When is surgery indicated for superficial peroneal nerve entrapment and what is its efficacy?

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

Surgical decompression may be indicated in cases of superficial peroneal nerve entrapment that is refractory to nonoperative options. This can include release of the nerve at the lateral leg for surgical decompression with partial or full fasciotomy. Some authors have also advocated fasciectomy in select cases. Neurolysis generally is not indicated, because it has not been shown to improve outcome.

Styf and Morberg reported that 80% of their patients were free from symptoms or satisfied with the result after decompression of the superficial peroneal nerve. [64] Three of 14 patients underwent local fasciectomy as well.

Styf reported on the use of fasciotomy and neurolysis to treat entrapment of the superficial peroneal nerve in 24 legs (21 patients). [39] Nine patients were satisfied with the result, another six had improvement but were not satisfied because of residual limitation of athletic activity, three had unchanged conditions, and one had a worsened condition. Conduction velocity in the superficial peroneal nerve increased postoperatively, though the change was insignificant.

In five of the patients, the nerve had an anomalous course, and in 11, fascial defects were present over the lateral compartment. [39] The author concluded that operative decompression of the superficial peroneal nerve produces cure or improvement in about 75% of cases but that it is less effective in athletes than in others.

Sridhara and Izzo reported complete symptomatic relief after surgical decompression. [65] Johnston and Howell reported dramatically relieved pain after release and anterior transposition of the nerve in patients who had had neuralgia after inversion ankle sprain. [66]


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