Fortier LM, Markel M, Thomas BG, Sherman WF, Thomas BH, Kaye AD.

An Update on
Peroneal Nerve Entrapment and Neuropathy. Orthopedic Reviews. 2021;13(2).
doi:10.52965/001c.24937

Reviews

An Update on Peroneal Nerve Entrapment and Neuropathy

a
Luc M. Fortier, BA 1 , Michael Markel, BS 1, Braden G. Thomas, BS 2, William F. Sherman, MD, MBA 3, Bennett H. Thomas,
BS 2, Alan D. Kaye, MD, PhD 4
1School of Medicine, Georgetown University, 2 School of Medicine, Louisiana State University Health Science Center Shreveport, 3 Department of
Orthopaedic Surgery, Tulane University, 4 Department of Anesthesiology, Louisiana State University Health Science Center Shreveport
Keywords: neuropathy, compression, entrapment, peroneal nerve
https://doi.org/10.52965/001c.24937

Orthopedic Reviews
Vol. 13, Issue 2, 2021

Peroneal neuropathy is the most common compressive neuropathy of the lower extremity.
It should be included in the differential diagnosis for patients presenting with foot drop,
the pain of the lower extremity, or numbness of the lower extremity. Symptoms of
peroneal neuropathy may occur due to compression of the common peroneal nerve
(CPN), superficial peroneal nerve (SPN), or deep peroneal nerve (DPN), each with
different clinical presentations. The CPN is most commonly compressed by the bony
prominence of the fibula, the SPN most commonly entrapped as it exits the lateral
compartment of the leg, and the DPN as it crosses underneath the extensor retinaculum.
Accurate and timely diagnosis of any peroneal neuropathy is important to avoid
progression of nerve injury and permanent nerve damage. The diagnosis is often made
with physical exam findings of decreased strength, altered sensation, and gait
abnormalities. Motor nerve conduction studies, electromyography studies, and diagnostic
nerve blocks can also assist in diagnosis and prognosis. First-line treatments include
removing anything that may be causing external compression, providing stability to
unstable joints, and reducing inflammation. Although many peroneal nerve entrapments
will resolve with observation and activity modification, surgical treatment is often
required when entrapment is refractory to these conservative management strategies.
Recently, additional options including microsurgical decompression and percutaneous
peripheral nerve stimulation have been reported; however, large studies reporting
outcomes are lacking.

INTRODUCTION clinical presentation, diagnosis, and treatment options.

As the most common compressive neuropathy of the lower EPIDEMIOLOGY

extremity, peroneal neuropathy, also known as fibular neu-
ropathy, is a consideration for any differential diagnosis in- Peroneal neuropathy is the most common compressive neu-
volving foot drop, the pain of the lower extremity, or numb- ropathy of the lower extremity.4 It is also the third most
ness of the lower extremity.1 Commonly, it affects athletes common focal neuropathy overall, after median and ulnar
and may hinder athletic performance.2 Peroneal neuropa- neuropathies. After high tibial osteotomies in conjunction
thy also affects the quality of life for those in occupations with fibular osteotomies, patients reported a 2-27% inci-
requiring significant squatting or kneeling.3 Understanding dence of peroneal neuropathy.1 Additionally, peroneal
the origin, prevalence, and causes of peroneal neuropathy nerve palsy exists in 0.3-1.3% of those who have undergone
is imperative to holistic care for all patients experiencing total knee arthroplasty.5 For knee dislocations due to high
lower extremity pain or weakness. This review aims to sum- energy trauma, 16-40% of patients were found to have com-
marize the current literature on peroneal neuropathy as mon peroneal nerve injury.6
it pertains to epidemiology, risk factors, pathophysiology, Children may also experience peroneal neuropathy. In a

a Corresponding Author:
Luc M. Fortier
Georgetown University School of Medicine
3900 Reservoir Road NW
Washington, DC 20007
Phone: (310) 254-6534
[email protected]
 An Update on Peroneal Nerve Entrapment and Neuropathy

case series examining 17 pediatric subjects with peroneal nerve then wraps around the bony prominence of the fibula,
neuropathy, the common peroneal nerve was most often in- a location that is susceptible to compression. Both the deep
jured in children (59%), followed by the deep (12%) and su- and superficial peroneal nerves arise from the common per-
perficial (5%) peroneal nerves. Twenty-four percent of chil- oneal nerve after it encounters the fibula.5 Symptoms of
dren in the study did not have a localizable level of injury.7 peroneal neuropathy may occur due to compression at the
Thus, peroneal neuropathy affects all ages and is a signifi- common, superficial, or deep, with slightly different clinical
cant cause of lower extremity weakness and pain. presentations for each.

RISK FACTORS COMMON PERONEAL NERVE (CPN)

The lateral leg compartment contains a fascial layer, known

Risk factors for peroneal neuropathy are most commonly
as the posterior crural intermuscular septum, deep to the
secondary to traumatic causes, followed by behavioral
peroneus longus muscle.15 This septum may compress the
causes.1 Traumatic causes of peroneal neuropathy, such as
nerve as the CPN passes underneath to enter the lateral
knee dislocations and fibular fractures, cause direct injury
compartment of the leg. Such compression results in the
to the nerve with poorer overall outcomes.
symptoms of CPN neuropathy.
Behavioral causes such as prolonged maintenance of a
crossed-leg posture or repetitive stretch from squatting
SUPERFICIAL PERONEAL NERVE (SPN)
may produce a peroneal nerve palsy with an acute presen-
tation.3 Weight loss also may induce peroneal neuropathy After the division of the common peroneal nerve into the
as one case series found that 20% of 150 subjects who ex- deep and superficial branches, the SPN travels in the lateral
perienced a mean of 10.9 kilograms (kg) of weight loss ex- compartment of the leg. Here, it passes anteroinferior be-
perienced peroneal nerve neuropathy.8 Bilateral peroneal tween the peroneus longus, peroneus brevis, and extensor
mononeuropathy was seen in patients undergoing extreme digitorum longus muscles. Upon reaching the lower third of
weight loss, and it was also noted in 10% of World War II the leg, the SPN pierces the crural fascia to exit the lateral
prisoners that had lost 5-11 kg.9 compartment of the leg and travels within subcutaneous
Surgeries including total knee arthroplasty, especially in fat.16 SPN entrapment most commonly occurs here as it ex-
the setting of a preoperative valgus knee, commonly report its the lateral compartment.17 The SPN then bifurcates into
postoperative peroneal symptoms. Carender et al. recently the intermediate (IDCN) and medial (MDCN) dorsal cuta-
performed a systematic review. They reported the incidence neous nerves.16
of common peroneal nerve injury and dysfunction after to- Athletes and dancers often experience compression of
tal knee arthroplasty (TKA) is 0.4 % and found that 66% of the SPN before it penetrates the crural fascia or at the pene-
cases with incomplete CPNP after TKA went on to complete tration point, causing SPN mononeuropathy. Forced inver-
recovery without surgical intervention. However, only 39% sion and foot plantar flexion could lead to SPN overstretch-
of patients with a complete CPNP after TKA had a complete ing and injury at its exiting point through the deep fascia.
recovery.10 Risk factors for postoperative palsy include the Recurrent stretch and inversion injuries and repetitive an-
use of epidural anesthesia, preoperative valgus deformity, kle sprains or even soft masses, like ganglia, may also in-
preoperative flexion contracture, higher body mass index, duce compression nerve injury of the SPN.16 SPN mononeu-
and history of diabetes mellitus.11–13 Due to the poor func- ropathy may also occur secondary to direct trauma, fibular
tional outcomes, common peroneal nerve neurolysis has fracture, tight-fitting legwear, fascial defects, or muscle
been proposed as a potential treatment for CPNP after TKA herniation.17
with variable results warranting further study.14
Diabetes may also predispose patients to peroneal neu- DEEP PERONEAL NERVE (DPN) – ANTERIOR TARSAL
ropathy as the deposition of sorbitol into nerves causes TUNNEL SYNDROME
neural edema, leading to compression.15 High tibial and
distal femoral osteotomies may also cause peroneal neu- Anterior Tarsal Tunnel Syndrome (ATTS) is the specific
ropathy by increasing the strain of the common peroneal name for the uncommon pathology of the DPN. The DPN
nerve after an alignment change. Additionally, surgery po- becomes entrapped between the extensor retinaculum on
sitioning with stirrups and immobilization with casting or the top of the ankle and the navicular and talus bones be-
orthoses have also been documented as a cause of peroneal neath.18 The most common cause of ATTS is trauma to the
neuropathies.4 Mass occupying lesions, such as ganglion dorsum of the foot. Trauma can lead to the formation of
cysts, may also play a role in the etiology of this neurologi- fibrosis, adding further compression. Talonavicular osteo-
cal deficit.1 phytosis, localized edema, high-heeled shoes, and ganglion
cysts are other possible contributors to this syndrome.18
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
The peroneal nerve arises from the L4, L5, S1, and S2 nerve
roots. These nerve roots travel through the lumbosacral The clinical presentation of peroneal neuropathy varies de-
plexus to form the sciatic nerve.4 The sciatic nerve courses pending on the location of nerve injury or compression. A
through the posterior thigh, where it branches into the tib- physical exam analyzing strength, sensation, and gait can
ial and common peroneal nerves.1 The common peroneal localize the specific nerves affected.

Orthopedic Reviews 2
 An Update on Peroneal Nerve Entrapment and Neuropathy

COMMON PERONEAL NERVE (CPN) COMMON PERONEAL NERVE (CPN)

Clinical presentation of CPN neuropathy includes weakness Aside from the clinical presentation of CPN neuropathy de-
of ankle dorsiflexion, great toe extension, foot eversion, and scribed in the previous section, the diagnosis may be aided
sensory loss to the dorsum of the foot. The severe inability by eliciting a Tinel’s sign or performing a diagnostic nerve
to dorsiflex and evert the foot is known as foot drop. It may block.22 Motor nerve conduction studies are another helpful
result in a steppage gait, which refers to increased hip flex- tool for diagnosis for localization. A recording electrode is
ion of the affected extremity during the swing phase.15 Foot placed over the extensor digitorum brevis, and the nerve is
drop can develop acutely or gradually over the course of stimulated at three separate locations: the anterior ankle,
several weeks, varying in severity.19 Patients suffering from fibular head, and popliteal fossa.23 A needle electromyo-
sensory impairments may have burning, tingling, numb- graphy (EMG), on the other hand, is necessary to assess
ness, and pain from the anterolateral aspect of the leg from the severity of the injury and can guide prognosis. An EMG
just below the nerve tunnel to the dorsal aspect of the should examine at least the tibialis anterior, peroneus
foot.15 longus, and biceps femoris. However, an EMG examining
other L4 to L5 and sciatic muscles can be tested in addition
SUPERFICIAL PERONEAL NERVE (SPN) to differentiating a CPN mononeuropathy from sciatic neu-
ropathy, lumbosacral plexopathy, and lumbar radiculopa-
Superficial peroneal nerve abnormalities are rarely present thy.23
in isolation. Early in the course of SPN neuropathy, there For cases without a clear etiology, ultrasound offers a
may only be symptoms during exercise.16 The SPN inner- less expensive and non-invasive option to guide treatment.
vates the fibularis longus and fibularis brevis muscles and Unlike electrodiagnostic studies alone, ultrasound can de-
relays sensory information from the dorsum of the foot and tect anatomic causes such as scarring, lesions, bone frag-
anterolateral leg.17 Consequently, great toe extension and ments infiltration, and movement tethering nerves. Con-
ankle dorsiflexion strength should be normal. However, tralateral comparison is often helpful in determining
weakness with foot eversion will likely be present.1 De- injury.24
creased or abnormal sensation in the lower lateral leg, and
the dorsum of the foot indicates involvement of the SPN or SUPERFICIAL PERONEAL NERVE (SPN)
the portion of the sciatic nerve in those areas.20 Alterna-
tively, there may be burning pain at the anterolateral leg SPN mononeuropathy is a relatively rare phenomenon.16
and dorsum of the foot, with pressure at the entrapment Symptoms may present similarly to CPN neuropathy, lateral
point eliciting retrograde pain. Sensation deficits in the first leg compartment entrapment syndrome, or L5 radiculopa-
dorsal web space and fifth toe are spared in SPN mononeu- thy, so it is important to rule these pathologies out before
ropathy.16 making a definite diagnosis.
Physical exam sensory findings sparing the dorsum of
DEEP PERONEAL NERVE (DPN) – ANTERIOR TARSAL the first web space and motor findings sparing weakness
TUNNEL SYNDROME of great toe extension and ankle dorsiflexion can assist in
the localization of CPN entrapment. Patients with muscle
DPN mononeuropathy is unique in that it may present with herniation or a fascial defect may also display a mass or
few symptoms or none at all.18 The DPN innervates the tib- swelling at the site of insult that worsens with use. An in-
ialis anterior, extensor digitorum longus, extensor hallu- jection of anesthetic to the area of suspicion with relief of
cis longus, fibularis tertius, and extensor digitorum brevis symptoms can confirm a suspected diagnosis.25
muscles. As a result, weakness of these muscles can indicate
a DPN palsy. The nerve also relays sensory information DEEP PERONEAL NERVE (DPN)
from the first web space; thus, paresthesias that radiate to
the first web space may also occur.17,20 Additionally, pa- Radiographic imaging is important for diagnosing DPN
tients with DPN neuropathy may present with anterior an- neuropathy specifically as the most common causes are sec-
kle or deep dorsal midfoot pain or dull aching that is worse ondary to nerve impingement by osteophytes and trauma.17
with activity and shoe wear. Symptoms may be evoked with Furthermore, symptoms of DPN neuropathy may be evoked
forced plantar or dorsiflexion.17 with forced plantar or dorsiflexion and/or a positive Tinel
In the rare setting of a deep peroneal neuropathy in con- sign over the site of entrapment. The precise site of com-
junction with an accessory deep fibular nerve completely pression can also be located by a nerve block of the affected
innervating the extensor digitorum brevis (EDM) muscle, area.25
foot drop with preserved toe extension can be seen.1
CONSERVATIVE TREATMENT
DIAGNOSIS
Treatment of peroneal nerve injuries varies based on the
Accurate and timely diagnosis of any peroneal neuropathy etiology and severity of symptoms. When left untreated,
is essential to avoid symptoms or irreversible nerve damage peroneal nerve palsy can progress to foot drop, limb dis-
progression.21 Diagnosis is made by patient history and ability, and eventually limb deformity. However, partial or
clinical examination, which may vary depending on the lo- full function often resolves over time, so initial treatment
cation and nerve involved. of a peroneal nerve palsy is nonsurgical with bracing and

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 An Update on Peroneal Nerve Entrapment and Neuropathy

observation. These initial non-invasive treatment options SURGICAL TREATMENT

include lifestyle modification and changes in activities that
trigger neuropathy.19 COMMON PERONEAL NERVE
The most common and effective nonsurgical treatment
When CPN entrapment is either refractory to nonsurgical
options for CPN have been physical therapy maneuvers with
treatment options or causes a severe reduction in conduc-
nerve gliding and nerve flossing.21 Padding of the fibular
tion such as a secondary mass effect or laceration, surgical
head is another indirect trauma injury option and can work
decompression or repair is the mainstay treatment op-
at night to prevent compression while sleeping.19
tion.30 CPN decompression has been shown to rapidly and
Management of an SPN palsy should be tailored to the
significantly improve drop foot and increase ankle stability
etiology. Conservative initial treatment is indicated, includ-
in those suffering from entrapment.31 Decompression is
ing physical therapy, appropriate footwear, limited injec-
typically performed under a microscope by carefully tran-
tions, and rehabilitation for ankle instability.17 For injuries
secting the two layers of fascia surrounding the nerve prox-
that include muscle weakness, strengthening of the dorsi-
imally and distally to the fibular neck, where CPN injury
flexors and evertors is indicated. If the muscle weakness is
most commonly occurs.2,31–33
severe, electrical stimulation can assist in the contraction of
In a prospective study consisting of 15 patients with CPN
the weakened muscles.19 Orthotic intervention is another
entrapment, 14 patients underwent surgical decompression
option for isolated SPN neuropathies and includes a lateral
after the failure of medical management.32 Of the 14 pa-
wedge shoe insert to decrease supination of the foot. Ankle
tients who underwent surgical decompression, 13 improved
foot orthosis is also indicated for DPN neuropathy and an-
motor function immediately after surgery and at 1, 6, and
kle dorsiflexor weakness.26
12 months postoperatively. At the same time, 7 also re-
An alternative treatment to consider before surgical in-
ported full recovery of motor function at 12 months post-
tervention includes hydrodissection.27 Treatment involves
operatively.32 A retrospective review of a prospective data-
injecting a nonirritating solution around the nerve to re-
base of patients with CPN palsy due to various etiologies
duce the pressure from surrounding structures. These solu-
showed clinical improvement in 28 of 30 patients who un-
tions include saline, anesthetics, steroids, plasma, and dex-
derwent neuroplasty and decompression.33 Another study
trose. The main functions of this treatment are to release
that reviewed subjects with CPN compression and foot drop
soft tissue adhesions that cause entrapment and restore
secondary to weight loss showed an 85% success rate in pa-
the nerve’s function. Hydrodissection has been used in con-
tients receiving external neurolysis at the fibular head.34 A
junction with ultrasound to guide the placement of the in-
recent retrospective analysis of 35 patients undergoing mi-
jection.27
croneurolysis and nerve decompression resulted in only 1
poor outcome, indicated by the inability to dorsiflex the an-
MINIMALLY INVASIVE TREATMENT kle to 90 degrees.35 Overall, surgical decompression effec-
tively treats CPN entrapment, with some studies showing a
A less invasive option for CPN surgical treatment was re- positive correlation between decreased time to surgery and
cently described by Morimoto et al., in which 33 legs were improved outcomes.32
treated with microsurgical decompression under local anes-
thesia.28 No sedatives were used during the procedure so SUPERFICIAL PERONEAL NERVE
that symptom improvement could be monitored intraoper-
atively. Upon decompression with dissection of the fibrous SPN entrapment is less common than CPN entrapment, and
band between the superficial head of the peroneus longus studies show that most patients who undergo decompres-
and soleus, all 22 patients reported symptom relief. There sive surgery for SPN entrapment have previously undergone
were no reported postoperative complications or symptom surgery for CPN entrapment.36 SPN entrapment is a com-
recurrence during the mean postoperative follow-up period monly missed diagnosis; therefore, surgeons working dis-
of 40 months.28 tally to the knee must be aware of the technical maneuvers
The superficial course of the SPN <1 cm deep to the der- and be familiar with the anatomy of the peripheral nerves
mis makes it particularly susceptible to injury and compres- in the lower extremity.37 Decompression of the SPN is per-
sion; nonetheless, it also makes it a candidate for peripheral formed where the nerve exits the lateral compartment and
nerve stimulation (PNS).29 Consequently, percutaneous should extend to include its terminal nerve branches.2,38
PNS is an alternative minimally invasive treatment method A small study of 5 patients, previously treated with sur-
for certain pain manifestations of peroneal neuropathy. A gical decompression of CPN entrapment, all showed im-
common target for SPN lead placement is in the distal leg, provement of symptoms immediately after SPN surgical de-
just proximal to the lateral malleolus. With ultrasound compression.36 Of these 5 patients, entrapment symptoms
guidance for lead implantation, nerve leads may be placed recurred in one patient who required additional complete
more accurately, resulting in increased pain relief using nerve decompression with no further return of symptoms.36
percutaneous PNS. Although large studies reporting out- A more extensive study of 54 patients undergoing SPN de-
comes from treatment with this modality are lacking, the compression showed 69% of subjects reported some im-
development of new percutaneous PNS systems and the use provement in the effect of pain on quality of life, with a pos-
of ultrasound for lead implantation have rapidly expanded itive correlation between pain severity and improvement
and offered a potential treatment option.29 with surgery.39 An additional study reported an 85% success
rate with SPN nerve decompression.38 The authors note
that failure of surgical decompression in those with chronic

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 An Update on Peroneal Nerve Entrapment and Neuropathy

nerve pain may be secondary to the centralization of pain also reported and treated with simple surgical resection of
over time.38 In these cases, pain management specialists the lesion.55
and biopsychologists are recommended to improve the suc-
cess of surgical decompression.38 SUPERFICIAL PERONEAL NERVE

DEEP PERONEAL NERVE Case reports of SPN entrapment are similar to CPN entrap-
ment in presentation, diagnosis, and treatment. Multiple
Compression of the DPN, known as ATTS, can be surgically cases involved muscle herniation leading to SPN compres-
treated with either an open or arthroscopic approach.40 sion; 12 cases of peroneus brevis herniation, and one of
Surgical approach involves an incision in the dorsum of the tibialis anterior herniation, all of which were treated with
foot and releasing the nerve from the inferior extensor reti- surgical nerve decompression via fasciotomy.56–58 Another
naculum to its entry into the deep fascia. It is also essential case reported nerve entrapment due to herniation, but in
to remove any associated osteophytes.41 In a study of 13 pa- this case, the SPN herniated with the peroneal muscles
tients who underwent surgical decompression of the DPN, through a fascial tear, requiring surgical fasciotomy to re-
6 underwent an endoscopic procedure, and 7 underwent lease the intrafascial septum.59
an open procedure.40 Twelve of the 13 patients reported SPN compression due to ganglion cysts were seen in a
significant improvement in condition, with no complica- case report of a young female dancer, requiring surgical cyst
tions.40 Another study of 18 patients undergoing surgical removal and nerve decompression to enable the patient to
release of the DPN reported excellent results in 60% and return to dancing.60 Another case report described entrap-
good results in 20%, while only 20% of patients showed no ment due to an SPN schwannoma, in which surgical re-
improvement.42 An additional study of 7 patients showed moval of the schwannoma resulted in symptom resolution.
immediate and lasting pain relief in 6 cases following sur- One unusual etiology of SPN entrapment was reported in a
gical DPN release, with recurrence of symptoms and sec- patient with a distal fibular fracture following a closed re-
ondary surgery in one case.41 duction.61 The nerve became trapped within the bony frag-
ments of the fracture site during reduction, which required
CASE REPORTS surgical decompression of the nerve and internal fixation of
the fracture.61
COMMON PERONEAL NERVE
DEEP PERONEAL NERVE
Many case reports of CPN entrapment are described in the
literature and are associated with many etiologies and Fewer case reports are detailing DPN entrapment, with a to-
treatment regimens. CPN compression secondary to a cystic tal of three identified. In these cases, DPN entrapment was
tibiofibular joint was reported in various cases.41,43–45 Two due to ganglion cysts in 2 cases and bony overgrowth of the
such cases described CPN compression due to intraneural navicular bone in 1 case.62–64 One of the ganglion cysts was
ganglion and synovial cysts.41,45 Complete return of motor treated with CT-guided fenestration, pulsed radiofrequency
function was accomplished via cyst aspiration in one case, modulation, and steroid injection into the cyst. In contrast,
while the other was treated with prompt surgical cyst re- the other ganglion cyst case was treated with ultrasound-
moval and nerve decompression.43,44 Two other reports of guided aspiration. Both patients reported successful nerve
cystic etiologies included an extraneural popliteal cyst and decompression and return of motor function.62,64 The case
two cases of children with extraneural tibiofibular joint syn- of DPN entrapment due to navicular bone overgrowth was
ovial cysts, all of which were treated with surgical cyst re- treated successfully with surgical nerve decompression.63
moval and CPN decompression.45,46
CPN compression due to bony growths were also com-
monly reported in multiple case reports.47–50 Two cases in-
CONCLUSION
volved osteochondromas of the fibular head causing CPN
entrapment, both of which achieved symptom resolution While entrapment neuropathies are relatively uncommon
with tumor excision.48,50 Rarer cases of bony overgrowth in the lower extremities, peroneal nerve entrapment is the
include melorheostosis, a bone hyperostosis disorder, and a most frequently encountered lower limb neuropathy.1,65
fabella, a sesamoid bone in the posterolateral knee, causing Due to the relative infrequency of lower limb neuropathies,
CPN compression that required treatment with surgical re- diagnosis can be difficult and often overlooked.65 Providers
moval of the bony lesions.47,49 must have a level of suspicion when patients present with
Some cases of CPN entrapment secondary to muscular chronic leg pain, foot drop, or ankle instability that has
etiologies include a cadaver with an unusual anatomical not responded to conservative medical management.65 Per-
variant of the distal biceps femoris and a diabetic patient oneal nerve entrapment is most commonly at or around
who presented with peroneal muscle infarction treated with the fibular head but can also occur in the calf, ankle, or
a splint and diabetic control.51,52 Two cases detailed pro- foot.1 Electrodiagnostic studies have shown to be helpful in
longed squatting as a source of CPN compression, in which the diagnosis of nerve entrapment and in determining the
one case was due to hemorrhoids and another due to work- type of injury and the level at which the entrapment oc-
ing on sewer pipes.53,54 The case of the sewer worker re- curs.1 First-line treatment usually includes removing any-
solved primarily with rest, while the patient with hemor- thing that may be causing external compression, providing
rhoids required physical therapy and external devices.53,54 stability to any unstable joints that may be putting tension
A rare case of a CPN schwannoma in a young patient was on the nerve, and reducing inflammation.65 Although many

Orthopedic Reviews 5
 An Update on Peroneal Nerve Entrapment and Neuropathy

peroneal nerve entrapments will resolve with less invasive essary treatment, whether that be conservative manage-
treatment. Surgical treatment is often required when en- ment or surgery.
trapment is refractory to conservative management.30 Sur-
gical treatment involves neurolysis via release of the over-
lying facial planes and should be tailored to address the
entrapment’s etiology and the specific location.65 Surgical CONFLICTS OF INTEREST
decompression reported positive outcomes in the cases we
studied, with most studies showing improvement in at least No conflict of interests to disclose.
80% of patients who underwent surgical decompres-
sion.32–36,38 Overall, a diagnosis of peroneal nerve entrap- Submitted: June 01, 2021 EDT, Accepted: June 16, 2021 EDT
ment is associated with a good prognosis, in which most
patients experience a full return of nerve function after nec-

Orthopedic Reviews 6
 An Update on Peroneal Nerve Entrapment and Neuropathy

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