From the Guidelines
Peroneal neuropathy is a condition where the peroneal nerve becomes damaged or compressed, resulting in foot drop, numbness, and weakness in the affected leg, and its causes and symptoms should be promptly assessed and managed to prevent further complications, particularly in people with diabetes, as emphasized in the 2023 standards of care in diabetes 1. The symptoms of peroneal neuropathy can vary, but common manifestations include foot drop, numbness, and weakness in the affected leg. In people with diabetes, diabetic neuropathies, including peroneal neuropathy, can be asymptomatic in up to 50% of cases, highlighting the importance of regular assessment and screening, as recommended in the 2023 standards of care in diabetes 1. Some key points to consider in the assessment and management of peroneal neuropathy include:
- The condition can result from compression at the fibular head due to various factors such as crossing legs, wearing tight casts, or direct trauma.
- Diabetic neuropathy, which includes peroneal neuropathy, is a diagnosis of exclusion, and nondiabetic neuropathies may be present in people with diabetes and may be treatable.
- Glycemic control can effectively prevent diabetic peripheral neuropathy and cardiac autonomic neuropathy in type 1 diabetes and may modestly slow their progression in type 2 diabetes, but it does not reverse neuronal loss, as noted in the 2023 standards of care in diabetes 1.
- Therapeutic strategies, including pharmacologic and nonpharmacologic approaches, can potentially reduce pain and improve quality of life in patients with peroneal neuropathy. Early recognition and appropriate management of peroneal neuropathy are crucial to prevent further complications, particularly in people with diabetes, and to improve symptoms, reduce sequelae, and enhance quality of life, as emphasized in the 2023 standards of care in diabetes 1.
From the Research
Causes of Peroneal Neuropathy
- Compression of the common peroneal nerve (CPN), superficial peroneal nerve (SPN), or deep peroneal nerve (DPN) is a common cause of peroneal neuropathy 2, 3
- The CPN is most commonly compressed by the bony prominence of the fibula, the SPN most commonly entrapped as it exits the lateral compartment of the leg, and the DPN as it crosses underneath the extensor retinaculum 2
- Numerous etiologies have been identified, including injury to the nerve anywhere along its course from the sciatic origin to the terminal branches in the foot and ankle 3
- Peroneal nerve entrapment neuropathy (PNEN) can be caused by lumbar degenerative disease, and can be a causative factor of residual symptoms after lumbar spinal surgery (LSS) 4
Symptoms of Peroneal Neuropathy
- Foot drop, pain of the lower extremity, or numbness of the lower extremity are common symptoms of peroneal neuropathy 2, 3
- Numbness and pain in the lateral lower thigh and instep, and motor weakness of the extensors of the toes and ankle are also symptoms of peroneal neuropathy 4, 5
- Intermittent claudication can be a presenting symptom of peroneal nerve entrapment neuropathy (PNEN) 5
- Decreased strength, altered sensation, and gait abnormalities can be physical exam findings of peroneal neuropathy 2
Diagnosis and Treatment of Peroneal Neuropathy
- Accurate and timely diagnosis of peroneal neuropathy is important to avoid progression of nerve injury and permanent nerve damage 2
- Diagnosis can be made with physical exam findings, motor nerve conduction studies, electromyography studies, and diagnostic nerve blocks 2
- First-line treatments include removing anything that may be causing external compression, providing stability to unstable joints, and reducing inflammation 2
- Surgical treatment, including microsurgical decompression and percutaneous peripheral nerve stimulation, may be required for refractory cases or those with compressive masses, acute lacerations, or severe conduction changes 2, 3, 4, 6