From the Guidelines
The peroneal nerve is at risk of injury during microphlebectomy, particularly near the fibular head, and careful planning to avoid this region is crucial to prevent complications such as foot drop or sensory loss. The peroneal nerve is a major peripheral nerve in the lower limb that branches from the sciatic nerve, dividing into two main branches: the superficial peroneal nerve and the deep peroneal nerve 1. This nerve is responsible for providing motor function to the muscles that dorsiflex and evert the foot, as well as sensory innervation to parts of the lower leg and dorsum of the foot. When considering procedures like microphlebectomy, it is essential to be aware of the anatomical location of the peroneal nerve, which is commonly found just medial to the biceps femoris tendon and near the fibular head 1. Injury to this nerve can cause significant morbidity, including sensory loss or foot drop, emphasizing the need for caution and precise planning to avoid this region during surgical procedures. Key considerations for preventing peroneal nerve injury include:
- Careful planning and awareness of the nerve's anatomical location
- Avoidance of the region near the fibular head during microphlebectomy
- Minimizing the risk of complications such as skin blistering, wound infections, and nerve injury Given the potential for significant morbidity associated with peroneal nerve injury, it is critical to prioritize careful planning and precise technique during microphlebectomy to avoid this complication, as highlighted in recent studies 1.
From the Research
Peroneal Nerve Overview
- The peroneal nerve is a nerve that supplies the muscles of the lower leg and foot, and its compromise can result in weakness of the ankle dorsiflexors and evertors, leading to foot drop 2.
- The peroneal nerve can be injured due to various causes, including traumatic and insidious causes, such as musculoskeletal injury, nerve traction, compression, or laceration, as well as mass lesions and metabolic syndromes 2.
Peroneal Nerve Injury and Treatment
- A study published in 2021 found that double nerve transfer from the tibial to the deep peroneal nerve can be an effective treatment for foot drop resulting from common peroneal nerve injury, with significant improvement in motor recovery and pain perception 3.
- Another study published in 2019 reported a case of compressive peroneal neuropathy caused by an intraneural ganglion cyst, which was treated with ultrasound-guided percutaneous cyst aspiration and corticosteroid injection, resulting in regeneration of the injured peroneal nerve and improvement in ankle dorsiflexor function 4.
Anatomical Considerations
- The superficial peroneal nerve can be visualized with combined ankle plantar flexion and inversion, but its anatomical localization changes with different foot and ankle positions, making it important to consider these changes during surgical procedures such as anterior ankle arthroscopy 5.
- A study published in 2019 found that the superficial peroneal nerve moves laterally when the ankle is moved from combined plantar flexion and inversion to the neutral or dorsiflexed position, highlighting the need for careful portal placement to avoid iatrogenic damage to the nerve 5.
Peroneal Tendon Sheath Injection
- Ultrasound-guided peroneal tendon sheath corticosteroid injection can be a safe and effective treatment for chronic peroneal tendinopathy or tears, with significant pain relief reported by patients, although the duration of pain relief can vary 6.
- A study published in 2019 found that preinjection duration of symptoms was associated with postinjection duration of pain relief, and that the injection was relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery 6.