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The peroneal nerve runs through the lateral portion of the lower leg, splitting into three branches, the common, superficial and deep nerve. Entrapment of these peroneal nerves are the most common of lower extremity neuropathies (Fortier et al, 2021). These nerves are supposed to glide smoothly around surrounding tissue, but entrapped nerves can be stuck or adhered to the surrounding tissue. This scar tissue can cause pain. Nerves can also be compressed by trauma, scar tissue from surgery, or surrounding anatomic structures.
Symptoms of peroneal neuropathy may occur due to compression at the common, superficial, or deep levels, with slightly differing symptom presentation for each. These symptoms may include weakness of the ankle in eversion or dorsiflexion, weakness of big toe extension, decreased sensation on the top of the foot or lower lateral leg, burning or a deep dull aching pain. These symptoms can range from mild discomfort to numbness, paralysis or severe pain.
Diagnosis is based on detailed history, physical examination and imaging. Certain physical tests may be utilized to reproduce symptoms and measure strength and sensation which may vary depending on the location and nerve involved.
Nerve conduction studies may also be performed to measure how fast an electrical impulse moves through the nerve to assess for damage or injury.
Imaging tests, such as a CT scan, ultrasound or magnetic resonance imaging (MRI) may be used to get a better picture of the nerves and structures in the affected area.
Initial treatment of pain caused by nerve entrapment consists of rest, ice, NSAIDs, relief of pressure at the site of pain, and stretching exercises.
Nerve hydrodissection uses fluid to release the nerve from the surrounding muscle or scar tissue. The nerve is first identified with ultrasound, and a solution of normal saline is gently placed around the entrapped nerve using ultrasound guidance. The solution releases the nerve from the surrounding tissue that is compressing the nerve.
If pain does not respond to any non-operative conservative interventions, surgical decompression of the affected nerve should be considered. Surgical approaches vary depending on which branch of the personal nerve is entrapped (Fortier et al, 2021).
Fortier LM, Markel M, Thomas BG, Sherman WF, Thomas BH, Kaye AD. An Update on Peroneal Nerve Entrapment and Neuropathy. Orthop Rev (Pavia). 2021 Jun 19;13(2):24937. doi: 10.52965/001c.24937. PMID: 34745471; PMCID: PMC8567814.
