Peroneal nerve entrapment occurs when the peroneal nerve is compressed at the level of the fibular neck, on the outer lateral side of the knee, as it passes from the outer and back portion of the knee to the front of the leg, causing various complaints in the leg and foot.
This condition can develop spontaneously, due to trauma, or from the pressure of ganglion cysts around the fibular neck. Patients may experience symptoms like numbness, tingling, or weakness on the outer side of the leg.
A detailed physical examination is crucial for an accurate diagnosis and treatment of peroneal nerve compression, as these symptoms can also originate from issues in the lumbar spine. Early diagnosis and appropriate treatment enable patients to quickly return to their daily lives and mobility.
What Causes Peroneal Nerve Compression?
The peroneal nerve may become compressed in various areas, particularly at the fibular head, a bony prominence on the outside of the knee. The primary causes of this compression include:
Trauma: Direct injuries, such as ankle sprains, can create pressure on the nerve. Specifically, sprains that force the ankle inward may lead to tension and compression on the nerve. Impacts on the area where the peroneal nerve moves from the back to the front of the knee (fibular tunnel) can also result in nerve damage. Fractures around the knee may similarly lead to peroneal nerve damage, causing foot drop.
Prolonged Compression: Constant leg crossing, prolonged squatting, or extended bedridden periods with the outer side of the knee in contact with a hard surface can contribute to peroneal nerve damage.
Diabetes: Uncontrolled high blood sugar levels increase the risk of compression for all peripheral nerves, including the peroneal nerve.
Tumors or Cysts: Abnormal growths or cysts near the peroneal nerve may exert pressure, resulting in symptoms.
Improper Ice Application: Applying ice over the outer knee area where the peroneal nerve is located and accidentally falling asleep may lead to nerve damage and foot drop.
Unknown Causes (Idiopathic): In some cases, peroneal nerve compression may have no identifiable cause, termed "idiopathic."
Weight Loss: Excessive weight loss can reduce the fat layer surrounding the peroneal nerve, increasing its contact with hard structures like bone, leading to nerve damage and foot drop.
These factors can create pressure on the peroneal nerve, impairing its function and causing symptoms in the leg and foot area.
Peroneal Nerve Compression in Diabetic Patients
Peroneal nerve compression is more common in diabetic patients. Diabetics often experience a condition called diabetic polyneuropathy, causing numbness, burning, tingling, and pain in the hands, legs, and feet. It’s essential to distinguish between diabetic polyneuropathy and peroneal nerve compression, as they frequently coexist in diabetic patients.
What Are the Symptoms of Peroneal Nerve Compression?
Pain: Sharp or sudden pain in the area between the knee and foot, particularly on the outer side of the knee, is a key indicator of peroneal nerve compression, typically worsening with movement or pressure.
Weakness: Compression can lead to weakness in the muscles controlling foot and ankle movements, increasing susceptibility to ankle sprains.
Foot Drop and Walking Difficulty: Individuals with peroneal nerve compression may experience foot drop and muscle weakness, leading to difficulty walking.
Paresthesia: This term describes abnormal sensations like tingling, prickling, numbness, or a "pins and needles" feeling. Many patients with peroneal nerve compression describe it as feeling like "bugs are crawling on their skin."
Dysesthesia: This describes heightened pain sensitivity to normally non-painful stimuli, such as light touch or tapping. Patients with dysesthesia may report discomfort while wearing socks, having bedsheets touch their feet, or feeling like hot water is poured on their feet during showers.
The Link Between Foot Drop and Peroneal Nerve Compression
Foot drop and peroneal nerve compression are closely related. Foot drop refers to the inability to raise the ankle (dorsiflexion), leading to walking difficulties. The peroneal nerve is the primary nerve controlling the muscles responsible for this movement. When the peroneal nerve is compressed, its function deteriorates, and the muscles it serves cannot receive adequate signals, resulting in a loss or reduction of the ankle’s upward movement.
Foot drop can also stem from other causes, such as herniated discs, spinal stenosis, or sciatic nerve damage. However, peroneal nerve compression, particularly at the fibular head, is the most frequent cause, as this area is vulnerable to trauma and compression. Reducing the pressure on the peroneal nerve is essential for resolving foot drop syndrome.
How is Peroneal Nerve Compression Diagnosed?
Diagnosis involves a comprehensive physical examination and various tests:
1. Listening to Patient’s Complaints: The history of symptoms like foot drop, leg numbness, tingling, or pain, as well as any related trauma, surgeries, or postures, aids in diagnosis.
2. Physical Examination: Palpation of the peroneal nerve checks for tenderness along the nerve pathway. Tinel’s test evaluates the presence of tingling radiating down the leg with pressure on the nerve (positive Tinel sign). Muscle strength tests assess ankle dorsiflexion and foot eversion strength.
3. Imaging Methods: MRI imaging can confirm the diagnosis or rule out other conditions, like tumors or cysts, that may cause compression.
4. Electromyography (EMG) and Nerve Conduction Studies: EMG and nerve conduction tests help determine the severity and location of compression, though they may not always yield positive results and should be interpreted with other findings.
Differential Diagnosis for Peroneal Nerve Compression
To distinguish peroneal nerve compression from conditions such as lumbar disc herniation, spinal stenosis, proximal tibiofibular joint issues, lateral meniscus tears, or biceps tendon problems, careful assessment is necessary. Lumbar spine issues may cause similar symptoms, so patients should also be evaluated for lumbar disc herniation, as both conditions can co-occur.
How is Peroneal Nerve Compression Treated?
Following clinical and laboratory evaluations, a diagnosis of peroneal nerve compression is established, and treatment begins. Early diagnosis is crucial to reduce pressure on the nerve and prevent permanent damage.
How is Peroneal Nerve Compression Surgery Performed?
In some cases, where nerve compression at the knee is confirmed, symptoms may resolve spontaneously. However, these patients should be closely monitored, and if no improvement is observed, surgery should be planned promptly. Open surgery releases the nerve from its compressed position on the lateral side of the knee. If cysts or tumors are the cause, the surgery is modified accordingly. Post-surgery, motor function returns in 95% of cases. Most patients experience complete symptom relief and noticeable comfort immediately after surgery.
Watch Dr. Utku Erdem Özer perform peroneal nerve compression surgery by clicking here:
What is the Postoperative Process for Peroneal Nerve Compression Surgery?
Peroneal nerve release is a 1-hour procedure usually performed under general anesthesia. After surgery, the wound is covered with waterproof dressing, allowing most patients to be discharged the same day. Patients can shower with waterproof dressings. Light walking (partial weight-bearing) is encouraged as pain permits. One week after surgery, patients can remove bandages and wet the incision area, and full walking activity is allowed.
In mild to moderate cases, numbness, tingling, pain, and even foot drop symptoms often resolve within hours after surgery. For long-standing or severe cases, symptom relief and muscle function recovery may be gradual, taking weeks to several months.
Patient Feedback After Peroneal Nerve Release Surgery
Watch feedback from a patient of Dr. Utku Erdem Özer who underwent peroneal nerve release surgery here:
Nerve Compression in the Knee Frequently Asked Questions
How is nerve compression in the knee treated?
Nerve compression, especially in the knee, can be treated with physical therapy , nerve decompression , splinting , or, if necessary, surgical intervention . The treatment method is determined depending on the severity and cause of the compression.
What are the symptoms of nerve compression in the leg?
Nerve compression in the leg usually manifests itself with symptoms of pain, tingling, numbness and muscle weakness. These symptoms become more pronounced, especially during movement.
Is there nerve compression in the kneecap?
Yes, there can be nerve compression around the kneecap. This can limit the range of motion of the knee and cause pain.
Does nerve compression affect the knee?
Yes, when the sciatic nerve or other leg nerves become compressed, it can lead to pain and discomfort in the knee area.
Conclusion
Nerve compression in the knee is a condition that occurs especially with the compression of the peroneal nerve and affects the walking functions of the person. It can develop due to reasons such as trauma, metabolic diseases and poor posture.
It is possible to improve this condition with physical therapy, rehabilitation and, if necessary, surgical intervention.
Starting treatment early and implementing a suitable rehabilitation program will speed up the recovery process and help achieve better results.
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