Heterotopic Ossification Is Associated with Painful Neuromas in Transtibial Amputees Undergoing Surgical Treatment of Symptomatic Neuromas

Background: A relationship between nerve and osseous regeneration has been described. During the surgical treatment of symptomatic neuroma in transtibial amputees, the authors have found that heterotopic ossification (HO) depicted on preoperative radiographs appeared to be associated with the location of symptomatic neuromas in both the peroneal and tibial nerve distributions. Methods: Data were collected for transtibial amputees who underwent surgical management of symptomatic neuroma and were prospectively enrolled from 2018 through 2023. Preoperative radiographs were assessed for the presence of HO located at the distal fibula and tibia. The presence of a peroneal or tibial neuroma was based on findings contained within the operative reports. Pain levels were measured on a numeric rating scale (0 to 10). Results: Sixty-five limbs of 62 amputees were included. Peroneal neuroma and presence of fibular HO ( P = 0.001) and tibial neuroma and presence of tibial HO ( P = 0.038) demonstrated an association. The odds of having a symptomatic peroneal neuroma with fibular HO present were greater than the odds of a symptomatic peroneal neuroma when fibular HO was absent (OR, 9.3 95% CI, 1.9 to −45.6; P = 0.006). Preoperative pain scores were significantly higher for all patients with HO ( P < 0.001), those with fibular HO ( P < 0.001), and those with tibial HO ( P < 0.001), compared with patients without HO. Conclusions: In patients with symptomatic neuromas, preoperative pain was worse when HO was present in the transtibial amputee’s residual limb. Further research on the neuroma–HO complex in symptomatic amputees is required. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.