What is the recommended approach for nerve decompression for the treatment of foot drop?

Updated: Mar 23, 2020
  • Author: James W Pritchett, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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The recommended approach for nerve decompression is through a longitudinal posterolateral incision centered at the fibular head and paralleling the biceps tendon and fibula. The peroneal nerve is identified at the biceps femoris and traced distally. The nerve is released proximally from its fibrous enclosure at the fibular neck. Distally, it is released to the level where it dives into the peroneus longus. The attachment of the peroneus longus at the fibular neck is also released.

A wider exposure should be used for posttraumatic exploration if immediate repair or grafting is anticipated. With the patient prone, a mildly curved incision is made just medial to the short head of the biceps femoris in the lower thigh, extending to the skin posterior to the fibular head and then toward the anterior compartment. Superficial and deep peroneal nerve branches are exposed distal to the fibular head. The peroneal nerve is traced obliquely across the popliteal fossa, and its division can be split away from the tibial fossa if further length is needed.

In general, limited exposure should be avoided, so as to facilitate the performance of intraoperative stimulation and recording studies. Having clear exposure of the lesion, as well as viable nerve proximally and distally, is essential. Surgical exploration with NAP monitoring of lesions in continuity can document sufficient peroneal recovery to allow the surgeon to avoid unnecessary resection and repair. Allograft nerve conduits and allograft cable grafts are an alternative to autografts for nerve reconstruction.

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