Neuropathy of the peroneal nerve: causes, symptoms and treatment

Neuropathy of the peroneal nerve is a disease that develops as a result of damage or compression of the peroneal nerve. There are several reasons for this condition. Symptoms are associated with impaired conduction of impulses along the nerve to the innervated muscles and skin areas, first of all it is the weakness of the muscles that unbend foot and her fingers, as well as a violation of sensitivity on the outer surface of the shin, the back surface of the foot and her fingers. Treatment of this pathology can be conservative and operative. From this article you can learn about what causes the neuropathy of the peroneal nerve, what it manifests and how it is treated.

To understand where the disease comes from, and what symptoms it characterizes, you should read some information on the anatomy of the peroneal nerve.

A small anatomical educational program

The fibular nerve is part of the sacral plexus. Fibers of the nerve go in the sciatic nerve and separate from it into a separate common peroneal nerve at or slightly above the popliteal fossa. Here, the common trunk of the peroneal nerve is directed to the outside of the popliteal fossa, spirals around the head of the fibula. In this place it lies superficially, it is covered only with fascia and skin, which creates the prerequisites for compression of the nerve from the outside. Then the peroneal nerve splits into a superficial and deep branch. Somewhat above the place of division of the nerve is another branch, the external cutaneous nerve of the shin, which, in the region of the lower third of the shin, joins the branch of the tibial nerve, forming the calf nerve. The gastrocnemius nerve innervates the posterolateral part of the lower third of the shin, the heel, the outer edge of the foot.

The superficial and deep branches of the peroneal nerve bear such a name due to their movement relative to the thickness of the muscles of the shin. The superficial peroneal nerve provides the innervation of the muscles that provide an elevation of the outer edge of the foot, as if the rotation of the foot, and also forms the sensitivity of the rear of the foot. The deep peroneal nerve innervates the muscles that extend the foot, fingers, provides a sensation of touch and pain in the first interdigital space. The compression of one or another branch, respectively, is accompanied by a violation of the removal of the foot outward, the inability to unbend fingers and the foot, a violation of sensitivity in various parts of the foot. Accordingly, the course of the nerve fibers, the places of its division and the removal of the external cutaneous nerve of the lower leg, the symptoms of compression or damage will be slightly different. Sometimes knowledge of the innervation of the innervation of the peroneal nerves of individual muscles and skin areas helps to establish the level of compression of the nerve before using additional methods of research.

Causes of neuropathy of the peroneal nerve

The appearance of the neuropathy of the peroneal nerve can be associated with different situations. It can be:

• trauma (especially often this cause is actual in injuries of the upper-external part of the lower leg, where the nerve lies superficially and next to the fibula. Fracture of the fibula in this area can cause damage to the nerve with bone fragments. And even a gypsum bandage imposed on this occasion can cause neuropathy of the peroneal nerve. Fracture is not the only traumatic cause. Falls, blows applied to this area, can also cause the neuropathy of the peroneal nerve);
• compression of the peroneal nerve at any part of its course. These are the so-called tunnel syndromes - upper and lower. The upper syndrome develops when the common peroneal nerve is compressed in the vascular bundle with an intensive approach of the biceps femoris with the fibula head. Usually such a situation develops in persons of certain professions forced to maintain a certain position for a long time (for example, cleaners of vegetables, berries, stackers of a parquet, pipes - a pose "on the haunches") or to make repeated movements, squeezing a vascular-nervous bundle in this area (seamstresses, mannequins). Depression can be caused by the favorite "pant leg". The lower tunnel syndrome develops when the deep peroneal nerve is compressed on the ankle of the ankle under the ligament or on the rear of the foot in the base of the I bone of the metatarsal. Depression in this area is possible when wearing an uncomfortable (tight) shoe and when applying a plaster bandage;
• violations of the blood supply of the peroneal nerve (ischemia of the nerve, as if a "stroke" of the nerve);
• incorrect position of the legs (legs) with prolonged operation or severe condition of the patient, accompanied by immobility. In this case, the nerve is compressed in the place of its most superficial location;
• getting into the fibers of the nerve when performing intramuscular injection in the gluteal region (where the peroneal nerve is an integral part of the sciatic nerve);
• severe infections, accompanied by the defeat of many nerves, including the peroneal;
• toxic lesions of peripheral nerves (for example, with severe renal failure, severe diabetes, drug and alcohol use);
• oncological diseases with metastasis and nerve compression by tumor nodes.

Of course, the first two groups of causes are most often encountered. The rest cause the neuropathy of the peroneal nerve very rarely, however, they can not be discounted.

Symptoms

Clinical signs of the neuropathy of the peroneal nerve depend on the site of its defeat (along the route) and the severity of the onset.

So, with an acute injury (for example, a fracture of the fibula with displacement of the fragments and damage to the nerve fibers), all symptoms occur simultaneously, although the first days may not come to the fore in connection with the pain and immobility of the limb. With the gradual injury of the peroneal nerve (when squatting, wearing uncomfortable shoes and those detailed situations) and the symptoms will appear gradually, for some time.

All the symptoms of the neuropathy of the peroneal nerve can be divided into motor and sensory nerves. Their combination depends on the level of the lesion (for which the anatomical information was presented above). Consider the signs of neuropathy of the peroneal nerve, depending on the level of damage:

• with high compression of the nerve (in the sciatic nerve fibers, in the popliteal fossa, that is, before dividing the nerve into a superficial and deep branch) arise:

1. disturbance of sensitivity of an ante-lateral surface of a shin, a back surface of a foot. This can be the absence of sensation of touch, the inability to distinguish between painful irritation and just a touch, heat and cold;
2. painful sensations along the lateral surface of the shin and foot, which increase with squatting;
3. violation of the extension of the foot and its fingers, up to the complete absence of such movements;
4. weakness or impossibility of removing the outer edge of the foot (lifting it);
5. the inability to stand on their heels and resemble them;
6. when walking, the patient is forced to lift his leg high so that he does not cling to his fingers, when the foot is lowered first to the surface the fingers fall down, and then the whole sole, the leg when walking, excessively bends in the knee and hip joints. Such a gait is called "cock" ("horse", peroneal, steppe) by analogy with the gait of the same bird and animal;
7. the foot takes the form of a "horse": it hangs down and as if rotated inwards with the bending of the fingers;
8. at a certain length of the existence of the neuropathy of the peroneal nerve develops weight loss (atrophy) of the muscles along the anterior-lateral surface of the tibia (estimated in comparison with the healthy limb);

• when the external cutaneous nerve of the lower leg is compressed, extremely sensitive changes occur (decrease in sensitivity) along the external surface of the shin. This may not be very noticeable, because the external cutaneous nerve of the leg is connected to the branch of the tibial nerve (the fibers of the latter take the role of innervation on themselves);
• damage to the peroneal peroneal nerve has the following symptoms:

1. pains with a shade of burning in the lower part of the lateral surface of the shin, on the rear of the foot and the first four toes of the foot;
2. decrease in sensitivity in these areas;
3. weakness in the removal and elevation of the outer edge of the foot;

• defeat of the deep branch of the peroneal nerve is accompanied by:

1. weakness of extension of the foot and her fingers;
2. a slight dangling of the foot;
3. a sensitivity disturbance at the rear of the foot between the first and second fingers;
4. with the prolonged existence of the process - atrophy of the small muscles of the rear of the foot, which becomes noticeable in comparison with a healthy foot (the bones protrude more clearly, the interdigital spaces sink).

It turns out that the level of lesion of the peroneal nerve clearly determines those or other symptoms. In some cases, it is possible to selectively violate the extension of the foot and its fingers, in others - to lift its outer edge, and sometimes - only sensitive disorders.

Treatment

Treatment of the neuropathy of the peroneal nerve is largely determined by the cause of its occurrence. Sometimes the replacement of a cast bandage, which squeezes the nerve, becomes the main method of treatment. If the reason is uncomfortable shoes, then her shift also contributes to recovery. If the cause in the existing concomitant pathology (diabetes, oncological disease), then in this case it is necessary to treat, in the first place turn, the main disease, and the remaining measures to restore the peroneal nerve will already be indirect (although mandatory).

The main medications used to treat the neuropathy of the peroneal nerve are:

• nonsteroidal anti-inflammatory drugs (Diclofenac, Ibuprofen, Xefokam, Nimesulid and others). They contribute to the reduction of pain syndrome, relieve edema in the nerve area, remove signs of inflammation;
• vitamins of group B (Milgamma, Neurorubin, Kombilipen and others);
• means for improving conduction along the nerve (Neuromidine, Galantamine, Proserin and others);
• preparations for improving the perfusion of the peroneal nerve (Trental, Cavinton, Pentoxifylline and others);
• antioxidants (Berlition, Espa-Lipon, Tiogamma and others).

Actively and successfully in complex treatment methods of physiotherapy are used: magnetotherapy, amplipulse, ultrasound, electrophoresis with medicinal substances, electrostimulation. Recovery is facilitated by massage and acupuncture (all procedures are selected individually, taking into account the contraindications available to the patient). Complexes of physiotherapy exercises are recommended.

To correct the "cock" gait use special orthoses, which fix the foot in the correct position, preventing it from hanging.

If conservative treatment does not work, then they resort to surgery. Most often it is necessary to do this with traumatic damage of the fibers of the peroneal nerve, especially with a complete break. When nerve regeneration does not occur, conservative methods are powerless. In such cases, the anatomical integrity of the nerve is restored.The earlier the operation is performed, the better the prognosis for recovery and recovery of the peroneal nerve function.

Operative treatment becomes a rescue for the patient and in cases of significant compression of the peroneal nerve. In this case, the structures that pinch the peroneal nerve are dissected or removed. This helps to restore the passage of nerve impulses. And then, with the help of the above conservative methods, the nerve is "brought" to full recovery.

Thus, the neuropathy of the peroneal nerve is a disease of the peripheral system, which can occur for various reasons. The main symptoms are associated with a violation of sensitivity in the shin and foot area, as well as the weakness of extension of the foot and its fingers. Therapeutic tactics largely depends on the cause of the neuropathy of the peroneal nerve, determined individually. One patient has enough conservative methods, the other may need both conservative and surgical intervention.

Educational film "Neuropathies of peripheral nerves. Clinic, features of diagnosis and treatment "(from 2: 3):

Neuropathy of peripheral nerves. Clinic, the basis of diagnosis and treatment.

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