Abstract
BACKGROUND: Peripheral nerve injuries in the lower extremities impose significant functional and quality-of-life challenges. Loss of plantar flexion is a major deficit. Novel nerve transfers are being introduced to restore function. A novel nerve transfer-partial superficial peroneal to a gastrocnemius branch of the tibial nerve-aimed at restoring plantar flexion is presented in a patient with an incomplete proximal thigh-level sciatic nerve injury. OBSERVATIONS: The case of a 27-year-old policeman with a right sciatic nerve injury from a gunshot wound sustained 11 months earlier, characterized by intact dorsiflexion and eversion but with complete loss of plantar flexion and inversion, is presented. The patient underwent a nerve transfer from the superficial peroneal nerve to the lateral gastrocnemius branch of the tibial nerve at 10 months postinjury. At the 2-year follow-up, the patient achieved M4 strength in plantar flexion while maintaining M5 strength in ankle eversion, dorsiflexion, and toe extension, with ongoing signs of reinnervation to the lateral gastrocnemius on electromyography. LESSONS: Partial transfer of the superficial peroneal nerve to the lateral gastrocnemius branch of the tibial nerve offers a promising solution for restoring plantar flexion in partial sciatic nerve injuries affecting the tibial division. Tailored distal nerve transfers can enhance recovery, underscoring the importance of surgical innovation in treating complex peripheral nerve injuries. https://thejns.org/doi/10.3171/CASE24888.