Patients with peroneal nerve compression neuropathy may experience numbness over the dorsum of the foot, toe extension weakness or foot drop, in addition to pain. The peroneal nerve branches off the sciatic nerve behind the knee, and descends in the anterior and lateral compartment of the leg on its way to the dorsum of the foot. It is responsible for supplying sensation over the antero-lateral calf as well as most of the top of the foot and toes. It also provides motor innervation controlling toe extension and foot elevation (dorsiflexion). The clinical presentation and severity of peroneal nerve neuropathy, due to excessive pressure on or injury to the nerve varies based on which of its three branches and compression sites are actually present:
Common peroneal nerve neuropathy is the most common peroneal nerve neuropathy due to excessive pressure of tissues surrounding the fibular neck (outer, lower part of the knee/upper calf). At this site, the nerve is located next to the fibula in a tight tunnel, where it is prone to compression and injury. Dysfunction of the common peroneal nerve can be characterized by top of the foot sensory deficits or foot and ankle motor weakness (“foot drop”). Physical examination may also reveal pain at the compression site. This condition is common in people who have had knee dislocations or a twisted ankle, but can also follow surgery or trauma in this anatomical region.
Diabetic patients, due to abnormal glucose metabolism, may develop swelling of the nerve, as well as narrowing of the tunnel itself. This alters the normally perfect relationship between the nerve and its tunnel, making it now too narrow for the more swollen nerve, resulting in peroneal nerve neuropathy. Therefore, diabetic patients are at much higher risk for experiencing symptoms of peroneal nerve neuropathy than the general population. (Peroneal nerve neuropathy is about three times more common in diabetics than in the general population.) Numbness of the toes and feet in diabetics that is present despite good blood glucose control requires evaluation by a peripheral nerve surgeon, and early surgical treatment before the nerve is irreversibly damaged. Peroneal nerve neuropathy can be treated and reversed with surgery, if treated in a timely manner.
Superficial peroneal nerve is prone to compression as it exits the deep fascia (outer muscle sheet) on its way to innervate the top of the foot and toes. Excessive pressure at that site can cause pain, especially during or following increased activities in younger and active individuals. Sensory dysfunction can be felt as pins and needles on the top of the foot, and numbness. Injury to this nerve is also not uncommon following orthopedic surgery or other procedures done in this anatomical region.
Deep peroneal nerve is second most common peroneal nerve compression neuropathy, due to excessive pressure of surrounding tissues on the nerve at mid dorsum of the foot. Patients often report pain while wearing tight shoes, they also report a pins and needles sensation and numbness in the first web space (between great and second toe). Compression neuropathy of this nerve is common in diabetics, as well as in patients who previously had trauma or surgery in this anatomical region.
You should see Dr. Ducic for peroneal nerve neuropathy if your symptoms persist:
- Despite the medical care prescribed to you by your physician
- Despite supportive medical care, such as activity and work adjustments
- After three months of prescribed medical and conservative care
- Despite good medical diabetic care
- If you had surgery for a different, non-nerve related problem that was complicated by an acute peroneal nerve functional loss (numbness, weakness or pain), timely evaluation and intervention within 6 or (at the most) 12 weeks after its onset is critical to maximize the likelihood of a positive outcome. Restoration of nerve function may be significantly reduced if decompression is done after 3 months from neuropathy onset. This is unfortunately often overlooked by many who instead choose physical therapy and a “let’s wait and see” approach.
Surgery for Peroneal Nerve Neuropathy
If symptoms continue to be present despite a reasonable observation period (>6-12 weeks) and conservative, supportive care and physical therapy, then you can see me for evaluation for possible surgical treatment. The success of the surgery depends on how long the nerve has been compressed, the severity of the compression, extent of nerve damage due to injury and presence of underlying medical or spine problems. I use advanced, minimally invasive techniques with the advantages of a quicker recovery, reduced possibility of infection and faster return to full function of the affected extremity. In addition, the shorter scar is aesthetically more appealing to all.
Based on which of the three aforementioned compression sites or their combination is identified; surgical treatment is aimed towards your symptomatic sites (anatomical cause of the neuropathy).
I often perform revision surgeries, which address continued neuropathy following previous surgery in patients who failed to get relief after procedures performed elsewhere.
During Peroneal Nerve Surgery:
- You will receive anesthesia so you won’t feel any pain during the surgery.
- A small incision is made over one of the three peroneal nerve compression sites. Instead of making large incisions, special instruments are used to conduct a minimally invasive approach. Fibrous tissue and bands squeezing the nerves are released to ease the pressure on the peroneal nerve; sometimes tissue around the nerve is removed if found to be abnormal. The skin is then closed in anatomical layers.
- Peroneal nerve release is an outpatient procedure, while ambulation is allowed immediately after the surgery. Your dressing will stay on for about a week, while the sutures are removed two to three weeks later.
If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.