{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T18:02:24Z","timestamp":1780941744731,"version":"3.54.1"},"reference-count":63,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Psoriasis, a chronic immune-mediated inflammatory disease, can affect musculoskeletal structures, including the Achilles tendon. Achilles pain in psoriasis patients may arise from tendinitis or neuropathic pain due to peripheral nerve dysfunction, such as sural nerve (SN) involvement, a condition frequently misdiagnosed due to limitations in conventional diagnostics. Fascial tissues are critical in nerve compression syndromes. This case explores the application of a novel quantitative Sonoguide Digital Palpation (SDP) protocol and ultrasound (US)-guided hydrodissection (HD) for SN dysfunction mimicking Achilles tendinopathy in a psoriasis patient. Case Presentation: A 41-year-old male with psoriasis presented with acute onset of right heel stiffness and paresthesia. Physical examination, radiographs, and ultrasound were performed. SDP, employing a validated four-criterion diagnostic framework (including fascial mobility quantification and concordant pain provocation), identified crural fascia restriction affecting SN and reproduced patient\u2019s concordant Achilles pain. High-resolution ultrasonography provided key morphological evidence, revealing a 2.6-fold enlargement of the sural nerve\u2019s cross-sectional area (CSA) on the affected side (13 mm2) compared to the asymptomatic side (5 mm2). Notably, a positive Tinel\u2019s sign was elicited over the psoriatic plaque. US-guided HD was performed using 50 cc of 5% dextrose in water (D5W) without local anesthetic below the psoriatic lesion. Post-HD, the patient reported immediate and significant pain relief (Numeric Pain Rating Scale (NPRS) score reduction from 8 to 2), confirming the prompt correction of a clinically important fascial restriction, associated with improved SN mobility, objectively verified by a post-procedure SDP assessment. At 24-month follow-up, sustained symptom relief and complete functional recovery were reported. Conclusions: This case highlights SDP\u2019s ability to objectively visualize and confirm fascial restriction as a cause of nerve dysfunction by quantitatively reproducing concordant pain. The objective finding of nerve swelling provides sonographic substantiation for the functional diagnosis of nerve dysfunction. This integrated diagnostic approach, combining dynamic functional assessment with morphological confirmation, offers a novel paradigm for evaluating peripheral nerve disorders. US-guided HD of the SN with D5W without local anesthetic shows promise as both a diagnostic confirmatory tool and therapeutic intervention for neuropathic Achilles pain in psoriasis patients with SN involvement, aligning with its efficacy in other peripheral neuropathies. The significant nerve swelling (13 mm2) provides robust morphological corroboration of the functional impairment diagnosed by SDP, offering a more comprehensive diagnostic paradigm.<\/jats:p>","DOI":"10.3390\/diagnostics15212706","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T07:31:58Z","timestamp":1761550318000},"page":"2706","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Novel Sonoguided Digital Palpation and Hydrodissection for Sural Nerve Dysfunction Mimicking Achilles Tendinopathy in a Psoriasis Patient"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yonghyun","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea"},{"name":"IncheonTerminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"},{"name":"International Association of Regenerative Medicine, Incheon 21574, Republic of Korea"},{"name":"MSKUS, San Diego, CA 92084, USA"},{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-829X","authenticated-orcid":false,"given":"King Hei Stanley","family":"Lam","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, New Territory, Hong Kong"},{"name":"The Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1207-348X","authenticated-orcid":false,"given":"Chanwool","family":"Park","sequence":"additional","affiliation":[{"name":"IncheonTerminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungbeom","family":"Kim","sequence":"additional","affiliation":[{"name":"IncheonTerminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minjae","family":"Lee","sequence":"additional","affiliation":[{"name":"IncheonTerminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"IncheonTerminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-9856","authenticated-orcid":false,"given":"Jihyo","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyemi","family":"Yu","sequence":"additional","affiliation":[{"name":"Bio Plastic Surgery Clinic, Seoul 06041, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonghyeok","family":"Lee","sequence":"additional","affiliation":[{"name":"Bareun Neurosurgery Clinic, Seoul 07273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8646-0918","authenticated-orcid":false,"given":"Daniel Chiung-Jui","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan 710, Taiwan"},{"name":"A Tempo Regeneration Center for Musicians, Tainan 700, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6722-0268","authenticated-orcid":false,"given":"Teinny","family":"Suryadi","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, North Jakarta 14350, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta 12950, Indonesia"},{"name":"Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta 11510, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-0988","authenticated-orcid":false,"given":"Anwar","family":"Suhaimi","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2346-2326","authenticated-orcid":false,"given":"Kenneth Dean","family":"Reeves","sequence":"additional","affiliation":[{"name":"Independent Researcher, Roeland Park, KS 66205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Campanati, A., Marani, A., Martina, E., 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