The patient came to the clinic 16-June-2003 complaining of condition after gun shoot to the right knee 01-June-2002  with non-functioning tibial nerve of the right leg. The patient was operated several times.

The patient then came to the clinic 30-July-2007 still complaining of non functioning right tibial nerve and pain behind the right knee, which was suspected as painful neuroma.

The patient the n came 11-July-2009 and 19-December-2009 with ECS performed 17-December-2009 confirming that the right tibial nerve is not functioning and very mild involvement of the right peroneal nerve. The patient to this moment underwent 5 surgeries to the lesion.

The lower third of the sciatic nerve was exposed and it was involved in massive scar in its lower part. Using ISIS HIghLine IOM the peroneal side of the sciatic nerve was functioning well and was responding well to currents with 1mA stimulation, but the tibial side was not functioning at all.

Neurolysis was undertaken and the tibial and peroneal nerves were neuroyzed down 7-8 cm below their emergence. The division was of low variant and the tibial nerve start to respond gradually to 4mA the 2 mA and the 1 mA. This was recorded and documented in the ISIS IOM and video-recorded. It was possible to record brisk response of planterflexion group of muscles during tibial nerve stimulation.

Routine closure of the wound. The movement of the right foot improved slightly and some planterflexion appeared after recovery.

The suspected painful neuroma could be a swelling of the nerve above some scar constriction, which disappear usually after neurolysis.

Without using IOM, it is impossible to make the proper decision of the best treatment modality fit to the patient.