Can nerve damage in the foot be repaired? Your surgical options

You stepped on glass, or you had an operation, and now part of your foot is numb, burning or weak. You want to know whether a surgeon can fix it. Often the answer is yes. Here is how the damage is matched to the repair, what results look like, and why the calendar matters.

Can nerve damage in the foot be repaired?

Nerve injuries run from mild to severe. In milder injuries the nerve’s outer structure holds together, the outlook is favorable, and surgery is often not needed. In the most severe injuries the inner structure is destroyed or the nerve is cut through. The outlook is then poor without help, and the options are repair, a graft or a transfer.^[1]

One point needs saying early. This article is about a nerve hurt at a specific place. Body-wide nerve damage from diabetes or other causes is a different problem with different treatment. See peripheral neuropathy.

Which surgery repairs nerve damage in the foot?

Dr. Efe Ozturk, a double board certified Foot and Ankle Surgeon and podiatrist, performs each of the operations below for appropriate patients.

• Direct repair. The two nerve ends are sewn together under magnification. Fresh cuts around the foot and ankle should be repaired when the wound is first explored, which may also lower the risk of a painful neuroma.^[2] In a review of 677 tibial nerve injuries, direct repair had the most good outcomes.^[6] The tibial nerve serves the sole of the foot. See nerve repair and reconstruction.
• Nerve graft. A graft bridges a gap when the ends can’t meet without tension. It can be a piece of your own nerve, which leaves a numb patch where it was taken, or processed donor nerve. Across 1,559 repairs, not limited to the foot, the two gave similar meaningful recovery. In short sensory gaps, rates were 81.6% and 87.1%, compared with 62.2% for hollow tubes.^[3]
• Nerve transfer. A working nerve branch is redirected to take over from a damaged one, close to the muscle.^[7] It is used to restore foot lift after a peroneal nerve injury. Good strength returned in 58% of people when several branches were used and 43% with one.^[4] See nerve transfer.
• Neuroma surgery. A neuroma is a painful knot at an injured nerve end. The surgeon removes it, then buries the nerve end or gives it a target.^[5] Targeted muscle reinnervation (TMR) joins the nerve to a nearby motor nerve. A regenerative peripheral nerve interface (RPNI) wraps the end in a small muscle graft. In a pooled analysis of 1,150 neuromas, not limited to the foot, good results came in 70% overall and 82% with TMR.^[8] See neuroma surgery.
• Decompression. Tight tissue pressing on a nerve is released. In a pooled study of 368 people with weak foot lift from a peroneal nerve problem at the knee, 53.9% reached full strength.^[9]
• Revision surgery and joint denervation. Revision surgery revisits a nerve when a first operation didn’t settle the problem. Joint denervation interrupts small nerves that carry pain from a joint. It is rarely reported, but it may help selected people with nerve-related pain around the ankle.^[10]

The right choice also depends on the nerve. Most long-standing nerve injuries around the foot and ankle are managed by removing the painful neuroma and burying the nerve end. The tibial nerve and its major branches are the exception.^[2] The tibial nerve also tends to recover better than the peroneal nerve. In graft repairs at the knee or leg, one large series reported good outcomes in 94% of tibial nerves and 40% of peroneal nerves.^[11]

How fast do nerves regrow after repair?

Nerves regrow about 1 mm a day, and only forward from the injury.^[1] That is a little over an inch a month. As a rough guide, a nerve regrowing from the ankle to the toes, about 8 inches, needs six to seven months. From the knee to the ankle, about 16 inches, it needs more than a year.

Tingling that moves forward along the nerve over time can be a good sign. Tingling that stays in one spot is less hopeful.^[1]

Why does timing matter for nerve repair?

A muscle cut off from its nerve can’t wait forever. A 2021 review of nerve surgery timing gives these guides:^[1]

• Nerves that run muscles. Repair within 24 hours when possible, or within 14 days of being seen if the injury is under six months old. After six months, grafts, nerve transfers or tendon transfers may be needed.
• The one-year mark. After a complete cut, regrowing fibers should reach the muscle within about a year. Permanent damage to the nerve-muscle connection has been seen as early as 12 months.
• Nerves that carry feeling. Repair within 14 days when possible, partly to prevent a neuroma. Feeling can still return years later, though less predictably.
• Lasting pain. If pain continues three to six months after a nerve injury, the review recommends planning surgical treatment.

The numbers are sobering. In a review of more than 200 arm nerve injuries, good or excellent muscle recovery fell from 85.7% with immediate repair to 71.9% at one to three months and 25.0% after six months.^[1] Those were arm nerves, but leg nerves show the same pattern. Tibial nerve injuries did better with surgery before seven months, and peroneal nerve injuries did better with a shorter wait.^[6,12]

Waiting is sometimes right. Open wounds with nerve injury should be explored within about a week. Closed injuries, such as a stretch or crush, are usually watched for three to six months.^[13] If recovery stalls during that time, a recent review advises exploring early.^[14] Nerve studies arranged with another specialist can help track this.

What are the limits of nerve repair?

Nerve repair improves function and pain, but normal feeling or full strength may not return. Lower limb neuroma surgery brought lasting improvement in 59% of people, while 19% still had severe pain. Smoking and low mood were linked to worse results.^[15] TMR and RPNI research comes mostly from people with amputations, and only one of 17 studies in a recent review was a randomized trial.^[16] Risks include infection, slow wound healing, a new neuroma and more surgery. Our Center for Lower Extremity Surgery explains how smoking and diabetes affect healing (external site).

Common questions

Can nerve damage in the foot heal on its own?

Mild injuries often can, given time. A nerve that has been cut through generally can’t. See can a pinched nerve in the foot heal on its own?

What is the right treatment for nerve damage in the foot?

It depends on the cause, the nerve and how long ago it happened. Start with an exam that pins down which nerve is hurt and how badly.

How do you help nerve damage in the foot heal?

Remove any pressure on the nerve. Protect numb skin from heat, cuts and tight shoes. Keep your blood sugar controlled and avoid smoking. Don’t wait months if the foot is weak.

When to see a specialist

Book an evaluation if numbness, burning or weakness has not improved a few days after a cut, injury or operation. We see patients in Lyndhurst, Paramus and Millburn.