Nerve repair and reconstruction

When is nerve repair considered?

• A nerve cut by an injury, such as a laceration on the top or side of the foot.
• A nerve damaged during an operation, when numbness or nerve pain in a specific area points to an injured nerve.
• A painful neuroma — a tangle of nerve fibres at an injured nerve end — especially when the other end of the nerve can be found and reconnected. See nerve pain after surgery or injury.
• A nerve trapped in scar tissue, where freeing it may be combined with repair of a damaged segment.

Most of the nerves involved in the foot and ankle are sensory nerves, which supply feeling to the skin. Repairing them aims to reduce pain and restore some protective sensation.

How nerve injuries differ

Nerve injuries range from mild to severe:^[1]

• Bruised or compressed — the nerve is intact and usually recovers over weeks to a few months.
• Internal damage with the outer sheath intact — the nerve fibres can regrow along their original path, and recovery may take many months.
• Completely cut — the nerve fibres cannot find their way back without surgery.

A careful examination, your history and, when helpful, imaging or nerve studies arranged with another specialist help decide which kind of injury is present and whether surgery could help.

Surgical options

• Direct repair. The two nerve ends are trimmed and sewn together under magnification, without tension.
• Nerve graft. When there is a gap, it can be bridged with a segment of a small sensory nerve taken from elsewhere in your body (an autograft, which leaves a small numb area where it was taken) or with a processed donor nerve (an allograft).
• Conduit. A hollow tube that guides regrowing nerve fibres across a short gap.
• Managing a painful nerve end. When the nerve end can’t be reconnected, options include removing the neuroma and relocating the nerve end into muscle or bone, or giving the nerve a “target” to grow into so a painful neuroma is less likely to re-form.^[4]

A 2023 meta-analysis found similar rates of meaningful recovery with a patient’s own nerve graft and with a processed donor nerve. For short sensory gaps, conduits had lower recovery rates and more pain-related complications.^[3] For painful neuromas, a pooled analysis of published studies found meaningful pain reduction in about three-quarters of patients overall, with no single technique clearly best; study quality varied.^[5]

Timing

For a cleanly cut nerve, repair is often recommended soon after the injury, when the ends can usually be brought together more easily. Repair can still be considered later, but the approach may change — for example, a graft may be needed — and the expected recovery may be less complete. The right timing depends on the nerve, the type of injury and your overall health.^[2]

Recovery and realistic expectations

• Regrowth is slow. After repair, nerve fibres regrow gradually from the repair site toward the skin — commonly estimated at about a millimetre a day — so recovery is measured in months.^[6]
• Sensations change as the nerve regrows. Tingling or “electric” feelings that move gradually down the foot can be a sign of regrowth.
• Protect numb skin from pressure, heat and injury while feeling returns.
• Desensitization therapy can help with an over-sensitive area.
• Results vary. The goal is meaningful improvement in pain and protective sensation; normal feeling may not return completely.

Risks

Risks discussed before nerve repair include infection and wound-healing problems; persistent pain or a new painful neuroma; numbness at a graft donor site; incomplete recovery of feeling; blood clots; and the possibility of needing further surgery. See also revision nerve surgery.

When to seek care

Consider an evaluation if you have numbness, burning or electric pain in part of your foot after an injury or operation that isn’t improving, or if you have a cut on your foot or ankle followed by numbness beyond the wound.