Early Surgical Treatment for Severe Idiopathic Compression of the Common Peroneal Nerve: A Case Series
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Published:
Apr 30, 2025
Keywords:
Common peroneal nerve, equinus foot, peripheral nerve compression
Main Article Content
Abstract
Introduction: Compression of the common peroneal nerve (CPN) is a common condition in the lower limb and can be either idiopathic or secondary. While secondary compressions have been extensively studied and show good outcomes with microsurgical decompression, evidence regarding idiopathic compressions remains limited. This study aims to report cases of severe idiopathic CPN compression treated surgically, evaluate clinical outcomes, and assess the need for a standardized treatment protocol.
Materials and Methods: A retrospective review was conducted on patients diagnosed with idiopathic CPN palsy over the past 10 years. Inclusion criteria comprised cases with a positive electromyogram, no history of trauma, negative MRI findings, and normal intraoperative findings. Patients with secondary nerve entrapment, spinal pathology, psychiatric disorders, or pregnancy were excluded. Severe cases were defined as those presenting with a dorsiflexion motor deficit of ≤2/5. Preoperative, intraoperative, and postoperative variables were analyzed.
Results: Eight patients met the inclusion criteria (2 women, 6 men). The mean time from diagnosis to surgery was 30 days, with an average follow-up of 959 days. All patients regained at least 4/5 dorsiflexion strength. Six patients achieved full recovery of both strength and sensation. No complications were reported.
Conclusions: Early decompression of the CPN is a safe and effective procedure for severe idiopathic compression. The establishment of a standardized treatment protocol is recommended.
Materials and Methods: A retrospective review was conducted on patients diagnosed with idiopathic CPN palsy over the past 10 years. Inclusion criteria comprised cases with a positive electromyogram, no history of trauma, negative MRI findings, and normal intraoperative findings. Patients with secondary nerve entrapment, spinal pathology, psychiatric disorders, or pregnancy were excluded. Severe cases were defined as those presenting with a dorsiflexion motor deficit of ≤2/5. Preoperative, intraoperative, and postoperative variables were analyzed.
Results: Eight patients met the inclusion criteria (2 women, 6 men). The mean time from diagnosis to surgery was 30 days, with an average follow-up of 959 days. All patients regained at least 4/5 dorsiflexion strength. Six patients achieved full recovery of both strength and sensation. No complications were reported.
Conclusions: Early decompression of the CPN is a safe and effective procedure for severe idiopathic compression. The establishment of a standardized treatment protocol is recommended.
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How to Cite
Abrego, M. O., Barbaglia, V., Holc, F., Bronenberg Victorica, P., Rellán, I., Donndorff, A. G., Gallucci, G. L., De Carli, P., & Boretto, J. G. (2025). Early Surgical Treatment for Severe Idiopathic Compression of the Common Peroneal Nerve: A Case Series. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(2), 115-122. https://doi.org/10.15417/issn.1852-7434.2025.90.2.2084
Section
Clinical Research
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22. Oosterbos C, Rummens S, Bogaerts K, Hoornaert S, Weyns F, Dubuisson A, et al. Conservative versus surgical
treatment of foot drop in peroneal nerve entrapment: rationale and design of a prospective, multi-centre, randomized parallel-group controlled trial. Trials 2022;23:1065. https://doi.org/10.1186/s13063-022-07009-x
23. Muhlestein WE, Wilson TJ. Analysis of outcome reporting in common peroneal neuropathy studies: a systematic review of the literatura. Acta Neurochir 2023;165:2597-604. https://doi.org/10.1007/s00701-023-05744-x
24. Tran TMA, Lim BG, Sheehy R, Robertson PL. Magnetic resonance imaging for common peroneal nerve injury
in trauma patients: Are routine knee sequences adequate for prediction of outcome? J Med Imaging Radiat Oncol
2019;63:54-60. https://doi.org/10.1111/1754-9485.12840
2. Marciniak C. Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil
Clin N Am 2013;24:121-37. https://doi.org/10.1016/j.pmr.2012.08.016
3. Fortier LM, Markel M, Thomas BG, Sherman WF, Thomas BH, Kaye AD. An update on peroneal nerve entrapment and neuropathy. Orthop Rev 2021;13:24937. https://doi.org/10.52965/001c.24937
4. Humphreys DB, Novak CB, Mackinnon SE. Patient outcome after common peroneal nerve decompression. J
Neurosurg 2007;107:314-8. https://doi.org/10.3171/JNS-07/08/0314
5. Fares MY, Dimassi Z, Fares J, Musharrafieh U. Peroneal neuropathy and bariatric surgery: untying the knot. Int J
Neurosci 2020;130:417-23. https://doi.org/10.1080/00207454.2019.1694926
6. Park S-H, Do H-K, Jo G-Y. Compressive peroneal neuropathy by an intraneural ganglion cyst combined with L5
radiculopathy: A case report. Medicine 2019;98:e17865. https://doi.org/10.1097/MD.0000000000017865
7. Jones HR Jr, Felice KJ, Gross PT. Pediatric peroneal mononeuropathy: a clinical and electromyographic study.
Muscle Nerve 1993;16:1167-73. https://doi.org/10.1002/mus.880161105
8. Mackay MJ, Ayres JM, Harmon IP, Tarakemeh A, Brubacher J, Vopat BG. Traumatic peroneal nerve injuries: A
systematic review. JBJS Rev 2022;10. https://doi.org/10.2106/JBJS.RVW.20.00256
9. Souter J, Swong K, McCoyd M, Balasubramanian N, Nielsen M, Prabhu VC. Surgical results of common peroneal
nerve neuroplasty at lateral fibular neck. World Neurosurg 2018;112:e465-72. https://doi.org/10.1016/j.wneu.2018.01.061
10. van Zantvoort APM, Setz MJM, Hoogeveen AR, Scheltinga MRM. Common peroneal nerve entrapment in the
differential diagnosis of chronic exertional compartment syndrome of the lateral lower leg: A report of 5 cases.
Orthop J Sports Med 2018;6:2325967118787761. https://doi.org/10.1177/2325967118787761
11. Oosterbos C, Decramer T, Rummens S, Weyns F, Dubuisson A, Ceuppens J, et al. Evidence in peroneal nerve
entrapment: A scoping review. Eur J Neurol 2022;29:665-79. https://doi.org/10.1111/ene.15145
12. Broekx S, Weyns F. External neurolysis as a treatment for foot drop secondary to weight loss: a retrospective
analysis of 200 cases. Acta Neurochir 2018;160:1847-56. https://doi.org/10.1007/s00701-018-3614-9
13. Tarabay B, Abdallah Y, Kobaiter-Maarrawi S, Yammine P, Maarrawi J. Outcome and prognosis of microsurgical
decompression in idiopathic severe common fibular nerve entrapment: Prospective clinical study. World Neurosurg 2019;126:e281-7. https://doi.org/10.1016/j.wneu.2019.02.042
14. Medical Research Council (Great Britain). Aids to the examination of the peripheral nervous system [Internet].
1976. Disponible en: https://books.google.com/books/about/Aids_to_the_Examination_of_the_Periphera. html?hl=&id=5RM10AEACAAJ
15. Seddon HJ. A Classification of nerve injuries. Br Med J 1942;2:237-9. https://doi.org/10.1136/bmj.2.4260.237
16. Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951;74:491-516.
https://doi.org/10.1093/brain/74.4.491
17. Faktorovich S, Filatov A, Rizvi Z. Common compression neuropathies. Clin Geriatr Med 2021;37:241-52.
https://doi.org/10.1016/j.cger.2021.01.011
18. Fabre T, Piton C, Andre D, Lasseur E, Durandeau A. Peroneal nerve entrapment. J Bone Joint Surg Am 1998;80:47-53. https://doi.org/10.2106/00004623-199801000-00009
19. Maalla R, Youssef M, Ben Lassoued N, Sebai MA, Essadam H. Peroneal nerve entrapment at the fibular head:
outcomes of neurolysis. Orthop Traumatol Surg Res 2013;99:719-22. https://doi.org/10.1016/j.otsr.2013.05.004
20. Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, et al. Chronic leg pain in athletes. Am J Sports Med 2015;43:1538-47. https://doi.org/10.1177/0363546514545859
21. Fakkel TM, Rinkel WD, Coert JH. Does lower extremity nerve decompression surgery improve quality of life? Plast Reconstr Surg 2022;150:1351-60. https://doi.org/10.1097/PRS.0000000000009699
22. Oosterbos C, Rummens S, Bogaerts K, Hoornaert S, Weyns F, Dubuisson A, et al. Conservative versus surgical
treatment of foot drop in peroneal nerve entrapment: rationale and design of a prospective, multi-centre, randomized parallel-group controlled trial. Trials 2022;23:1065. https://doi.org/10.1186/s13063-022-07009-x
23. Muhlestein WE, Wilson TJ. Analysis of outcome reporting in common peroneal neuropathy studies: a systematic review of the literatura. Acta Neurochir 2023;165:2597-604. https://doi.org/10.1007/s00701-023-05744-x
24. Tran TMA, Lim BG, Sheehy R, Robertson PL. Magnetic resonance imaging for common peroneal nerve injury
in trauma patients: Are routine knee sequences adequate for prediction of outcome? J Med Imaging Radiat Oncol
2019;63:54-60. https://doi.org/10.1111/1754-9485.12840