1504 - Sural Percutaneous Nerve Stimulator Implantation to Treat Chronic Ankle Pain due to Osteoarthritis

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AS

Asim Shafique, DO

PM&R Resident
Virginia Commonwealth University
Richmond, Virginia, United States

Co-Author(s)

BM

Bhargavi Madhu, DO

Resident
Larkin Community Hospital South
South Miami, Florida, United States
MB

Michael Bejarano, DO, MS

PM&R Resident
Virginia Commonwealth University (VCU)
Richmond, Virginia, United States

Corresponding Author(s)

DT

Daniel Tsukanov, DO

PM&R Physician
Virginia Commonwealth University (VCU)
Richmond, Virginia, United States

Submitter(s)

AS

Asim Shafique, DO

Virginia Commonwealth University
Richmond, Virginia, United States

Case Diagnosis: Sural percutaneous nerve stimulator implantation to treat chronic ankle pain due to osteoarthritis

Case Description: A 68-year-old male presented to the pain clinic with a history of chronic left ankle pain. On exam, there was tenderness to the posterolateral foot with decreased range of motion in inversion and eversion. MRI of the left ankle showed mild-moderate tibiotalar and calcanocuboid degeneration. The patient failed all conservative treatment measures including physical therapy, topicals, corticosteroid and viscosupplementation injections. He then underwent diagnostic sural nerve block using bupivacaine with a post-procedure pain score of 0. He then received sural nerve hot radiofrequency ablation with three months of relief. This was repeated with the same effect. Next, he underwent peripheral nerve stimulator (PNS) implantation targeting the sural nerve under ultrasound guidance.

Discussions: Ankle pain attributed to osteoarthritis can cause debilitating pain from cartilage loss, synovitis and subchondral bone changes. This patient had persistent lateral ankle pain despite failed conservative therapies and only transient relief after numerous hot radiofrequency ablations to the sural nerve. He was an appropriate candidate for PNS targeting the sural nerve due to poor durability from prior interventions and pain isolated to the sural distribution. Post-implantation, pain decreased from 7/10 to 2/10 (71%) with marked functional gains in weight-bearing and gait without motor compromise. Existing literature supports lower-extremity PNS broadly but offers limited data specific to PNS application for lateral ankle osteoarthritis-related pain. This case highlights distal branch PNS for focal ankle osteoarthritis after failed conservative care and limited invasive procedure response.

Conclusions:

PNS can be an effective interventional pain modality in the setting of chronic ankle pain due to osteoarthritis with multiple failed conservative and/or invasive treatments. It has the potential to reduce pain and significantly improve function. Decreased pain can improve functional status and decrease physical barriers to activities of daily living.