Peroneal palsy involves damage to the fibular nerve. Paresis is one of the nerve compression syndromes.
What is peroneal palsy?
Peroneal palsy also the name peroneal paresis. This refers to damage to the common fibular nerve (peroneal nerve). The paralysis is counted among the nerve compression syndromes, which occur relatively frequently. Both individual parts of the nerve and the entire nerve can be affected. Damage to the fibular nerve is manifested by paralysis of the muscles responsible for actively lifting and bending the foot and toes. The common peroneal nerve, also called the common fibular nerve, forms one of two main branches of the sciatic nerve (sciatic nerve). It has sensory and motor portions. The second main branch is formed by the tibial nerve (nervus tibialis), which also has sensitive and motor parts. The common peroneal nerve travels laterally along the knee, passing the head of the fibula in a posterior direction. It then divides into the profundal fibular nerve and the superficial fibular nerve. The main function of the fibular nerve is to control the lower leg extensor muscles. In doing so, it provides for the pulling of the foot within the upper ankle joint in the upper direction as well as for the external rotations of the foot. At the same time, the nerve is also responsible for dorsiflexion of the toes. Posterior to the fibular head, the common peroneal nerve is considered to be at risk for injury because its course is close to the surface in this area.
Causes
Peroneal palsy is caused by mechanical pressure in the region of the fibular head, which is due to the delicate location of the fibular nerve at this site. People who have little fat and muscle tissue are considered to be particularly at risk. It is not uncommon for peroneal palsy to result from medical intervention. This includes, for example, a plaster cast that has been applied too tightly. The resulting increase in external pressure causes damage to the peroneal nerve, which is restricted in its extension. However, the fibular nerve can also be affected during surgical procedures. Because of the sensitive position of the nerve, it is often the victim of injuries such as a fibular head fracture. In the case of incorrect positioning when bedridden, paralysis of the fibular nerve can occur. The same applies to work activities such as tiling or constantly crossing the legs. In rare cases, aneurysms in the popliteal fossa, a ganglion at the tibiofibular joint or a Baker’s cyst are also responsible for peroneal paresis. Other conceivable indications include herniated discs and circulatory problems due to acute occlusion of the leg artery.
Symptoms, complaints, and signs
In peroneal palsy, the patient usually suffers from difficulty walking as well as malalignment of the affected foot. If the deep branch of the fibular nerve, the fibular nerve, is damaged, this results in disorders of the extensor process. Doctors then speak of a foot jack weakness or a pointed foot, which causes a stepper or stork gait. In this case, the affected person pulls his knee unusually high in order not to let the toes drag along the floor. If there is an impairment of the superficial fibular nerve, the lateral edge of the foot can no longer be actively lifted, which is due to a disturbance of the inward rotation. Both phenomena sometimes occur in combination, depending on the level at which the nerve damage is located. Other possible complaints of peroneal nerve palsy include sensory disturbances, which can be seen on the dorsum of the foot, the lateral edge of the foot, or the front of the lower leg.
Diagnosis and course of the disease
If peroneal palsy is suspected, the physician first looks at the patient’s medical history and asks about any previous injuries or conditions. He then performs a physical examination, during which he tests the Achilles tendon reflexes as well as the peroneal reflexes. While the Achilles tendon reflex is fully functional in peroneal palsy, the peroneal reflex is found to be weakened. Electroneurography is another diagnostic option.Here, the doctor measures how quickly an impulse is passed between two electrodes by the nerve. The procedure makes it possible to determine the exact position of the nerve damage. Differential diagnosis also plays an important role. For example, it is important to rule out L5 syndrome, since herniated discs can pinch off the 5th nerve root, causing symptoms of loss and numbness in the foot. However, unlike peroneal palsy, pain usually occurs in L5 syndrome. In most cases, peroneal palsy takes a positive course. Especially in the case of pressure damage, the prospects of recovery are considered good. However, this requires the patient to see a physician quickly if he or she experiences discomfort, as this improves the chances of success.
Complications
In most cases, peroneal palsy has a very negative effect on the movement of the affected person. This can result in various discomforts when the affected person stands and walks, so that the patient’s quality of life is significantly reduced. Under certain circumstances, the affected person is also dependent on walking aids due to the peroneal paralysis. Likewise, the legs can no longer be stretched properly, so that the performance of various activities and sports is also no longer possible for the patient without further ado. In children, peroneal palsy can cause developmental delays. Similarly, paralysis or other sensory disturbances may occur in the calves or the entire legs. Pain may also occur, making everyday life difficult. Furthermore, peroneal paralysis can also lead to psychological complaints or depression, so that patients are dependent on psychological treatment. However, the further course of the disease depends very much on the extent of the nerve damage. Treatment is not possible in every case. However, there are no particular complications during treatment. The life expectancy of the affected person is also not affected by peroneal palsy.
When should one go to the doctor?
Pain in the fibula should be examined by a doctor as soon as it persists for more than two to three days. If there is any difficulty walking, discomfort or severe pain, it is best to consult the family doctor the same day. Peroneal palsy occurs mainly after injury or damage during medical procedures. If the above symptoms occur after sports or during physiotherapy, a doctor should be consulted immediately. If there is already damage to the fibula, such as after a fracture or surgery in the affected area, medical advice is also needed. Peroneal paralysis is treated by an orthopedist. Other points of contact are sports physicians, physiotherapists and specialists in nerve disorders. Severe paralysis must be treated surgically. After the initial treatment, the stability of the fibula must be consolidated by physiotherapy and other measures. Close consultation with the physician is necessary so that adjunctive drug therapy can be adjusted to the progress of recovery and any pain.
Treatment and therapy
Treatment of peroneal palsy depends on how severe the nerve damage is. All triggering factors, such as crossing the legs, must be stopped. Therapy of the paresis is usually conservative. In the course of physiotherapy, the muscles can be rebuilt. Sometimes a special peroneal spring is used, which is a dynamic foot lift system that allows the patient to walk more easily. If conservative therapy does not result in improvement, surgery is usually performed to relieve the fibular head. If peroneal palsy is caused by an underlying condition such as a tumor or Baker’s cyst, the first step is to treat it, which usually results in improvement of the paralysis.
Outlook and prognosis
No uniformly good prognosis can be given for peroneal palsies. The cause and extent of damage to the common fibular nerve may vary. This affects the outcome of medical or physical therapy treatment. First, the cause and extent of the peroneal palsy must be determined. If the common fibular nerve was only exposed to pressure damage, the resulting damage and paralysis can usually be repaired.However, the situation is different if the damage has produced permanent paralysis. In this case, the full functionality of muscles and nerves often cannot be restored. The prognosis is worst when the common fibular nerve has been completely severed. Treatment of peroneal paralysis is first of all about reducing the degree of paralysis as much as possible. This is the only way to improve the prognosis for the affected person. The medical ideal is to restore full functional capacity. The secondary goal of treatment is to circumvent possible complications. One such complication would be a pointed foot. Surgical procedures have unfortunately not proven effective for peroneal palsy. If necessary, a peroneal splint can facilitate walking with a pointed foot. Medical professionals achieve the relatively most successful treatment results with functional electrical stimulation (FES) using a mobile foot lift system. This can mitigate the severity of a walking disability. In the long term, new nerve pathways may even form.
Prevention
Preventing peroneal palsy is not easy. For example, triggering injuries to the fibular nerve must be avoided.
Aftercare
Peroneal palsy is a serious complaint and disease that must be examined and treated by a doctor in any case. In this regard, affected individuals should see a doctor at the first symptoms and signs of the disease to avoid further complications or other ailments. The measures and options for follow-up care are severely limited, and the further course depends very much on the time of diagnosis. Most patients are dependent on the measures of physiotherapy or physiotherapy for this disease. Many of the exercises from such therapies can also be repeated in the patient’s own home, thus accelerating treatment and healing. Many of those affected also depend on the help and support of their own family. Loving conversations are very important to prevent the development of depression or other psychological upsets. If peroneal palsy is treated by surgery, affected persons should rest and take care of their body after such an operation. In this regard, unnecessary exertion or other physical activities should be refrained from so as not to put unnecessary strain on the body.
This is what you can do yourself
In this disease, as soon as possible, a conscientious differential diagnosis is important. Only in this way can the causes of peroneal palsy be found and even eliminated, especially if the disease occurred due to mechanical stimuli. Then, however, the chances are good that the peroneal paralysis will heal completely. If, for example, the paralysis was caused by a cast that was applied too tightly, the treating physician will loosen the cast. However, if the patient – who is usually very slim in this case – constantly crosses his legs when sitting, he should consider accompanying behavioral therapy. Only in this way can the patient get rid of this habit and find a healthier sitting posture. If the condition is still acute, it can be very painful and significantly reduce the quality of life. In some cases, the treating orthopedist or sports physician will advise surgery. He will also prescribe physiotherapy and medications such as painkillers. It is especially important to keep the physiotherapy appointments, even if they prove painful at first. Physical therapy will stabilize the treatment outcome and rebuild the muscles. Then the patient should also resume moderate sports. He may need support such as a peroneal spring or a walker to walk, but walking or even hiking are still good ways to exercise the muscle and prevent new disease.
