Peroneal nerve paresis is caused by mechanical pressure damage to the common peroneal nerve, which carries both motor and sensory nerve fibers in the lower leg. The cardinal symptom of paresis, in addition to stepper gait, is sensory disturbances in the area of the lateral lower leg. The treatment consists of targeted physiotherapy and protection of the nerve in the knee area.
What is peroneal palsy?
The Nervus fibularis communis – the “common fibula nerve” – is also known as Nervus peroneus communis and is a derivative of the Nervus sciaticus. In addition to somatomotor fibers, the nerve carries general somatosensory nerve fibers. The nerve tract runs medial to the musculus biceps femoris to the head of the fibula and migrates into the fibularis box, where the nerve divides into the terminal branches Nervus fibularis superficialis and Nervus fibularis profundus. See electronicsencyclopedia for Slang Kwashiorkor.
The common fibular nerve supplies some extensors of the lower leg with motor nerve fibers, among other things, and thus plays an important role in the extension of the legs. The term peroneal nerve paresis summarizes lesions of the common fibular nerve.
Paresis is essentially paralysis of the muscles, which can be caused by lesions in the motor nerve fibers. In addition to signs of paralysis, a lesion in the common fibular nerve can result in sensory disturbances, since the nerve also contains sensitive fibers.
The common peroneal nerve is relatively exposed in the region of the head of the fibula. For this reason, the nerve in this area in particular is extremely susceptible to damage that can occur as a result of mechanical pressure. Little muscle and fat tissue or rapid weight loss are risk factors for peroneal nerve palsy.
In most cases, however, the cause of paresis is a fracture of the fibula. A poorly padded lower leg cast can also put pressure on the fibula head and the adjacent common peroneal nerve. Peroneal nerve paresis can also occur as part of the compartment syndrome.
If you have little muscle and fat tissue, you can cause damage to the nerve tract even if you cross your legs for a long time. In individual cases, ganglions, neurinomas, tumors and Baker’s cysts can also cause peroneal nerve paresis. All of the above causes have in common the mechanical pressure on the exposed nerve tract.
Symptoms, Ailments & Signs
The nervus peroneus communis – the “common calf nerve” – supplies not only the musculus peroneus longus – the “long fibula muscle” – the musculus peroneus brevis – the “short fibula muscle” -, the musculus tibialis anterior – the “front shinbone muscle” – and the musculus extensor digitorum longus – the “long toe extensor” – as well as the musculus extensor hallucis longus – the “long big toe extensor” -, the musculus extensor digitorum brevis – the “short toe extensor” – and the musculus extensor hallucis brevis – the “short big toe extensor”. motor nerve fibers.
The sensitive innervation of the nerve tract plays a role for the lateral lower leg region and the back of the foot. With peroneal nerve palsy, patients suffer from a partial or complete failure of the common peroneal nerve, which usually causes paralysis of the foot and toe flexor muscles.
The leading symptom of the clinical picture is therefore a stepping gait, whereby the foot can often only be positioned to a small extent. Since the affected nerve also carries sensory fibers, pressure damage often leads to sensory disturbances on the lateral lower leg and in the area of the back of the foot. The severity of the symptoms depends on the extent of the mechanical damage.
Diagnosis & course of disease
At the beginning of the diagnosis there is a thorough anamnesis with a neurological examination. The damaged nerve in the area of the head of the fibula usually shows tenderness on pressure. This phenomenon is known as Tinel’s sign and gives the neurologist the first indication of peroneal nerve paresis. Electroneurography shows conduction delays.
In terms of differential diagnosis, the paresis must be distinguished from an L5 syndrome, which would also be associated with pain in the affected area and a weakening of the tibialis posterior reflex. There is a favorable prognosis for patients with peroneal nerve palsy. Depending on the extent of the damage, full muscle function can be restored within a few days to months.
Due to peroneal nerve paresis, patients primarily suffer from various sensory disturbances and disturbances of sensitivity. The patient’s quality of life is significantly restricted and reduced due to the disorders, so that there can be considerable restrictions and complaints in everyday life. As a rule, it cannot be universally predicted whether complete healing will occur.
The patients mainly suffer from restricted mobility, so that they may also be dependent on the help of other people in their lives. Pain in the knees or legs can also occur as a result of peroneal nerve paresis and continue to have a negative impact on quality of life. The further course of peroneal nerve paresis depends very much on the type and origin of the damage to the nerves.
It cannot be universally predicted whether this will lead to complete healing. Treatment for this condition usually depends on the cause. Surgical interventions are possible. However, the affected person is also dependent on various therapies in order to increase his mobility again. The life expectancy of the patient is not negatively influenced by the peroneal nerve palsy.
When should you go to the doctor?
Peroneal nerve paresis should always be examined by a doctor. If there is no examination and medical treatment, peroneal nerve palsy can lead to irreversible damage and complications that can make life much more difficult for the person affected. A doctor should be consulted if there is severe pain in the feet and thus limitations in movement. Especially after an accident, a doctor should be consulted if there is paralysis or pain in the foot or the back of the foot.
The pain can also occur at night, which can lead to difficulty sleeping and irritability. Life expectancy itself is usually not negatively affected by peroneal palsy if the accident only affected the foot region. Peroneal nerve paresis can be diagnosed by a sports doctor, an orthopedist or in the hospital. However, further treatment depends heavily on the extent of the damage, so that surgical intervention may be necessary.
Treatment & Therapy
Treatment of patients with peroneal nerve palsy depends on the primary cause of the damage. Underlying diseases must be recorded in the diagnostics in order to be able to start a causal therapy. If, for example, a tumor or a Baker’s cyst is responsible for the pressure injury, the growth must be resected as quickly as possible.
The sooner the pressure on the muscle is released, the more likely the patient is to fully recover. If there is no underlying disease and the pressure injury occurred as a result of an accident, physiotherapy is the focus of treatment. Muscle strength is restored in the affected area in targeted physiotherapeutic sessions.
If the pressure damage to the nerve is extremely pronounced, a peroneus splint can be prescribed. Further pressure damage to the nerve must be avoided as a matter of urgency. For this reason, patients are advised against kneeling activities, for example.
Since pressure damage or at least strain on the common peroneal nerve can also occur in the course of certain movements or sports activities, the patient must be informed about permissible and impermissible types of movement. A basic protection of the nerve is indicated for the time after the damage so that the nerve tracts can recover from the lesions. Electrical stimulation of the damaged pathways can be part of the therapy in individual cases.
Outlook & Forecast
The further course of a peroneal nerve palsy cannot generally be predicted. This depends very much on how badly the nerves of the person concerned were damaged and whether they can be repaired again. However, early diagnosis of this disease and subsequent treatment always have a very positive effect on the further course of the disease and can also prevent the occurrence of further complications or symptoms. For this reason, those affected by peroneal nerve paresis should consult a doctor as early as possible and also initiate treatment.
If the disease is not treated, the affected nerves can die off completely, resulting in permanent sensory disturbances or tingling. These complaints have a very negative effect on the quality of life of those affected and can significantly reduce it. The symptoms can be alleviated and limited by measures of physiotherapy or physiotherapy . However, a complete cure is not always possible. In some cases, the symptoms can also be alleviated by electrical stimulation. Peroneal nerve paresis does not limit the life expectancy of those affected. It is also possible that the patient’s full muscular strength cannot be restored.
Peroneal nerve paresis can only be prevented to the extent that pressure damage to the common peroneal nerve can be avoided. The nerve is extremely exposed, especially in the knee area. Therefore, kneeling activities and other stresses on the nerve in the knee area should be avoided to prevent paresis.
The same goes for crossing your legs. Peroneal nerve paresis cannot be completely ruled out by these preventive measures, but the general risk of the disease can at least be minimized by this approach.
In the case of peroneal nerve palsy, patients usually have very few or no special follow-up measures available. First and foremost, a doctor should be consulted at an early stage so that the symptoms do not worsen further or other complications occur. The sooner a doctor is consulted, the better the further course of the disease.
Most of those affected are dependent on physiotherapy or physiotherapy for this disease. Those affected should also carry out the exercises from such a therapy at home in order to accelerate healing and to expose the body to less stress. As a rule, the activity that caused the peroneal nerve palsy should be avoided, which can also be a sporting activity.
Ideally, those affected should no longer kneel down. Sometimes they are dependent on the help of other people in everyday life. The disease usually does not reduce the life expectancy of the person affected. Sometimes patients also need psychological support to prevent depression or other mental upsets.
You can do that yourself
Adequate protection of the knee is particularly important for patients with peroneal nerve paresis. Heavy physical strain on the knee should be avoided as a matter of principle. Sports activities should also be chosen according to the needs of the organism. All sports that contribute to heavy use of the knee should be avoided. They include long-distance runners, athletics and ball sports.
When the first complaints and irregularities of the musculoskeletal system appear, periods of rest and protection of the knee are essential. Techniques learned in physiotherapy, which contribute to relieving the knee in everyday life, should be used independently. In particular, locomotion or the carrying and lifting of heavy objects must be optimized.
Since peroneal nerve paresis leads to sensory and sensitivity disorders, it is particularly important to deal with the symptoms and inconveniences correctly. The use of mental techniques and relaxation methods have proven to be helpful for a large number of those affected. Through yoga or meditation, patients are able to better deal with the symptoms in everyday life. Cognitive training also helps to reduce stress and to cope better emotionally with the disease.
Since full recovery is not achieved in some cases, psychotherapy should be considered. This helps with the mental change in lifestyle due to the changed circumstances.