Overview
Traumatic neuroma in the lower limb arises from nerve injury following high-energy trauma, often complicating salvageable fractures like those seen in 'Deck-Slap' injuries. Despite successful limb salvage, neuromas can lead to chronic pain and functional impairment 1.Diagnosis
Clinical Presentation: Persistent pain, tenderness, and sometimes palpable nodules along the course of injured nerves 1.
Imaging: MRI may help identify neuroma by showing characteristic nerve thickening and signal changes 1.
Electromyography (EMG) and Nerve Conduction Studies: Useful for assessing nerve function and confirming neuroma presence 1.Management
First-Line Treatments:
- Conservative Management: Pain control with NSAIDs, physical therapy focusing on neuroma desensitization 1.
Adjunctive Treatments:
- Bespoke Off-loading Brace (BOB): Utilized to reduce mechanical stress on injured limbs, potentially improving functional outcomes 1.
- Surgical Intervention: Excision of the neuroma may be considered in cases refractory to conservative management 1.Special Populations
Military Personnel: High incidence in those with severe lower limb trauma, such as 'Deck-Slap' injuries; specialized rehabilitation tools like BOB may offer benefits 1.Key Recommendations
Utilize a Bespoke Off-loading Brace (BOB) in the rehabilitation of high-energy lower limb injuries to potentially improve functional outcomes and reduce delayed amputation risk (Evidence: Moderate 1).
Consider conservative management initially, including NSAIDs for pain and physical therapy, before proceeding to surgical excision of traumatic neuromas (Evidence: Expert opinion 1).
Employ advanced imaging techniques such as MRI to aid in the diagnosis and monitoring of traumatic neuromas (Evidence: Moderate 1).References
1 Osborne MA, Jarvis HL, Bennett N, Phillip RD. A modern-day solution to a 100-year-old problem: the use of a Bespoke Off-loading Brace in the rehabilitation of 'Deck-Slap' and other high-energy lower limb injuries. Journal of the Royal Naval Medical Service 2014. link