Which nerves are involved in foot drop (peroneal nerve palsy)?

From the Guidelines

Foot drop is primarily caused by damage to the common peroneal nerve, which can result in sensory loss or foot drop, as highlighted in a recent study published in 2023 1. When considering the nerves involved in foot drop, also known as peroneal nerve palsy, it is essential to understand the anatomy and function of the peroneal nerves. The common peroneal nerve, located near the fibular head, is particularly susceptible to injury, which can lead to foot drop.

• The common peroneal nerve branches from the sciatic nerve and divides into the deep and superficial peroneal nerves.
• The deep peroneal nerve innervates the muscles responsible for dorsiflexion of the foot and extension of the toes.
• The superficial peroneal nerve controls the muscles for foot eversion. As noted in the study, care should be taken to avoid the region near the fibular head to prevent common peroneal nerve injury during procedures like microphlebectomy 1. Key points to consider in the diagnosis and management of foot drop include:
• Identifying the underlying cause of nerve damage, such as compression, trauma, or diabetes.
• Determining the location and severity of nerve damage to guide treatment.
• Considering the potential for less common causes of foot drop, such as damage to the sciatic nerve, L5 nerve root, or central nervous system disorders.

From the Research

Nerves Involved in Foot Drop

The nerves involved in foot drop, also known as peroneal nerve palsy, include:

• Common peroneal nerve 2, 3, 4
• Deep peroneal nerve 2, 4, 5, 6
• Superficial peroneal nerve 2, 4, 5
• Tibial nerve 2, 4, 5, 6
• Sciatic nerve 2, 4

Causes of Foot Drop

Foot drop can be caused by various factors, including:

• Traumatic damage to the common peroneal nerve 2
• Sharp injury 2
• Gunshot wound 2
• Sciatic nerve tumor 2
• Radiculopathy 2
• Hip replacement surgery 2
• Ankle sprain 3
• Iatrogenic nerve injury 4
• Infection and hip wound 4
• Lumbosacral fusion or laminectomy 4
• Hip surgery 4
• Knee surgery 4
• Compartment syndrome 4
• Posterior tibial entrapment and tarsal tunnel syndrome 4

Treatment of Foot Drop

Treatment of foot drop may involve:

• Nerve transfer of functional fascicles of either the superficial peroneal nerve or the tibial nerve to the deep peroneal nerve 2, 4, 5
• Neurolysis of the peroneal nerve 4
• Decompression 4
• Transfer of the nerve of the soleus muscle to the deep peroneal nerve 6