Common peroneal nerve lesions often present with foot drop and loss of sensation in the lower leg and foot. The common peroneal nerve is susceptible to injury where it passes between muscles in the leg and around the fibula bone. Injuries can occur from trauma, fractures, compression, ischemia or tight footwear and result in weakness of ankle dorsiflexion. Physical exams may show reduced foot movement and sensation loss while nerve conduction studies can identify injuries. Treatment focuses on bracing, stimulation, positioning and protective devices to prevent foot drop and sprains.

1. COMMON PERONEAL NERVE
LESIONS
Presented by
Louis law Mwadziwana

2.  Common
peroneal neuropathy is the most
common mononeuropathy encountered in the
lower limb.
 Weakness
of ankle dorsiflexion and the
resultant foot drop are common
presentations.
 It
may also present with loss of sensation
limited to the distribution of the deep or
superficial peroneal nerve or its branches

3. The common peroneal nerve is closely related to the
head and neck of the fibular.
 The nerve passes between the two heads of the
peroneus longus where it is flattened and its
constituent bundles are separated so that the nutrient
vessels are exposed and are left unprotected between
them.
 It then curves round the neck of the fibula and then
divide into its deep and superficial divisions.
 Just before the nerve enters the peroneus longus it is
held applied to bone and muscle attachments of the
deep fascia. Not only is the nerve fixed at this point it is
also angulated where it turns abruptly laterally from the
gastrocnemius to pass between the two heads of the
peroneus longus.


6.  The
above anatomical features render the
nerve and its nutrient vessels susceptible
to damage in injuries about the knee.

7.  Traction
• By posterior dislocation of the tibio-fibular joint
 Compression
• By pressure from an improperly applied plaster
 Trauma during accidents
• By fractures of the neck of the fibula
 Ischemia
• By compression ischaemia resulting from crossing
the legs or adopting an unusual posture, such as
squatting

8.  Cutaneous
sensation is impaired over the
lateral aspect of the lower leg and ankle and
dorsum of the foot.
 Reduced
dorsiflexion and eversion of the foot
and of toe extension
• The patients will compensate by having a steppage
gait.
 N.B
Inversion and plantar flexion are normal.

9.  Progressive
weakness of the peronei and
tibialis anterior muscles which result in foot
drop.
 The
peroneus longus , tibialis anterior and
the extensor digitorum wastes.
 N.B
The paresis results in ankle weakness
and predispose to ankle sprains

10. 
Deep peroneal nerve is rarely injured in the region of
the ankle

Usually injury is due to a tight-fitting rim or strap from a
shoe.

Pain in the region with minimal weakness and sensory
disturbance involving only the web space between
digits 1 and 2.

Physical exam reveals minimal abnormalities.

Nerve conduction studies demonstrate a prolonged
distal motor latency.

11.  Assistive
and adaptive devices and
equipment.
• Canes, crutches, or walkers may be used to help
prevent falling, normalize gait patterns, or unload
a painful weight-bearing limb.
 Electrical
Stimulation.
• Transcutaneous electrical nerve stimulation
(TENS) for the reduction or obliteration of pain.

12.  Positioning.
• Correct positioning of limb
 Protective
Devices and Equipment eg
splints, orthoses
 Cryotherapy,
massage

13. Sunderland S, Nerves and nerve
injuries, 2nd edition, 1978, pages 974- 977
 Mendell R et al, Diagnosis and
management of peripheral nerve
disorders, 2001, pages 621 – 625
 Apley, System of orthopaedics and
fractures, 5th edition, 1978, page 126
 M. F. REINDERS, J. H. B. GEERTZEN and J. S.
RIETMAN, Prosthetics and Orthotics
International, 1996, 20, 197-198


14. THANK YOU