[Perforating plantar ulcer. Interfascicular neurolysis of the posterior tibial nerve].

The authors report the case of a 45-year-old man with perforant ulceration of the foot. The rapid evolution of the cutaneous and bone lesions (three years) necessitated a bilateral intermetacarpo-phalangeal amputation. After conventional therapy, a large necrotic zone remained on the sole of the left foot as well as hyperkeratosis of the right foot. Following Bourrel's protocol for the treatment of leprosy, the authors proposed a posterior tibial nerve neurography, which confirmed the compression of the nerve in the tarsal tunnel. In addition, histological examination of the nerve branches of the sole of the foot showed fibrous thickening of the nerve, endoneural invasion by fibroblasts, and loss of myelin. An interfascicular neurolysis of the posterior tibial nerve at the level of the tarsal tunnel together with a periarterial sympathectomy on both sides, led to rapid recovery. At the same operation, a skin graft was used to cover the skin defect with excellent results in ten days. Ten months later healing remains complete.