Peroneal Mononeuropathy 

  • Author: Pinky Agarwal, MD; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Aug 3, 2010
 

Background

Mononeuropathies can occur secondary to direct trauma, compression, stretch injury, ischemia, infection, or inflammatory disease. Dancers are also prone to superficial and deep peroneal nerve entrapments.[1]

Nerve entrapments are due to compression of the nerve by either normal structures or an external source. The most common nerve entrapments are at the median nerve of the wrist (ie, carpal tunnel syndrome) and ulnar nerve of the elbow (ie, cubital tunnel syndrome). For more information, see eMedicine article Nerve Entrapment Syndromes.

In the lower extremity, peroneal neuropathy is the most common isolated mononeuropathy. In patients of our electrodiagnostic laboratory, it is the third most common mononeuropathy overall.

Next

Pathophysiology

Compression and entrapment neuropathies are predominantly demyelinating.

  • Myelin loss results in slowing of the nerve conduction through the area involved.
  • When acute compression occurs, this may result in a conduction block. When the compression is more chronic, only slowing across the involved segment may be seen.
  • When compression is severe, ischemic changes occur that cause secondary axonal damage.
  • Pure demyelinating lesions typically have a better capacity to recover.

The pathophysiology of ischemic injuries and nerve transection is axonal damage. When axonal damage occurs, recovery is slower and longer and may not be complete.

  • This results in wallerian degeneration distally, and recovery requires the nerve to regenerate and reinnervate.
  • This process is slower than healing from other types of injuries and may not be complete.
  • Nerve conduction studies and electromyography (EMG) can aid in defining the lesion location and type.

Knowledge of peroneal nerve anatomy is essential to understanding the mechanism of its injury and to localizing the site of the lesion.

  • The peroneal nerve is a division of the sciatic nerve, which splits at or slightly above the popliteal fossa to form the tibial and common peroneal nerves.
  • The common peroneal nerve extends anterolaterally to wind around the neck of the fibula.
  • At this level, the nerve is superficial, covered only by skin and subcutaneous tissue. Here, it is predisposed to direct compression.
  • The nerve then dives into the peroneus longus muscle, where tethering can occur, making it susceptible to stretch injury at this level.
  • The nerve then divides into the superficial and deep peroneal branches.
    • The superficial branch supplies the foot everters and sensation to the skin of the lateral calf and dorsum of the foot.
    • The deep peroneal branch supplies the foot and toe dorsiflexors and has a small sensory component, which innervates only the skin of the web space between the first and second toes.
Previous
Next

Epidemiology

Race

No racial predilection is known.

Sex

No gender proclivity is known.

Age

Peroneal mononeuropathy is uncommon in children but has been reported in all age groups.

Previous
Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Pinky Agarwal, MD  Clinical Assistant Professor, Department of Neurology, University of Washington; Attending Neurologist, Booth Gardner Parkinson's Care Center, Kirkland, WA

Pinky Agarwal, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Association of Clinical Research Professionals, and Movement Disorders Society

Disclosure: Nothing to disclose.

Coauthor(s)

Alida Griffith, MD  Movement Disorders Neurologist, Booth Gardner Parkinson's Care Center

Disclosure: TEVA Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Specialty Editor Board

Aashit K Shah, MD  Associate Professor of Neurology, Wayne State University; Program Director, Clinical Neurophysiology Fellowship, Department of Neurology, Detroit Medical Center

Aashit K Shah, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Glenn Lopate, MD  Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology

Disclosure: Nothing to disclose.

References

  1. Kennedy JG, Baxter DE. Nerve disorders in dancers. Clin Sports Med. Apr 2008;27(2):329-34. [Medline].

  2. Kabayel L, Balci K, Turgut N, Kabayel DD. Development of entrapment neuropathies in acute stroke patients. Acta Neurol Scand. Jul 2009;120(1):53-8. [Medline].

  3. Chan M, Campbell C, Lim RK. De novo footdrop resulting from an isolated acute repetitive strain injury. Pediatr Emerg Care. Feb 2009;25(2):102-4. [Medline].

  4. Kennedy JG, Baxter DE. Nerve disorders in dancers. Clin Sports Med. Apr 2008;27(2):329-34. [Medline].

  5. Mnif H, Koubaa M, Zrig M, Zammel N, Abid A. Peroneal nerve palsy resulting from fibular head osteochondroma. Orthopedics. Jul 2009;32(7):528. [Medline].

  6. Terrence Jose Jerome J. Superficial peroneal nerve lipoma. Rom J Morphol Embryol. 2009;50(1):137-9. [Medline].

  7. Bonnevialle P, Dubrana F, Galau B, Lustig S, Barbier O, Neyret P. Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. Orthop Traumatol Surg Res. Feb 2010;96(1):64-9. [Medline].

  8. O'Neill PJ, Parks BG, Walsh R, Simmons LM, Miller SD. Excursion and strain of the superficial peroneal nerve during inversion ankle sprain. J Bone Joint Surg Am. May 2007;89(5):979-86. [Medline].

  9. Seyyed Hosseinzadeh HR, Eajazi A, Kazemi SM, Daftari Besheli L, Hassas Yeganeh M, Aydanloo A. Sudden peroneal nerve palsy in a varus arthritic knee. Orthopedics. Dec 2009;32(12):920-3. [Medline].

  10. Weyns FJ, Beckers F, Vanormelingen L, Vandersteen M, Niville E. Foot drop as a complication of weight loss after bariatric surgery: is it preventable?. Obes Surg. Sep 2007;17(9):1209-12. [Medline].

  11. Weber P, Rost B. [Anorexia nervosa and nervus peronaeus lesions]. Z Kinder Jugendpsychiatr Psychother. Sep 2009;37(5):469-72. [Medline].

  12. Baker JF, Lui DF, Kiely PD, Synnott KA. Foot drop--an unusual presentation of exertional compartment syndrome. Clin J Sport Med. May 2009;19(3):236-7. [Medline].

  13. Kollrack YM, Möllenhoff G. [Exertional compartment syndrome of the lower leg and common peroneal nerve palsy as combined injury after weight lifting]. Sportverletz Sportschaden. Sep 2009;23(3):165-8. [Medline].

  14. Marcu D, Dunbar WH, Kaplan LD. Footdrop without significant pain as late presentation of acute peroneal compartment syndrome in an intercollegiate football player. Am J Orthop (Belle Mead NJ). May 2009;38(5):241-4. [Medline].

  15. Liem NR, Bourque PR, Michaud C. Acute exertional compartment syndrome in the setting of anabolic steroids: an unusual cause of bilateral footdrop. Muscle Nerve. Jul 2005;32(1):113-7. [Medline].

  16. Mckenna J, Ibrahim A. Isolated common peroneal nerve palsy in sarcoidosis. Ir Med J. Nov-Dec 2008;101(10):313-4. [Medline].

  17. McKay G, Gill I, Chauhan S. Lyme disease: an unusual case of peripheral nerve palsy. J Bone Joint Surg Br. May 2010;92(5):713-5. [Medline].

  18. Fukuda H. Bilateral peroneal nerve palsy caused by intermittent pneumatic compression. Intern Med. 2006;45(2):93-4. [Medline].

  19. Singhal A, Varma M, Goyal N, Vij V, Wadhawan M, Gupta S. Peroneal neuropathy following liver transplantation: possible predisposing factors and outcome. Exp Clin Transplant. Dec 2009;7(4):252-5. [Medline].

  20. Kayal R, Katirji B. Atypical deep peroneal neuropathy in the setting of an accessory deep peroneal nerve. Muscle Nerve. Aug 2009;40(2):313-5. [Medline].

  21. El Demellawy D, Bain J, Algawad H, Provias JP. Inflammatory pseudotumor of the peroneal nerve: case report and literature review. Ann Diagn Pathol. Feb 2008;12(1):44-7. [Medline].

  22. Vieira RL, Rosenberg ZS, Kiprovski K. MRI of the distal biceps femoris muscle: normal anatomy, variants, and association with common peroneal entrapment neuropathy. AJR Am J Roentgenol. Sep 2007;189(3):549-55. [Medline].

  23. Ersozlu S, Ozulku M, Yildirim E, Tandogan R. Common peroneal nerve palsy from an untreated popliteal pseudoaneurysm after penetrating injury. J Vasc Surg. Feb 2007;45(2):408-10. [Medline].

  24. Visser LH. High-resolution sonography of the common peroneal nerve: detection of intraneural ganglia. Neurology. Oct 24 2006;67(8):1473-5. [Medline].

  25. Nodera H, Sato K, Terasawa Y, Takamatsu N, Kaji R. High-resolution sonography detects inflammatory changes in vasculitic neuropathy. Muscle Nerve. Sep 2006;34(3):380-1. [Medline].

  26. Spinner RJ, Amrami KK, Angius D, Wang H, Carmichael SW. Peroneal and tibial intraneural ganglia: correlation between intraepineurial compartments observed on magnetic resonance images and the potential importance of these compartments. Neurosurg Focus. Jun 15 2007;22(6):E17. [Medline].

  27. Aprile I, Tonali P, Caliandro P, Pazzaglia C, Foschini M, Di Stasio E, et al. Italian multicentre study of peroneal mononeuropathy: multiperspective follow-up. Neurol Sci. Feb 2009;30(1):37-44. [Medline].

  28. Ozkan T, Tuncer S, Ozturk K, Aydin A, Ozkan S. Tibialis posterior tendon transfer for persistent drop foot after peroneal nerve repair. J Reconstr Microsurg. Mar 2009;25(3):157-64. [Medline].

  29. Nath RK, Lyons AB, Paizi M. Successful management of foot drop by nerve transfers to the deep peroneal nerve. J Reconstr Microsurg. Aug 2008;24(6):419-27. [Medline].

  30. Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Prestini G. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res. Jun 2008;466(6):1454-66. [Medline].

  31. Humphreys DB, Novak CB, Mackinnon SE. Patient outcome after common peroneal nerve decompression. J Neurosurg. Aug 2007;107(2):314-8. [Medline].

  32. Campbell WW. Focal Neuropathies. Essentials of electrodiagnostic medicine. 1999;255-278.

  33. Katirji B. Peroneal neuropathy. Neurol Clin. Aug 1999;17(3):567-91, vii. [Medline].

  34. Katirji B, Wilbourn AJ. High sciatic lesion mimicking peroneal neuropathy at the fibular head. J Neurol Sci. Feb 1994;121(2):172-5. [Medline].

  35. Marciniak C, Armon C, Wilson J. Practice parameter: utility of electrodiagnostic techniques in evaluating patients with suspected peroneal neuropathy: an evidence-based review. Muscle Nerve. Apr 2005;31(4):520-7. [Medline].

  36. Masakado Y, Kawakami M, Suzuki K, Abe L, Ota T, Kimura A. Clinical neurophysiology in the diagnosis of peroneal nerve palsy. Keio J Med. Jun 2008;57(2):84-9. [Medline].

  37. Stewart JD. Foot drop: where, why and what to do?. Pract Neurol. Jun 2008;8(3):158-69. [Medline].

  38. Turner OA, Taslitz N, Ward S. Common peroneal nerve entrapment. Handbook of peripheral nerve entrapments. 1990;119-124.

  39. Wilbourn AJ. AAEE case report #12: Common peroneal mononeuropathy at the fibular head. Muscle Nerve. Nov-Dec 1986;9(9):825-36. [Medline].

  40. Williams FH, Johns JS, Weiss JM, et al. Neuromuscular rehabilitation and electrodiagnosis. 1. Mononeuropathy. Arch Phys Med Rehabil. Mar 2005;86(3 Suppl 1):S3-10. [Medline].

 
Previous
Next
 
Peroneal sensory distribution: The striped area is the superficial peroneal sensory distribution. The green solid area represents the deep peroneal sensory distribution. All 3 areas shaded would be numb in a patient with a common peroneal nerve lesion.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.