What is the anatomy of the superficial peroneal nerve in nerve entrapment syndromes of the lower extremity?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

The superficial peroneal nerve, one of the branches of the common peroneal nerve, travels in the lateral compartment and supplies the peroneus longus and peroneus brevis. In most individuals, it pierces the deep fascia and emerges into the subcutaneous fat at approximately the level of the middle and lower third of the leg and at an average of about 10-15 cm above the tip of the lateral malleolus. [12]

At an average of 4-6 cm proximal to the ankle joint, the superficial peroneal nerve divides into a large (2.9 mm) medial dorsal cutaneous nerve and a smaller (2 mm), more laterally located intermediate dorsal cutaneous nerve.

In 28% of patients, the superficial peroneal nerve branches more proximally. In these cases, the medial dorsal cutaneous branch usually follows the more common track of the superficial peroneal nerve and emerges into the subcutaneous tissues in the distal lateral leg. The intermediate dorsal cutaneous nerve penetrates the crural fascia more distally, either anterior or posterior to the fibula and at an average of 4-6 cm proximal to the ankle joint.

At the level of the malleoli, in most patients, the medial dorsal cutaneous nerve is located at approximately half of the distance from the lateral malleolus to the medial malleolus, and the intermediate dorsal cutaneous nerve is located at approximately one third of this distance.

The medial dorsal cutaneous nerve supplies the skin of the dorsomedial aspect of the ankle, the medial aspect of the hallux, and the second and third digits (except for the first webspace). The intermediate dorsal cutaneous nerve supplies the skin on the dorsolateral part of the ankle and gives off dorsal digital nerves for the third, fourth, and fifth toes.

Accessory branches of the superficial peroneal nerve have been reported to cross over the lateral malleolus, where they have been entrapped by fascial bands. An accessory motor branch of the superficial peroneal nerve has also been found to innervate the extensor digitorum brevis in some patients. [13]


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