From the Guidelines
Treatment for peroneal nerve injury should prioritize avoiding further injury to the nerve, particularly in procedures like microphlebectomy, where care should be taken to avoid the region near the fibular head to prevent complications such as foot drop or sensory loss. When considering treatment for peroneal nerve injury, it's essential to understand the potential risks and complications associated with surgical procedures. For instance, microphlebectomy, a method used for treating lower extremity chronic venous disease, involves the surgical excision of pathologic vessels and can lead to complications like skin blistering, wound infections, and less commonly, injury to small sensory nerves or the common peroneal nerve itself 1.
Given the potential for significant morbidity associated with peroneal nerve injury, including foot drop and sensory loss, treatment should focus on preventing further injury and managing symptoms. This can include:
- Conservative measures such as rest and avoiding activities that exacerbate symptoms
- Physical therapy to maintain range of motion and prevent contractures
- Use of ankle-foot orthoses (AFOs) or braces to prevent foot drop
- Pain management with NSAIDs or neuropathic pain medications
- Surgical intervention, such as nerve decompression or repair, for severe cases or when conservative treatment fails
It's crucial to approach treatment with caution, considering the potential for complications, and to prioritize measures that minimize the risk of further nerve injury, as highlighted by the need for care in avoiding the common peroneal nerve during microphlebectomy procedures 1. Regular follow-up with a healthcare provider is essential to monitor progress and adjust treatment as necessary to optimize outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Peroneal Nerve Treatment Options
- Nonsurgical measures, including activity modification, bracing, physical therapy, and medication, can be beneficial for many patients with peroneal nerve palsy 2.
- Surgical decompression is considered for refractory cases, compressive masses, acute lacerations, or severe conduction changes, with typically favorable results 2, 3.
- Tendon and nerve transfers can be used in cases of failed decompression or poor prognosis for nerve recovery 2.
Diagnosis and Prognosis
- Accurate and timely diagnosis of peroneal neuropathy is crucial to avoid progression of nerve injury and permanent nerve damage 4.
- Diagnosis can be made with physical exam findings, motor nerve conduction studies, electromyography studies, and diagnostic nerve blocks 4.
- Neurodiagnostic studies can help identify the site of a lesion and determine the appropriate treatment and prognosis 2.
Specific Treatment Approaches
- Microsurgical decompression and percutaneous peripheral nerve stimulation are additional options, although large studies reporting outcomes are lacking 4.
- Physical therapy management, including mechanical interface, pain modalities, soft tissue mobilization, and neural mobilization, can be effective in some cases, as reported in a case study on entrapment of the superficial peroneal nerve 5.
- Peroneal (fibular) nerve release is a low-risk procedure that can provide excellent results with pain relief and return of function when secondary to compression of the nerve at the fibular head 3.