The peroneal muscle and tendons run down the outside of the lower leg and into the foot. The Peroneus brevis tendon attaches to a bone on the outside and middle of the foot. The Peroneus longus tendon runs under the foot and attaches near the inside of the arch. Together, they serve to help stabilize the foot and ankle of the human body. A peroneal nerve injury affects a major nerve in your leg known as the fibular or common peroneal nerve.
This significant nerve begins in the back part of your knee and allows you to feel the outsides of the lower legs, the tops of the feet, and the skin between the big toe and second toe. It also manages some of the muscles in the leg and the foot.
If the peroneal nerve is suddenly injured, both your legs and feet may feel numb, and you may have difficulty moving them. The peroneal nerve can be damaged by leg injuries, such as a dislocated knee, a broken bone, or surgical complications. In severe cases, there are other conditions that are considered as a peroneal nerve injury, such as:
- Peroneal nerve palsy – Peroneal nerve palsy is a condition that is caused by chronic pressure on the nerve as it passes along the side of the knee. This most often occurs in people who are confined to a bed or a wheelchair with pressure on the side of the knee. A knee injury or fracture of the lower leg may also cause this problem
- Peroneal nerve dysfunction – Peroneal nerve dysfunction is a type of peripheral neuropathy that is specific to the peroneal nerve. Damage to this nerve is most often caused by a one-time injury, such as a knee, leg, or ankle sprain or fracture; however, it can also be caused by habitual leg crossing and prolonged immobility.
Causes & Symptoms of Peroneal Nerve Injury
When a nerve is compressed, damaged, or degenerated along its path, it is called neuropathy. Peroneal nerve injury commonly occurs due to neuropathy of the following nerves:
- Common peroneal nerve – Neuropathy of this nerve may occur due to trauma to the knee, fracture of the fibula bone, pressure from tight boots or plaster, excessive weight loss, ankle sprain, or as a complication of knee surgery.
- Deep peroneal nerve – Neuropathy of this nerve may occur due to increased pressure within the muscle bundles of the leg or compartment syndrome, fracture of the leg’s tibial bone, or internal bleeding within the leg.
- Sciatic nerve – Neuropathy of the sciatic nerve may occur due to repeated injections in the hip, a complication of hip surgery, or trauma to the hip and/or pelvis.
Neuropathy of the common peroneal nerve occurs more frequently compared to other nerves in the leg. This nerve runs superficially near the knee, covered by skin and a thin layer of underlying tissue, making it vulnerable to direct injury (peroneal nerve injury).
There are several potential causes of peroneal nerve injury, such as overuse activities, surgery, instability, or any compression on the outside of the knee. Trauma and nerve compression, especially caused by a fractured or dislocated ankle, can all cause injury to the peroneal nerve. Other causes linked to this condition include:
- Fracture in the knee or leg.
- Knee dislocation.
- Hip/knee replacement surgeries.
- Compression of the peroneal nerve by a nerve sheath tumor or nerve cyst.
- Compression of the peroneal nerve.
Generally, peroneal nerve injury can affect many different parts of your body and has a variety of symptoms. Because other medical issues might produce the same exact signs as peroneal nerve damage, it is critical to see an experienced physician who can identify your problem and provide suitable treatment choices.
Furthermore, another known cause of peroneal nerve injury is from forceful and repetitive action of plantar flexion (pointing toes downward) while keeping the knee straight which can be seen in runners and ballet dancers.
Peroneal nerve injuries include a large number of symptoms that can be present prior to the injury, such as:
Nerve pain in the knee
Nerve pain in the knee can be extremely irritating and life-altering during regular activities as well as sporting events. Nerve pain located in the knee can radiate from the lumbar spine, the pelvis, or the small nerves in the knee.
Twitching / Spasms
Knee twitching and / or spasms are common occurrences that can be caused by a wide variety of factors. Normally, this symptom does not require further treatment. However, in some situations, knee twitching may be a sign of a more serious condition. Knee twitching is often accompanied by a feeling of pins and needles or tingling in the knee.
There are many possible causes of burning pain on the lateral side of the knee while kneeling. One possibility is that you may have patellofemoral syndrome, which is a condition that results in pain around the kneecap.
Knees are vulnerable to buckle, causing a sensation of one or both knees giving out that mainly affects adults. When our knees begin to feel unstable, weak, or begin to give out, it is easy to become stressed since we rely heavily on them for movement.
Who gets a Peroneal Nerve Injury?
Certain risk factors that are linked to peroneal nerve injuries include:
- Occupational laborers – Occupations such as fruit picking or other jobs that require prolonged kneeling or squatting, such as flooring or tiling may cause peroneal nerve injury due to nerve compression.
- Habitual postures – such as regular crossing of legs may lead to peroneal nerve compression near the knee and is a risk factor for another condition known as foot drop.
- Underweight – Being underweight (anorexia) can increase the chance of injuring the peroneal nerve due to the excessive loss of weight.
- Recent trauma – If you recently injured your leg from an activity, you may have a higher risk of compressing your peroneal nerve.
How Does a Peroneal Nerve Injury Affect You? How Serious is it?
Oftentimes, peroneal nerve injury may be accompanied by certain symptoms, which can indicate serious medical conditions. A few examples of serious symptoms include:
- Decreased ability to walk.
- Permanent decrease in sensation in the legs or feet.
- Permanent weakness or paralysis in the legs or feet.
- Side effects of medicines.
- Severe pain and numbness.
Recommended Treatment & Rehabilitation for a Peroneal Nerve Injury
A peroneal nerve injury can be difficult to diagnose due to several potential causes with overlapping symptoms. The diagnostic process for peroneal nerve injury includes conducting a physical exam and reviewing the medical history. If needed, additional imaging tests may be required:
- Physical examination – During a physical exam, your doctor may check for pain and numbness in the toes, feet, and leg. He or she will also check for response to certain stimuli, such as gently pressing the toes or calf region.
- Medical history – A medical history may include your doctor reviewing the onset of weakness and other symptoms, as well as any concomitant medical conditions (such as diabetes or multiple sclerosis), and trauma or injury to the back, hip, leg, or foot.
If imaging tests are needed, the first-line test for checking nerve and muscle health in the legs is electrodiagnostic testing, which includes nerve conduction study and electromyography:
- Electromyography (EMG) – In an EMG test, tiny needles are inserted into the affected muscles to test the electrical activity.
- Nerve conduction study – This imaging test involves the assessment of motor and sensory nerve conduction using electrodes that are taped on the skin of the leg. The tests help identify if the nerves in the leg are damaged.
- Magnetic Resonance Neurography (MRN) – This is an advanced and detailed medical imaging test for nerves, which may be more effective than electromyography testing.
After a diagnosis has been done, physiotherapy may be further advised. A physiotherapist will work with you by designing a special treatment plan specific to your condition and goals. Here are some treatments that will be included in your physiotherapy session:
Exercise is the primary treatment for patients with peroneal nerve injury. Strengthening exercises of the muscles within the foot and the lower limbs help maintain muscle tone. Such exercises will help strengthen and stretch the foot while returning mobility to the ankle.
Stretching exercises are also a great treatment for peroneal nerve injury. Your physiotherapist will advise you to sit on the floor, place a towel around the foot, hold onto both ends, and gently pull the towel towards them. This helps stretch the muscles of the calf and foot.
Your physiotherapist may advise a treatment regime that includes electrical stimulations of the nerves and muscle fibers. This helps generate electrical impulses within the muscles and can, to an extent, help increase the tone and contractility.
Gait training is recommended for those with gait problems. This treatment helps you walk more efficiently and improve stability by incorporating different strength and balance exercises. At times, gait training requires the use of walkers, canes, and parallel bars to safeguard you.
Once your symptoms begin to subside, your physiotherapist will design a specific exercise plan in order to ensure you maintain your full knee range of motion. The following exercise examples include:
Stand straight with your feet hip-width apart. Next, lower your bottom down and backward, as if you were going to sit in a chair. Stop when your knees reach about a 90-degree angle. Try not to lean your upper body forward more than a few inches. You may want to move your arms forward for balance or stand next to a wall, counter, or other support. Straighten your legs to return to standing straight, then repeat 2-3 times a day.
Side leg raises
Lie on your side with your injured leg on top. Slowly raise your injured leg toward the ceiling. Hold this position for 10 seconds, then repeat this method 3-4 times a day.
Laying on the floor with the ends of a resistance band or tubing in each hand, bring your knees to your chest. Put the tubing across the bottoms of your feet and take up any slack in the resistance band. Afterward, while keeping your elbows on the floor and your hands by your chest, slowly press on both legs outward, leading with your heels until your legs are straight. Gently return to a bent-knee position before repeating this exercise 3-4 times a day.
While sitting on a chair with both feet on the floor hip-width apart, slowly raise one leg out in front of you until it’s level with the floor. Then, slowly lower the same leg back to the floor and repeat 2-3 times a day.
Stand tall with feet shoulder-distance apart at the base of a set of stairs. Next, shift your weight onto one foot. Place your right foot entirely on the stop and press yourself up so that your body is up onto the step, placing the left foot next to the right foot on the stair. Slowly lower your left foot back to the floor and steady yourself. Continue this process with your right foot on the step as you repeat this method 2-3 times a day.
Alternative & Homeopathic Treatment for a Peroneal Nerve Injury
Homeopathic treatment for peroneal nerve injury depends on the cause. However, most treatments focus on reducing pain and discomfort with over-the-counter painkillers such as ibuprofen or aspirin. Here are other home remedies you can try:
- Vitamins – Some cases of peroneal neuropathy are related to vitamin deficiencies. Vitamin B is essential for your nerve health. Vitamin D can also help prevent nerve pain.
- Warm bath – Taking a warm bath can be soothing and can also alleviate pain symptoms from peroneal nerve injuries. Warm water increases blood circulation throughout the body, decreasing pain symptoms from numbness.
- Essential oils – Some essential oils, including chamomile and Roman lavender, help to increase circulation in the body. They also have pain-relieving and anti-inflammatory properties that could boost healing.