A peroneal nerve injury can be extremely serious and can cause life long debilitation. These injuries tend to be complex and difficult to treat and may involve a number of different physicians depending on the nature of the injury. Read on to find out more about the peroneal nerve, how it can be damaged and different ways it can treated.
What Is the Peroneal Nerve?
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The peroneal nerve is located in the bottom part of the leg and is connected to and works as a part of the sciatic nerve. The sciatic nerve works to supply mobility and feeling to the lower part of the leg, foot and toes. The peroneal nerve is divided into two parts but both work together. The deep peroneal, located as the name suggests, at a deeper level of the leg, supplies nerves to the superficial peroneal nerve. Damage to the peroneal nerve can result in minor loss of mobility or, in more extreme cases can result in permanent disability.
What causes Peroneal Nerve Injury?
The majority of peroneal nerve injuries are caused by trauma or come as a result of medical treatment. For example, damage can be caused from knee replacement surgery, knee dislocations and fractures.
There are a number of factors that can cause damage to the peroneal nerve and it can be something that will develop over time. Common causes include long duration of bed rest, pressure in obstetric stirrups, hyper flexion of the knee and conditioning in ballet dancers. In addition to these causes, one of the most common is habitual leg crossing. Continuous crossing of the legs compresses the peroneal nerve which can lead to damage over time.
Peroneal nerve damage is more commonly seen in those who are extremely underweight or suffering with anorexia, those who are suffering with certain autoimmune diseases or conditions or those who have nerve damage related to other medical issues like diabetes. Those who suffer from disorders that affect the nerves like Charcot-Marie-Tooth disease are also more likely to get a peroneal nerve injury.
What Are the Symptoms of Peroneal Nerve Damage?
There are a number of symptoms that are associated with peroneal nerve damage, these include weakness in the ankles or feet, toes dragging whilst walking, being unable to hold feet up and a decreased sensation (feeling numb or tingling) in upper or lower leg as well as the top of the foot.
When the peroneal nerve is impaired or under pressure the outcome can be something called foot drop. Foot drop is where the foot can can not function the same way it used to due to weakness or damage of the peroneal nerve or the fibular nerve. Those suffering with foot drop typically can find difficulty in, or will not be able to, raise their toes or the foot from the ankle.
When diagnosing a peroneal nerve injury your doctor will typically perform two kinds of tests. A physical examination will be provided to asses symptoms in more detail, the doctor will be looking to see if the patient is showing signs of muscle loss, difficulty in controlling their legs and feet or muscle loss and deterioration.
There are a number of nerve activity tests that can also be carried out in order to diagnose a peroneal nerve injury. These include having the activity in the muscles tested (Electromyography), testing how quickly electric signals can pass through your nerves (Nerve Conduction Tests) and an MRI. Blood tests, X-rays and other scans may also be recommended depending on the severity of the case and the symptoms being displayed.
Do You Need a Specialist Physician to Treat the Peroneal Nerve?
The kind of doctor needed to treat a peroneal nerve injury can be dependent on how the injury itself was obtained along with the severity of the symptoms. If you suspect you have a peroneal nerve injury see a general physician first, they will then refer you to a relevant specialist to help treat your individual case.
The kind of specialist that will be able to assist with peroneal nerve damage include the following:
- Neurologist – specializes in the treatment of the nervous system and works with patients suffering from nerve damage.
- Physiatrist – specializes in non-surgical care from nerve, muscle and bone injuries and disorders that impair normal everyday function.
- Podiatrist - specializes in treating foot and ankle injuries.
- Orthopaedic Spine Surgeon – specializes in treating conditions that affect the musculoskeletal system. Your musculoskeletal system if anything related to bones, muscles, tendons, ligaments and joints.
- Neurosurgeon - specializes in treating diseases and conditions that affect the nervous system including the spine, spinal cord, brain and the peripheral nerves. Neurosurgeons provide both surgical and non surgical treatments.
What Treatment Can Be Administered?
Peroneal nerve damage has been historically difficult to treat. The typical method of treatment would involve bracing the leg in a bid to relieve pressure and aid the return of nerve function. Extensive physiotherapy may also be prescribed for a minimum of six months but more often even longer in order to rebuild the muscle and nerve strength in the leg. However, the results of such therapies can have minimal long term benefits and results.
When is comes to treating peroneal nerve damage surgery may be recommended. There are two types of surgical procedures involving the peroneal nerve:
- Peroneal nerve decompression – this is the surgical process of decompressing the peroneal nerve. An slit is typically made in the fibula (calf bone) and connective tissue around the nerves in the leg at the side will be released to ease the pressure.
- Deep peroneal nerve decompression – this surgical procedure also involves releasing pressure in the leg. In this surgery a ligament from the “extensor digitorum brevis muscle” will be causing pain, this muscle crosses over the deep side of the peroneal nerve and is released to ease the pressure and pain in the leg.
In some extreme cases a tendon transfer surgery can be carried out which can help to restore mobility and movement in the leg and foot.
What Is the Standard Recovery Time?
Recovery time following a peroneal nerve injury is dependent on the severity of the case and the treatment that was provided.
Patients who do not have surgery to treat a peroneal nerve injury may undergo a series of intense physiotherapy treatments. Through this form of therapy, patients may find their symptoms to improve slightly but may find that they will never fully recover. The use of leg braces is also highly inconsistent, with some reporting positive results and others reporting no improvement.
Patients that undergo surgery as treatment for their nerve injury will also have an extended recovery time from the surgery of at least eight to 10 weeks. Following the surgery and extra therapy to improve and regain mobility it is possible to make a good recovery but again, it is case specific and impossible to provide one answer to recovery time. Peroneal nerve damage can be extremely difficult to treat and completely fix. Those that have obtained a more serious injury are less likely to achieve the full mobility they had prior to the injury.
Treatment of a peroneal nerve injury is not a quick one, and whether or not a patient undergoes physical therapy or has surgery a minimal time frame of eight to 10 weeks should be considered to treating minor a peroneal nerve injury. However this can extend over the period of years in more extreme cases that require extensive treatment and surgery.
Peroneal nerve damage can be caused over an extended period of time or caused by a severe trauma or injury. There are a number of symptoms that can indicate damage to the peroneal nerve all of which will be felt in the leg or foot. They include numbness, loss of control or weakness. When it comes to treating a peroneal nerve injury there is not always a clear solution. Treatment of the injury depends heavily on the severity of the injury and how the injury was obtained.
In some cases, extensive physical therapy can be successful, however in more extreme cases surgery may be offered. However, with any of the different types of treatment that may be available for peroneal nerve injury, the chances of recovering fully depend heavily on the severity of the injury prior to treatment. In some cases patients may be able to make a full recovery or suffer only minor side effects that will only alter their life slightly. Yet in more serious cases a peroneal nerve injury can result in permanent disability.
As the treatment of peroneal nerve injuries relies heavily on the nature of the injury itself, there is not one specific type of physician trained for treatment. There are a number of doctors that may be able to offer treatment for a peroneal nerve injury however, as previously stated the recovery rate with any kind of doctor that treats a peroneal nerve injury again, depends on the nature of the initial injury.