Common Peroneal Nerve Decompression Surgery Helps Relieve the Symptoms of Peroneal Neuropathy

Common Peroneal Nerve Decompression SurgeryYou take a step forward, but your foot fails to lift. It remains stubbornly grounded, as if it was disconnected from your brain's command. You try to shake off the tingling sensation that races down your leg, but it lingers as a persistent reminder of a mysterious force at play. 

Common peroneal nerve compression, also known as peroneal neuropathy or peroneal nerve entrapment, is characterized by damage or compression of the common peroneal nerve. This produces symptoms that can be a frustrating mixture of pain, weakness, and uncertainty. Many people with this condition say it's as if their lower leg has launched its own secret rebellion—defying them at every attempt to regain control. 

If you're struggling with peroneal nerve entrapment, nerve decompression surgery may be able to help. As a board-certified plastic surgeon with additional fellowship training in peripheral nerve surgery, Dr. Eric H. Williams has extensive experience helping patients with common peroneal nerve compression—and he may be able to do the same for you.

Understanding Common Peroneal Nerve Compression 

The common peroneal nerve is a branch of the sciatic nerve, which is a major nerve in the lower extremity that wraps around the outside of your knee. Also known as the common fibular nerve, it innervates the muscles and provides sensation to the front and side of the lower leg, as well as the top of the foot.

Compression of the common peroneal nerve can occur at various locations along its course, most commonly at the fibular head, which is the bony prominence on the outside of the knee. This compression can result from a variety of causes, including:

  • Trauma. A direct injury, such as an ankle sprain, can cause nerve compression. When you forcibly twist your ankle inward, it puts pressure and tension on the nerve. 
  • Prolonged pressure. Consistently crossing the legs or spending extended periods of time in a position that puts pressure on the fibular head can lead to nerve compression. For example, if you were to have an operation where you were under anesthesia for an extended time, you could develop common peroneal nerve compression. People who squat for long periods of time, such as baseball catchers, can develop common peroneal nerve compression.
  • Diabetes. Uncontrolled high blood sugar causes the common peroneal nerve to swell. Since the tunnel the nerve travels through doesn't get bigger, this leads to compression. 
  • Tumors or cysts. Abnormal growths or masses in the vicinity of the common peroneal nerve can compress it and result in symptoms.
  • Genetics. Hereditary neuropathy with pressure palsies (HNPP) is a rare inherited disorder characterized by numbness, tingling, and muscle weakness in the limbs with multiple types of nerve compression. This condition primarily impacts the peripheral nerves, which serve as the communication link between the brain, spinal cord, and the muscles and sensory cells responsible for detecting touch, pain, and temperature.

In some cases, compression of the common peroneal nerve has no known cause. The term "idiopathic" is used to describe nerve compression that arises without a known or identifiable cause.

Diagnosing Peroneal Neuropathy in the Common Peroneal Nerve

The symptoms of common peroneal nerve compression typically include:

  • Pain. Sharp or shooting pain in the lower leg or around the lateral knee, often exacerbated by movement or pressure, is a primary sign of peroneal nerve entrapment.
  • Weakness. Common peroneal nerve compression may lead to weakness in the muscles that control foot and ankle movements. 
  • Difficulty walking. People with this compression of the common peroneal nerve often report an impaired gait due to weakness or foot drop.
  • Paresthesia. This term refers to an abnormal sensation often described as a tingling, prickling, numbness, or "pins and needles" feeling. Many people with common peroneal nerve compression describe it as the "creepy crawlies." 
  • Dysesthesia. This term refers to painfully hypersensitive sensations experienced in response to normal stimuli. People with dysesthesia related to common peroneal nerve compression may say that wearing socks is painful, having bedsheets touch their feet drives them crazy, or that water from the shower feels like battery acid being dripped on their feet. 

Please note that the common peroneal nerve only affects the top of your foot. If you have these symptoms in another location, you likely have a different type of nerve compression. If you have symptoms affecting the top of your foot and another location, you likely have multiple types of nerve compression.

An electromyography (EMG) nerve conduction study is the most commonly used test for diagnosing common peroneal nerve compression. However, the nerve has to be significantly injured for this test to have a positive result. You can have a normal EMG and still suffer from common peroneal nerve compression. 

Looking for a positive Tinel's sign is a better alternative for diagnosing common peroneal nerve compression. You can test for this yourself at home. If the Tinel's sign is present, there is about an 85% chance your symptoms can improve with surgical nerve release. 

Why Medication Isn't the Answer

Conservative measures such as activity modifications or physical therapy can help mild cases of common peroneal nerve compression, but it's important to avoid becoming over-reliant on pain-relieving medication. When a nerve is compressed and dying, medication only muffles the symptoms. Imagine that your friend is crying because she hurt her ankle, and you decide to stick a gag in her mouth. She'll stop crying, but the gag doesn't treat her ankle injury. It only creates new problems by making it harder for her to breathe.

If a nerve is being compressed or pinched, nerve decompression surgery is the correct treatment.  

What to Expect From Nerve Decompression Surgery

Surgical nerve release aims to relieve the compression or entrapment of the common peroneal nerve, allowing it to function properly and promoting nerve recovery. Here's how the process works:

  • Identification of the compression site. During the surgery, the surgeon identifies the specific location where the common peroneal nerve is compressed or entrapped. This may involve exploring the area around the fibular head or other potential sites of compression.
  • Release of the compression. Once the compression site is identified, the surgeon proceeds to release the pressure on the nerve. This can involve removing any surrounding structures (such as fibrous bands or tumors or cysts) that are compressing the nerve or causing entrapment. The goal is to create more space for the nerve and relieve the pressure.
  • Nerve mobilization. In some cases, the surgeon may gently mobilize the nerve to ensure it can move freely without any restrictions. This can help prevent future compression or entrapment and promote nerve healing.
  • Repair or reconstruction (if necessary). If there is evidence of nerve damage, such as a nerve laceration or significant injury, the surgeon may perform repair or reconstruction procedures. This can involve suturing the nerve ends together or using grafts to bridge any gaps in the nerve.
  • Recovery. Some patients have more challenging anatomy and more severe cases than others, but there have been a few patients that have been able to return to work the next day after surgery. It's generally recommended to plan for a few days to a week of limited activities.  However, you may need longer if your job is physically active. You'll also want to refrain from driving for at least two to three days, depending on how you feel and what pain medications you are taking.

The general concept behind nerve decompression surgery for the common peroneal nerve is similar to what happens during carpal tunnel surgery. Both surgeries aim to relieve pressure on a compressed nerve. In carpal tunnel surgery, the median nerve is decompressed at the wrist, while in common peroneal nerve decompression, the peroneal nerve is released from compression at the fibular head or other potential entrapment sites.

Let Us Help You Reclaim Your Mobility and Move Toward a Pain-Free Future 

Close your eyes for a moment and envision a life where the first thing you think about in the morning is not the top of your foot burning, and every step is easier. Imagine feeling the ground beneath your feet without the burden of pain and/or weakness. Picture yourself walking effortlessly, unhindered by the nagging discomfort that has plagued you for far too long. It's a future brimming with possibilities, where you can reclaim your mobility and embrace an active lifestyle. 

Now is the time to take the first step toward a brighter tomorrow. Your journey to a pain-free future starts here, with The Dellon Institutes for Peripheral Nerve Surgery. If you would like more information or want to request your appointment with Dr. Eric H. Williams, simply call our office at (410) 709-3868 or fill out a contact form here

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.