Peroneal (Fibular) Nerve Injury

What is a peroneal nerve injury?

A peroneal nerve injury affects a major nerve in your leg called the fibular or common peroneal nerve. This nerve starts in the back part of your knee and allows you to feel the outsides of the lower legs, the tops of the feet, and the skin between the big toe and second toe. It also controls some of the muscles in the leg and the foot.

If the peroneal nerve is injured, your legs and feet may feel numb, and you may have difficulty moving them. The peroneal nerve can be damaged by leg injuries like a dislocated knee, a broken bone, or surgery complication.

You can also injure it by wearing high heels for long periods of time. Treatment depends on how severe your injury is, but can include surgery to repair or replace the damaged nerve.

What are symptoms of peroneal nerve damage?

The first sign of injury may be tingling on the outer edge of the leg and thigh, the area between the big toe and second toe, and the top of your foot. Next you’ll feel numbness, which means that the injury has progressed, or is more severe.

If the injury is severe, you may have difficulty moving your foot in different directions. One hallmark symptom of a peroneal nerve injury is the inability to point your toes or your foot up toward the ceiling or point it outward.

You may also notice your foot is pointing to the floor when you stand, a condition known as “foot drop.” This can make it difficult to walk, and you may find yourself stumbling over roots, curbs, and steps.

Main symptoms

• Numbness and tingling in the top of the foot or in the outer part of the thigh or leg.
• Numbness and tingling of the skin between the big toe and second toe.
• Tripping or being clumsy: this occurs because your foot may “hang” down toward the floor.
• Foot drop: the affected foot drags on the floor.
• Weakness in pointing your foot/toes up toward the ceiling.
• Difficulty walking.
• Muscle loss (atrophy) in the outer edge of the leg.

Other symptoms you may have

If you have a type of peroneal nerve injury called deep peroneal nerve entrapment (also known as anterior tarsal tunnel syndrome), you may have only the following symptoms:

• Tingling or vague pain of the top of the foot and skin between the big toe and second toe.
• Inability to point your second, third, and fourth toes upward (but your big toe is normal).

Causes of a peroneal nerve injury

The common peroneal nerve runs very close to the surface of your skin just below the knee, which is why it is so easy to injure. It can become injured in the following ways:

• A cut through the nerve (such as by trauma or during an orthopedic surgery).
• A broken bone or dislocated knee puts pressure on the nerve.
• Too much pressure is placed on the nerve by you crossing your legs or laying on the nerve for too long.
• A tumor or cyst is pushing on the nerve.

Risk factors

You may be more susceptible to a peroneal nerve injury if you:

• Need prolonged bed rest (after a surgery or medical procedure) where you may put weight on the fibular nerve for an extended period of time.
• Had prior bone fractures or knee dislocations.
• Wear poorly fitting shoes or wear high heels for a long period of time.
• Cross your legs for a long period of time.
• Have certain conditions, like diabetes, autoimmune diseases, or anorexia, according to the U.S. National Library of Medicine.

Next steps

If you had a traumatic leg injury, like a broken bone, knee dislocation, or a deep wound through your leg, you should seek medical attention right away. Alert your doctor if you have any tingling or numbness in your leg. You may have damaged the peroneal nerve, which would need to be repaired with surgery.

If symptoms come on slowly, without a traumatic incident, call your doctor as soon as you notice them. The doctor will likely refer you to an orthopedic surgeon, neurologist (nerve specialist), or neurosurgeon, who may recommend further testing with MRI, nerve ultrasound, or a nerve conduction study.

If you do not see a doctor to diagnose the condition, the numbness and paralysis could become permanent.

Peroneal nerve injury treatment

Seeing a doctor as soon as possible can help prevent long-term damage. Treating it will also help minimize your pain and increase your mobility.

Treatment depends on the severity of the nerve damage. This may include letting the nerve heal on its own or may require surgery to repair or replace the nerve, or to remove a tumor or growth causing nerve injury. Medications can help control symptoms.

Non surgical treatments include:

• Time to let the nerve heal.
• An orthotic boot device to keep your foot up and to help you walk.
• Physical therapy.
• Ice.
• Ankle brace.
• Over-the-counter pain medications.
• You may have to avoid wearing high heel shoes and crossing your legs.

If you have a deep fibular nerve entrapment injury:

• Change your shoes from high heels or tight-fitting shoes to supportive shoes with a well-padded tongue.
• Try different shoe lacing configurations.
• Splint the ankle at night.

There are several over-the-counter (OTC) options you can consider to help manage your symptoms.

• Pain Relievers: For pain and inflammation, OTC medications like ibuprofen or acetaminophen can offer relief.
• Braces and Supports: To stabilize the affected area and prevent further injury, consider using a foot or ankle brace.

Surgery

Your surgeon may recommend any of these surgeries, depending on what caused the fibular nerve injury. Depending on the surgery, they may be outpatient procedures, but many will require you to stay in the hospital for a little bit:

• Repair of the nerve (putting the nerve back together if it is apart).
• Replacement of the nerve (also called grafting).
• Fixing the fracture or dislocation that is pressing on the nerve.
• Removal of the tumor of cyst that is pressing on the nerve.

Recovery depends on the extent of the nerve damage. It is important to closely follow your doctor’s treatment plan and have frequent monitoring during the course of your treatment.