Tracking Pixel
Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Peroneal Nerve


- See: 
      - Innerv. Musc. Lower Limb 
      - Innervation of the Leg and Foot:

- Anatomy:
     - common peroneal nerve is derived from (L4, L5, S1, S2) as a part of the sciatic nerve;
     - posterior component, supplies short head of biceps femoris in thigh, crosses posterior to lateral head of gastrocnemius, and becomes subQ behind head of fibula;
     - it penetrates the posterior intermuscular septum, and becomes closely opposed to the periosteum of the proximal fibula;
     - it then divides into superficial & deep peroneal nerves;
     - nerve also gives off a lateral sural cutaneous brach which joins with the the medial sural cutaneous nerve (from tibial nerve) to form the sural nerve;
     - superficial peroneal nerve:
            - supplies lateral compartment of leg, first passing between peroneus longus
            - passes in a straight line from the common peroneal nerve;
            - along the length of the proximal one third of the fibula, the superficial peroneal nerve is on the lateral cortex of the fibula;
            - passes between peroneus longus & peroneus brevis;
            - superficial sensory nerves:
                  - subcutaneous superficial sensory branch lies between peroneus brevis and EDL msucles.
                  - superficial peroneal nerve is accompanied by a true vascular axis that is supplied by tibialis anterior artery along its course.
                  - about 10-12 cm above the tip of the lateral malleolus, the superficial peroneal nerve pierces the fascia;
                  - about 6-7 cm distal to the fibula, the superficial peroneal nerve bifurcates into intermediate and medial dorsal cutaneous nerves;
                  - location of cutaneous nerves: (from Huene and Bunnell (1995))
                        - branches of the superficial peroneal nerve or the sural nerve may be injured during ORIF of Ankle frx;
                        - these nerves are most at risk at the junction of the distal and middle thirds of the lateral border of the fibula;
                        - in 22% of legs, braches of either nerve will cross the frx site;
                        - in 54% of legs, branches of superficial peroneal will lie within 5 mm of the anterolateral border of the fibula;
                        - safest interval is 12 mm posterior to anterolateral border of  fibula at 10 cm from fibular tip, and 10 mm posterior to anterolateral border
                                 at 5 cm proximal to tip; 
     - superficial peroneal nerve block:
            - provides anesthesia over the superolateral foot;
            - in thin patients the nerve can often be visualized by stretching the skin over the dorsum of the foot;
            - subcutaneous "field block" with continuous wheal from lateral margin of achilles tendon around anterior ankle to the medial margin of the achilles tendon
                      will anesthetize all superficial nerves of the foot: superficial peroneal, saphenous, and sural; 
            - references:
                  - Surgical anatomy of the superficial peroneal nerve in the ankle and foot.
                  - Anatomical variations in the course of the superficial peroneal nerve.
                  - Operative anatomy of nerves encountered in the lateral approach to the distal part of the fibula.
                  - Anatomic relations between ankle arthroscopic portal sites and superficial peroneal and saphenous nerves
                  - New York School of Regional Anesthesia.
                  - Anesthesia UK. 
     - deep peroneal nerve:
            - courses anteriorly around fibula, taking a sharp turn as it rounds the fibular neck, to enter anterior compartment of leg;
                  - because of the sharp turn, the nerve is more tethered than the superficial branch;
            - immediately below the fibular head, the deep peroneal nerve lies on the anterior cortex of the fibula for a distance of 3-4 cm;
            - nerve passes under the intermuscular septum (between lateral and anterior compartments) which is a point of entrapment;
                  - note that when this septum is pulled taunt, it compresses the deep peroneal nerve w/o affecting the superficial nerve;
            - it supplies anterior compartment muscles as it travels w/ the the anterior tibial artery, lying between the tibialis anterior and the EHL;
            - it passes underneath extensor retinaculum, sends a motor branch to EDB, and finally sends a sensory branch to the interspace between the first and second toes; 
            - deep peroneal nerve block:
                     - provides anesthesia over the first webspace, with some deep contribution to joints of the lesser toes;
                     - from medial to lateral: EHL, Dorsalis pedis artery, Deep Peroneal Nerve, EDL;
                     - 2-3 cm distal to intermalleolar line, inject just above bone, between EHL and DP pulse; 
            - references:
                     - Palsy of the deep peroneal nerve after proximal tibial osteotomy. An anatomical study.
                     - Relationship of the common peroneal nerve and its branches to the head and neck of the fibula. 
                     - New York School of Regional Anesthesia 
                     - Anesthesia UK.
                     - Clinical importance of the lateral branch of the deep peroneal nerve


- Peroneal Nerve Palsy:



 Peroneal nerve repair. Surgical results.

 Peroneal nerve palsy after early cast application for femoral fractures in children.

 Anatomic considerations of pin placement in the proximal tibia and its relationship to the peroneal nerve.

 Peroneal nerve entrapment
 
 Anatomic Location of the Peroneal Nerve at the Level of the Proximal Aspect of the Tibia: Gerdy's Safe Zone.

New tendon transfer for correction of drop-foot in common peroneal nerve palsy.

Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements

Surgical Decompression Improves Symptoms of Late Peroneal Nerve Dysfunction After TKA



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, April 29, 2013 6:56 am