Results of posterior tibial nerve grafting at the ankle

The results of interfascicular interposition nerve grafting for posterior tibial nerve deficit at the ankle are reported for eight patients. The sural nerve was the donor nerve in all cases. Mean age at injury was 36.3 years (range 22 to 50 years). Mean postoperative follow-up is 5.0 years (range 2.25 to 8.0 years). In five of the patients, the primary indication for nerve grafting was pain or numbness in degree sufficient to consider amputation. Mean graft length was 9.8 cm (range 4 to 18 cm). After grafting, all eight patients ambulate without assistive devices and are productively employed or have resumed pre-injury household activities. All patients received postoperative sensory re-education. Sensory recovery has been to S4 level in two, to S3+ in four, and to S3 in two. There have been no foot ulcerations. It is concluded that grafting the posterior tibial nerve is indicated for the treatment of pain and recovery of sensation in carefully selected patients, and is capable of predictably restoring at least some touch sensibility.