There are many reasons why you may experience knee or leg pain or have a loss of sensation in those areas.
One of the most common causes is damage to the common peroneal nerve.
This damage may be caused by a sports injury, due to a medical condition or it can also be caused by compression of the nerve.
Where is the Common Peroneal Nerve?
The common peroneal nerve is one part of the sciatic nerve and is located behind the knee.
Due to where it is located, this nerve sustains more injuries than most of the other nerves in the lower leg.
If the nerve is damaged, it can affect the ability to feel or move the lower part of the leg, the foot or toes.
Causes of Common Peroneal Nerve Damage
When a nerve is damaged, either its myelin sheath, which covers a branch of the nerve cell called the axon, can be damaged or the nerve cell itself can be destroyed.
This can cause several problems like affecting major motor functions and foot drop because the peroneal nerve helps to stimulate the muscles that control the foot.
There are several reasons for common peroneal nerve pain caused by damage.
Since the nerve is located behind the knee, any trauma, such as a blow to the knee, or other injuries to it can compress or damage the nerve.
Damage to this nerve isn’t uncommon when playing football or participating in other sports.
The peroneal nerve is also located at the back of the fibula, at the top of it, and winds around it where it breaks off into two branches, the superficial and deep peroneal nerves.
Since it is wound around the fibula, a break or damage to this bone can also result in an injury to the common peroneal nerve.
Compression of the nerve can also result in damage and compression can be caused by doing something as simple as crossing your legs or wearing tall boots that come up to the back of the knee.
It can also be damaged when the leg is in awkward positions during sleep, surgery or a coma or it can be damaged by some type of constriction to the lower leg, such as having a cast on the leg if it has been broken.
Who is More Susceptible to Nerve Damage?
There are some people who are more susceptible to having common peroneal nerve pain or nerve damage.
People who are thin, especially when caused by issues such as anorexia, will experience more damage due to compression.
Diabetics may have neuropathy issues with the peroneal nerve or people with polyarteritis nodosa, which is a disease of the blood vessels, are more susceptible to having the peroneal nerve damaged.
People who have a disease called Charcot-Marie-Tooth may also have issues with their common peroneal nerve.
The disease is hereditary and all of the nerves in the body are affected by damage to the peroneal nerve often happening in the early stages of the disease.
Also, prolonged exposure to certain toxins can damage this nerve.
Symptoms of Common Peroneal Nerve Pain
There are several signs of problems with the common peroneal nerve, especially in regard to some loss of motor function.
Along with common peroneal nerve pain, you may also experience numbness or be tingling in either the upper or the lower leg, in the foot or the toes.
The tingling or numbness may be more pronounced in the top of the foot.
Since the peroneal nerve helps to control the function of the foot, damage to this nerve can affect the ability to hold the foot in an up position.
In addition to foot drop, when you walk, your foot may make a slap on the ground or the toes may drag.
Damage to the common peroneal nerve can sometimes affect a person’s ability to walk unaided.
Testing for Common Peroneal Nerve Damage
When you consult with a doctor regarding the common peroneal nerve pain or numbness you’re having, there are certain tests they may do to help diagnose the problem.
A physical exam can help reveal problems such as problems with muscle control or atrophy of some of the muscles in your leg or foot.
It may also show you having difficulty being able to lift your foot or your toes.
Your doctor may also order some tests done that will help him or she make a diagnosis, such as nerve conduction tests, an MRI to look for nerve compression or Electromyography.
The EMG will help test the electrical activity in the muscles of your leg or foot. A nerve ultrasound may also be done to help make an accurate diagnosis.
Treating Common Peroneal Nerve Damage
Most of the treatments for common peroneal nerve pain due to damage are centered around helping the patient regain their mobility.
Any disease leading to nerve damage, such as diabetes, will need to be included in the treatment.
To help reduce any swelling or inflammation of the nerve, your doctor may administer corticosteroid shots.
If the nerve damage is because of issues like crossing your legs, you may be prescribed a pad to wear to discourage crossing your legs and to help prevent any further damage it can cause.
Surgery may be necessary if there is no sign of improvement with other treatments, if there is damage to the axon of the nerve or if there are mobility issues due to the common peroneal nerve being damaged.
The surgery may help relieve compression of the nerve or remove tumors that are present.
If you do have continued common peroneal nerve pain, your doctor may prescribe pain medications to reduce it.
In addition, you may need physical therapy and/or use some orthopedic devices to help reduce problems with damage to the nerve like braces, splints or orthopedic shoes.
These treatments can help you regain your independence by helping improve any problems you have with mobility due to nerve damage.
Peroneal Nerve Injury
The peroneal nerve forms part of the peripheral nervous system that branches from the sciatic nerve which runs down the exterior side of your lower leg.
A peroneal nerve injury is a form of peripheral neuropathy that is specific to the peroneal nerve.
Alongside the sciatic nerve, it serves to supply sensation and movement to your lower extremities.
A one-time injury is typically the cause of damage to this nerve such as a leg, knee, or ankle fracture or sprain.
Additionally, it can also result from prolonged immobility and habitual leg crossing.
Peroneal nerve injury does not discriminate on an age basis. However, conditions such as diabetic neuropathy, exposure to some toxins, and anorexia can increase your susceptibility to this nerve dysfunction.
Symptoms of peroneal nerve injury
When this nerve gets injured, you may begin feeling numbness or tingling in your lower leg’s front side.
Additionally, the affected areas are slightly desensitized to touch. You may also experience similar symptoms around your buttocks because of nerve compression at a higher level.
Also, you are bound to experience weakness in the foot as you try to lift it upwards or outwards.
Peroneal nerve damage is closely linked to foot drop. Foot drop refers to the inability to clear the foot off the floor entirely when walking.
This results in a ‘slapping gait’ where the foot slaps on the ground as the person is walking.
Causes of peroneal nerve injury
The peroneal nerve dysfunction is usually caused by injuries to the exterior knee as this is where the nerve is closest to the skin.
Infections, inflammation, and swelling can also cause damage to this nerve as well as sustained pressure to the exterior of your knee particularly if you enjoy sitting with your legs crossed.
In addition, crossing your legs while wearing constricted clothing makes you more vulnerable to peroneal nerve damage.
Other injuries such as dislocated knee or fibular fracture can also lead to nerve injury. The peroneal nerve can also get damaged during surgery.
Treating Peroneal Nerve Injuries
The means of treatment will depend on the cause of damage. If it is an acute injury to your exterior knee that is causing the symptoms, discomfort or pain typically recedes once the injury heals and the swelling or pressure on the nerve reduces.
However, if it is a constant pressure that has resulted in nerve damage, you need to see a specialist immediately.
Also, symptoms resulting from direct injury to the peroneal nerve are challenging to manage.
Nevertheless, the nerve damage typically heals slowly on its own except in severe cases.
Inefficient use of the leg causes muscle atrophy. As such, physical therapy comes in handy in enhancing your leg’s muscle control and strength.
Therefore, stretching and strength exercises are ideal for improving the patient’s condition.
Nevertheless, some treatments include:
Steroids are at times recommended for alleviating pressure and swelling on the nerve.
The steroid is typically used in combination with an anesthetic and introduced into the troubled area.
The purpose of steroids is to inhibit the production of proteins that cause inflammation.
The anesthetic serves to block nerve conduction in the field of application thus numbing the sensations of pain. If steroids and anesthesia do not work, you may require surgery.
Peroneal Nerve Decompression
This is a procedure that reduces pressure on the peroneal nerve while eliminating any lesions.
It involves introducing a slight incision below the lateral knee while following the nerve’s course.
It is distally tracked to the superficial and deep branches. The physician then releases the nerve by disarticulating the lateral septum between the soleus aponeurosis and peroneus longus.
They will then retract the muscle medially thus attaining the full division of the deep and superficial segments of the arch.
Any site of compression or entrapment along this path is then released. Nerve grafting can be considered in events of structurally severed or damaged nerves.
Due to the multiple causes of peroneal nerve injury, it is deal to consult a physician to get a proper assessment.
This will ensure you are treated for the right cause using the appropriate treatment.
Deep Peroneal Nerve Injury
This is the more severe form of peroneal nerve damage. Also known as, deep peroneal nerve entrapment, it commonly results from fractures, wearing ill-fitting boots, or placing undue pressure on the legs.
If left untreated, deep peroneal nerve injury leads to loss of muscle control and atrophy in the foot muscles.
Common Peroneal Nerve Injury
This is the typical form of peroneal nerve damage that is being discussed in this article.
Peroneal Nerve Injury Exercises
For individuals who physical therapy can help improve their peroneal nerve dysfunction, they will need to work with a physical therapist (PT) to come up with a program that will suit your needs.
Most of the program will consist of strength training. Strength training helps sustain the leg’s muscle mass thereby marinating muscle strength which, in turn, facilitates mobility.
Your PT will make you use resistance bands, body weight, and actual weights to help you recover mobility and strengthen your muscles.
Your PT will incorporate flexibility exercises alongside your strength training.
Flexibility movements typically involve stretching your hamstrings, calves, joints, tendons, knees, and other muscles of the foot and leg.
These movements enhance your mobility and flexibility by making you better at performing exercises that treat peroneal nerve damage.
Additionally, stretching helps alleviate some of the discomfort associated with peroneal nerve dysfunction.
As your flexibility and muscle strength improves, your PT will likely add cardiovascular exercises to your routine.
They will consist of low-impact activities such as swimming, biking, and water aerobics.
High impact exercises such as running are not advisable for someone recovering from nerve damage as they cause repetitive stress.
As such, high-impact cardio can result in serious health complications. Thus, even just 10 minutes of cardio is sufficient in the beginning.
However, as you build endurance and strength, you should increase this number. Aim for 30 minutes of cardio per day.
This video details the causes and treatment of Peroneal nerve injury: