Posterior Tibial Nerve Schwannoma
A 38 year old, healthy mother of two children attended my clinic a few weeks ago after having surgery to remove a schwannoma from the posterior tibial nerve near the medial ankle. She reported that she had been living with schwannoma about 10 years without it being symptomatic enough to inhibit her function. However, her symptoms worsened once she fell pregnant about 12 months ago. As her pregnancy progressed, she experienced worsening ankle pain and stiffness.
She had to soldier on and wait until her baby was born before she had surgery. The image above is from her surgery. It’s a great photo that clearly shows the schwannoma ballooning out from the tibial nerve. I’ll be treating her for a few sessions to guide her return to normal daily routine followed by a return to her preferred sporting and recreational activities.
In this patient’s case she received an accurate diagnosis and was able to wait until it suited her to have the tumour removed. In other instances, the symptoms of the schwannoma have been mistaken for other conditions. A paper by Banshelkikar and Nistane (2015) described a case report in which a patient’s schwannoma was mistaken for lower back nerve root symptoms and treated as such for over 5 years! This would have amounted to a great deal of frustration and financial loss for the patient. It’s an unfortunate case report that highlights the need for clinicians to consider alternative hypotheses to explain a patient’s symptoms- particularly when treatment is proving to be ineffective.