Foot and Ankle Surgery and American Board of Podiatric Medicine
Pratibha Patel, DPM, FACPM Assistant Professor, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL; Fellow, American Board of Podiatric Medicine
Edgardo R. Rodriguez-Collazo, DPM
Director of Outreach Strategies, 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 Saint Joseph – Chicago, Chicago, IL
Ashka Trivedi, DPM Assistant Professor, Department of Medicine and Science, Rosalind Franklin University of Medicine and Science, North Chicago, IL
Qeena C. Woodard, DPM, FACFAS, FACPM, CWS Associate Professor, Podiatric Medicine and Surgery Department, Associate Dean of Clinical Experiences, Dr. William M. Scholl College of Podiatric Medicine, North Chicago, IL; Associate, Private Practice, Smith Centers for Foot and Ankle Care, Chicago, IL; Fellow, American College of Foot and Ankle Surgery; Fellow, American Board of Podiatric Medicine; Certified Wound Specialist, American Board of Wound Healing
In this Issue:
FEATURE ARTICLE: The Influence Peripheral Nerve Surgery on Chronic Pain
Lauren L. Schnack, DPM, MS
CONDENSATIONS and COMMENTARIES
Implantable Neuromodulation Device in the Lower Limb: An Adjunctive Procedure in Patients with Continued Chronic Pain after Failed Revisional Microneurosurgical Procedure in a Nonreconstructable Zone of Injury
Commentary by Erin Klein, DPM
Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques
Commentary by Ashka Trivedi, DPM
An Updated Nerve Sparing Surgical Technique for Addressing Morton’s Neuroma
Commentary by Leland Jaffe, DPM
Surgical Treatment Protocol for Peripheral Nerve Dysfunction of the Lower Extremity: A Systematic Approach
Commentary by Qeena C. Woodard, DPM
Conduit-Assisted Allograft Neurorrhaphy for the Treatment of Intractable Lower Extremity Pain Due to Neuromas-in-Continuity
Commentary by Sitong (Tom) Chen, DPM
Regenerative Peripheral Nerve Interface for the Treatment of Iatrogenic Neuroma-in-Continuity Cases in the Foot: Two Case Reports
Commentary by Qeena C. Woodard, DPM
Reset Neurectomy for Cutaneous Nerve Injuries
Commentary by Ashka Trivedi, DPM
Saphenous Nerve to Posterior Tibial Nerve Transfer: A New Approach to Restore Sensations of Sole in Diabetic Sensory Polyneuropathy
Commentary by Darrell R. Latva, DPM
Damage to the Superficial Peroneal Nerve in Operative Treatment of Fibula Fractures: Straight to the Bone? Case Report and Review of the Literature
Commentary by Pratibha Patel, DPM
Targeted Muscle Reinnervation in the Lower Leg: An Anatomical Study
Commentary by Edgardo R. Rodriguez-Collazo, DPM
AUDIO LECTURE 1: Identifying Lower Extremity Peripheral Nerve Pathology in the Office
Lauren L. Schnack, DPM, MS
AUDIO LECTURE 2: Surgically Addressing Peripheral Nerve Pathology
Lauren L. Schnack, DPM, MS