How do people damage the peroneal (common peroneal) nerve?

From the Guidelines

People damage the peroneal nerve through direct trauma, compression, stretching, or medical conditions, with common causes including knee injuries, leg fractures, and prolonged pressure from crossing legs or wearing tight casts, as well as medical procedures like microphlebectomy, where care should be taken to avoid the region near the fibular head 1. When considering the potential for peroneal nerve damage, it's essential to recognize the nerve's vulnerability as it wraps around the fibular head near the knee, where it lies close to the skin surface with minimal protection. Some of the key factors that contribute to peroneal nerve damage include:

• Direct trauma to the knee or leg
• Compression from prolonged pressure or tight casts
• Stretching or traction injuries, such as those that may occur during sports activities 1
• Medical conditions like diabetes, alcoholism, and vitamin deficiencies, which can make the nerve more susceptible to damage Symptoms of peroneal nerve damage typically include foot drop, numbness or tingling on the top of the foot and outer shin, and weakness when turning the foot outward. Treatment depends on the cause but may include removing sources of compression, physical therapy, bracing, and in severe cases, surgery, with early recognition and treatment being crucial to prevent permanent nerve damage and disability. In the context of medical procedures, care should be taken to avoid the region near the fibular head to minimize the risk of peroneal nerve injury, particularly during microphlebectomy 1.

From the Research

Causes of Peroneal Nerve Damage

• Trauma, including sharp or blunt force, traction, fracture, laceration, and avulsion, is the most frequent cause of common peroneal nerve (CPN) injury 2
• Iatrogenic injury, such as application of tight plaster, retraction injury, or division during operation, can also cause CPN damage 2
• Varicose vein operations can result in CPN injury, with nerve damage being the most frequent major complication leading to legal action 2, 3
• Short saphenous vein surgery is a specific type of operation that carries a risk of CPN injury, with an incidence of 4.7% reported in one study 3

Mechanisms of Injury

• The common peroneal nerve is most vulnerable to injury as it crosses the neck of the fibula 2
• Traumatic injuries, such as those resulting from accidents or falls, can cause CPN damage 4
• Surgical procedures, including varicose vein operations and short saphenous vein surgery, can also result in CPN injury 2, 3

Clinical Presentation and Treatment

• CPN injury can result in significant disability and poor outcomes if left untreated or undertreated 2, 4
• Treatment options for CPN injury include neurolysis, direct suture, and nerve graft, with varying degrees of success reported in different studies 4, 5
• The choice of treatment depends on the severity and mechanism of injury, as well as the individual patient's characteristics and needs 4, 5