Peroneal neuropathy is the most common compressive neuropathy of the lower extremity. It should be included in the differential diagnosis for patients presenting with
foot drop, the
pain of the lower extremity, or
numbness of the lower extremity. Symptoms of
peroneal neuropathy may occur due to compression of the common peroneal nerve (CPN), superficial peroneal nerve (SPN), or deep peroneal nerve (
DPN), each with different clinical presentations. 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. Accurate and timely diagnosis of any
peroneal neuropathy is important to avoid progression of nerve injury and permanent nerve damage. The diagnosis is often made with physical exam findings of decreased strength, altered sensation, and gait abnormalities. Motor nerve conduction studies, electromyography studies, and diagnostic
nerve blocks can also assist in diagnosis and prognosis. First-line treatments include removing anything that may be causing external compression, providing stability to unstable joints, and reducing
inflammation. Although many
peroneal nerve entrapments will resolve with observation and activity modification, surgical treatment is often required when entrapment is refractory to these
conservative management strategies. Recently, additional options including microsurgical
decompression and percutaneous peripheral nerve stimulation have been reported; however, large studies reporting outcomes are lacking.