The patient a Libyan citizen came to the clinic 15-January-2002 complaining of pain right foot for 2 years after stab wound by glass. She got pain whole lower limb. In Tunisia she was operated for neuroma in May-2000 without effect. Another operation in October-2000. Then in Jordan elsewhere was 3d time operated 2 months ago. The patient was operated by me 28-January-2002. The right sympathetic chain of the right lower limb was resected and sent for histologic verification. This procedure was done considering that causalgia have place.

On examination: The patient in agonizing pain, limping due to pain in the right foot. The first wound was closed with signs of infection.

He was sent for investigations and CT-scan of both feet was uninformative.

The patient was treated conservatively and several times she came to the clinic. She came 15-June-2002 with painful mass medial aspect behind the pervious incision. She was treated conservatively. Then she came 14-September-2002 showing that the mass became bigger and painful.

Medial incision parallel to the palpated mass. The flexor hallucis longus identified and retracted. The deep branches of the medial planter artery and nerves were intact and preserved. The mass identified resected and sent for histological verification. It was granulamateous mass from the ligamentum plantare mediale.   Routine closure of the wound.

Smooth postoperative recovery. Se was sent to the ward.

The patient came to the clinic 25-September-2002 with clean wound.

This case is challenging in pain treating strategies. A lot of surgeries and persistence of pain.