Common Peroneal Nerve Entrapment

with Rehab

The peroneal nerve and its branches are responsible for muscle control of the muscles that extend to the toes, foot, ankle. This nerve is also responsible for sensation on the outer side of the lower leg and foot. Injury to the peroneal nerve results in problems with sensation and muscle control in these areas. Injury to the peroneal nerve often occurs in the area where the nerve passes around the top of one of the lower leg bones (fibular head). The nerve becomes trapped, causing pain, tingling, numbness, or burning sensations.

SYMPTOMS

  • Pain, tingling, numbness, or burning on the top of the foot, ankle, or outer part of the lower leg.

  • Pain that gets worse with physical activity (walking, running, squatting).

  • Weakness when lifting the foot, including moving the ankle and toes upward (foot drop), or turning the foot outward with walking.

  • Problems walking (having to lift the foot high) or running, including tripping over the foot.

  • Inflammation, bruising (contusion), and tenderness near the outer part of the knee (or just below the knee).

CAUSES

Common peroneal nerve entrapment is caused by pressure being placed on the peroneal nerve. This pressure may occur due to direct contact (being tackled at the knees), inflammation, a cyst in the knee, or a healing fracture around the knee. Less commonly, peroneal nerve entrapment may be caused by a stretch injury (knee sprain) or with swelling in the leg (compartment syndrome).

RISK INCREASES WITH:

  • Recurring foot, ankle, or knee sprains.

  • Playing sports on uneven ground, which may result in knee or ankle sprains.

  • Direct injury (trauma) to the knee.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment.

PROGNOSIS

Common peroneal nerve entrapment is often curable with non-surgical treatment. Often symptoms will go away on their own (spontaneously). Sometimes, surgery is needed to relieve pressure from the nerve.

RELATED COMPLICATIONS

  • Permanent pain, tingling, numbness, or weakness of the affected foot, ankle, and leg.

  • Inability to compete, due to pain or weakness.

  • Injury to other parts of the body, as a result of repeated tripping and falling over the foot.

TREATMENT

Treatment first involves resting from any activities that cause the symptoms to get worse. The use of ice and medicine may reduce pain and inflammation. If ice is used, do not place it directly on the skin. Instead, place a towel in-between. If there is weakness of the muscles, causing foot drop, bracing the ankle and foot may be needed. It is important to perform strengthening and stretching exercises to maintain muscle strength. These exercises may be completed at home or with a therapist. If pain continues to get worse, despite treatment, or a cyst is present, surgery may be needed to relieve the pressure on the nerve. If the pressure on the nerve is due to compartment syndrome, a fascial (sheet of connective tissue) release may need to be performed. The earlier surgery is performed, the better your chances of full recovery.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse.

  • Symptoms do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Common Peroneal Nerve Entrapment

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation, so your littlest toes rise slightly toward the ceiling.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove your shoes and sit on a chair, preferably not on a carpeted surface.

  • Place your right / left foot directly under your knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair, until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Gastroc, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Soleus, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg, so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool, keeping a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist, until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Common Peroneal Nerve Entrapment

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

STRENGTH - Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you, using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band across your opposite foot, away from the pole, slowly, pull your little toe out and up. Make sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercises __________ times per day.