Overview
Peroneal nerve injury involves damage to the common peroneal nerve, often leading to foot drop and sensory deficits in the lower leg and foot. It can result from various causes, including iatrogenic trauma during procedures like endovenous laser ablation for varicose veins and traumatic injuries such as retinaculum damage 12.Diagnosis
Clinical Presentation: Foot drop, sensory loss over the dorsum of the foot, and weakness in ankle dorsiflexion and toe extension 1.
Electromyography (EMG): Absence of motor unit action potentials (MUAP) in affected muscles like tibialis anterior 1.
Imaging: Radiographs may show avulsion fractures indicative of retinaculum injuries 2.
Intraoperative Assessment: Nerve exploration and stimulation to confirm damage and assess fascicle viability 1.Management
Conservative Management: Immobilization with casting for retinaculum injuries 2.
Surgical Intervention:
- Nerve Transfer: Partial tibial nerve transfer for severe iatrogenic palsy 1.
- Retinaculum Reconstruction: Operative repair for recurrent subluxation of peroneal tendons 2.
Rehabilitation: Post-surgical physical therapy focusing on muscle strengthening and gait training 1.Special Populations
Elderly: Higher risk of poor functional recovery post-injury; surgical interventions like nerve transfer may be considered 1.Key Recommendations
Surgical exploration and nerve transfer may be indicated for severe iatrogenic peroneal nerve palsy with poor prognosis (Evidence: Weak 1).
Operative reconstruction of the peroneal retinaculum is recommended for recurrent subluxation following conservative management (Evidence: Weak 2).
Early immobilization with casting can be effective for superior peroneal retinaculum injuries (Evidence: Weak 2).References
1 Uemura T, Miyashima Y, Konishi S, Takamatsu K, Nakamura H. Partial tibial nerve transfer for iatrogenic peroneal nerve palsy after endovenous laser ablation for varicose veins of the lower extremity: A case report. Microsurgery 2023. link
2 Cwinn AA, Marx JA. Peroneal retinaculum injury: an unusual cause of ankle pain. Annals of emergency medicine 1987. link80297-4)
3 Figura MA. Peroneus tertius myocele: a rare herniation of the lower extremity. The Journal of foot surgery 1983. link