SLR - August 2012 - Jay Seidel
Reference: Nogueira, M.P. and Paley, D.. Prophylactic and Therapeutic Peroneal Nerve Decompression for Deformity Correction and Lengthening. Operative Techniques in Orthopaedics 21:180-183. 2011. Elsevier Inc.
Scientific Literature Review
Reviewed by: Jay Seidel, DPM
Residency Program: PinnacleHealth System, Harrisburg, PA
Podiatric Relevance:
Nerve entrapment and injury are recognized complications of trauma, acute deformity correction, and of limb lengthening, all if which may be encountered by the podiatric physician. The primary entrapment of the peroneal nerve is at the neck of the fibula, where peroneal nerve decompression is performed to avoid injury and ensure recovery. This article details a specific surgical technique of decompression.
Methods:
The peroneal nerve passes through two potential entrapment tunnels: the peroneal fascia and the intermuscular septum. A short oblique skin incision is made in the same direction as the nerve, and the superficial peroneal fascia is divided outside of the peroneal muscles. The common peroneal nerve is identified, and the peroneal muscle fascia is cut. The underlying peroneal muscles are then retracted medially exposing the deep peroneal muscle fascia, which is then divided. A transverse fascial incision is extended towards the tibia crossing the intermuscular septum between the anterior and lateral compartments of the leg. The muscle on either side is retracted, and the septum is transected under direct vision.
Results:
When nerve decompression was performed on patients undergoing limb lengthening, it was noted that typical signs of nerve entrapment were found, but not signs of stretch injury. Nogueira et al has suggested that the observed sudden loss of nerve potentials which was observed minutes after acute valgus to varus correction may be related to nerve entrapment instead of stretch injury. Nerve entrapment might also be a factor when stretch, acute trauma, or compression injury occurs. The peroneal tunnels are normally very tight, leaving little space to accommodate additional swelling.
Conclusions:
Immediate decompression of the nerve leads to restoration of normal potentials. It is recommend to prophylactically decompress when the nerve is at risk for stretch or entrapment as the result of acute deformity correction of valgus or flexion of the proximal tibia, distal femur and knee. Therapeutic decompression of the peroneal nerve is suggested as soon as possible, preferably within 24 hours, after a peroneal nerve injury from any cause.