In peroneal paralysis, the peroneal nerve is damaged. Paresis is one of the nerve compression syndromes.
What is peroneal paralysis?
Peroneal paralysis also called peroneal paralysis. What is meant by this is damage to the common fibula nerve (nervus peroneus communis). The paralysis is counted among the nerve compression syndromes that occur relatively frequently. Individual parts of the nerve as well as the entire nerve can be affected. Damage to the fibula nerve is noticeable through paralysis of the muscles responsible for actively lifting and bending the foot and toes. The common peroneal nerve, also known as the common fibular nervecalled, forms one of two main branches of the sciatic nerve (Nervus ischiadus). It has sensitive and motor parts. The second main branch is formed by the tibial nerve (nervus tibialis), which is also equipped with sensory and motor parts.
The common peroneal nerve runs laterally along the knee and passes the fibula head in a posterior direction. It then divides into the deep fibular nerve and the superficial fibular nerve. The main function of the peroneal nerve is to control the extensor muscles of the lower leg. See AbbreviationFinder for abbreviations related to Peroneal Paralysis.
In doing so, it ensures that the foot is pulled upwards within the ankle joint, as well as for the external foot rotations. At the same time, the nerve is also responsible for the dorsiflexion of the toes. Behind the head of the fibula, the common peroneal nerve is considered at risk of injury because it runs close to the surface in this area.
Causes
Peroneal paralysis is caused by mechanical pressure in the region of the fibular head, which is due to the sensitive location of the peroneal nerve at this point. People who have little fat and muscle tissue are considered to be particularly at risk. It is not uncommon for peroneus paralysis to result from medical interventions.
This includes, for example, a plaster cast that was applied too tightly. The resulting external pressure causes damage to the common peroneal nerve, which is restricted in its expansion. But the fibula nerve can also be affected during surgical interventions.
Because of the nerve’s delicate position, it is a common victim of injuries such as a fibular head fracture. Improper positioning when bedridden can lead to paralysis of the fibula nerve. The same applies to work activities such as laying tiles or constantly crossing your legs.
In rare cases, aneurysms in the hollow of the knee, a ganglion (ganglion) at the tibiofibular joint or a Baker’s cyst are also responsible for peroneal nerve paresis. Other conceivable indications are herniated discs and circulatory disorders due to an acute occlusion of the leg artery.
Symptoms, Ailments & Signs
In the case of peroneus paralysis, the patient usually has difficulty walking and deformities of the affected foot. Damage to the deep branch of the calf nerve, the fibular nerve, results in disturbances in the stretching process. Doctors then speak of a drop foot or a drop foot, which lead to a stepper or stork walk.
The affected person pulls their knee up unusually so as not to drag their toes along the floor. If the superficial fibular nerve is impaired, the lateral edge of the foot can no longer be actively raised, which is due to a disruption in inward rotation.
Both phenomena sometimes occur in combination, depending on the level of nerve damage. Other possible symptoms of peroneal nerve paresis are sensory disturbances that appear on the back of the foot, the lateral edge of the foot or the front of the lower leg.
Diagnosis & course of disease
If there is a suspicion of peroneus paralysis, the doctor first looks at the patient’s medical history and asks about possible previous injuries or previous illnesses. He then performs a physical exam, during which he tests the Achilles tendon reflexes as well as the peroneus reflexes.
While the Achilles tendon reflex is fully functional in peroneal palsy, the peroneal reflex is weakened. Electroneurography is another diagnostic option. The doctor measures how quickly an impulse is transmitted between two electrodes by the nerve. The procedure allows the exact position of the nerve damage to be determined.
The differential diagnosis also plays an important role. It is important to rule out an L5 syndrome, since herniated discs can squeeze the 5th nerve root, which leads to symptoms of loss and numbness in the foot. However, in contrast to peroneal paralysis, L5 syndrome usually involves pain.
In most cases, the peroneus paralysis takes a positive course. In the case of pressure injuries in particular, the prospects of recovery are considered good. To do this, however, the patient must consult a doctor quickly if he feels any discomfort, as this improves the chances of success.
Complications
In most cases, paralysis of the peroneus has a very negative effect on the movement of the person concerned. This can lead to various complaints when standing and walking the affected person, so that the patient’s quality of life is significantly reduced. Under certain circumstances, the person affected is also dependent on walking aids due to the paralysis of the peroneus.
Likewise, the legs can no longer be stretched properly, so that it is no longer possible for the patient to carry out various activities and sports. In children, peroneal paralysis can lead to developmental delays. Paralysis or other sensory disorders can also occur in the calves or the entire leg. Pain can also occur and make everyday life difficult.
Furthermore, paralysis of the peroneus can also lead to psychological complaints or depression, so that the patients are dependent on psychological treatment. However, the further course of the disease depends very much on the severity of the nerve damage. Treatment cannot be carried out in every case. However, the treatment does not lead to any particular complications. The life expectancy of those affected is also not affected by the peroneus paralysis.
When should you go to the doctor?
Fibula pain should be evaluated by a doctor if it persists for more than two to three days. If you have difficulty walking, discomfort or severe pain, it is best to consult your family doctor on the same day. Peroneal paralysis occurs mainly after injuries or damage during medical measures. If the above symptoms occur after exercise or as part of physiotherapy, you should speak to a doctor immediately.
If there is already damage to the fibula, for example after a fracture or an operation in the area concerned, medical advice is also required. Peroneal paralysis is treated by an orthopedist. Other contact points are sports physicians, physiotherapists and specialists for nervous disorders. Severe paralysis must be treated surgically. After the initial treatment, the stability of the fibula must be strengthened through physiotherapy and other measures. Close consultation with the doctor is necessary so that the accompanying drug therapy can be adjusted to the progress of recovery and any pain.
Treatment & Therapy
Treatment for peroneal nerve palsy depends on how severe the nerve damage is. All triggering factors, such as crossing your legs, must be eliminated. Paresis is usually treated conservatively. Muscles can be rebuilt with physiotherapy.
Sometimes a special peroneus spring is also used, which is a dynamic foot lifter system that enables the patient to walk more easily. If conservative therapy does not lead to an improvement, an operation is usually carried out to relieve the head of the fibula. If the peroneal nerve palsy is caused by an underlying disease such as a tumor or a Baker’s cyst, it must first be treated, which can usually lead to an improvement in the paralysis.
Outlook & Forecast
No uniformly good prognosis can be given for peroneal paralysis. The cause and extent of damage to the common peroneal nerve can vary. This influences the outcome of medical or physiotherapeutic treatment.
First, the cause and extent of the peroneal paralysis must be determined. If the common fibular nerve was only exposed to pressure damage, the resulting damage and paralysis can usually be repaired. But the situation is different if the damage has caused permanent paralysis. In this case, the full functionality of muscles and nerves can often not be restored. The prognosis is worst when the common fibular nerve has been completely severed.
The first step in treating peroneal paralysis is to reduce the degree of paralysis as much as possible. This is the only way to improve the prognosis for those affected. The medical ideal is the restoration of full functionality. The secondary goal of treatment is to circumvent possible complications. Such would be given for example by a pointed foot. Unfortunately, surgical procedures have not proven successful in the case of peroneus paralysis. If necessary, a peroneal splint can make it easier to walk with a pointed foot.
The physicians achieve the relatively most successful treatment results with functional electrical stimulation (FES) with a mobile foot lifter system. This can reduce the severity of a walking disability. In the long term, new nerve tracts can even form.
Prevention
Preventing peroneal paralysis is not easy. In this way, triggering injuries to the fibula nerve must be avoided.
Aftercare
Peroneal paralysis is a serious condition and disease that must be examined and treated by a doctor. Those affected should consult a doctor as soon as the first symptoms and signs of the disease appear, so that there are no further complications or other complaints.
The measures and the options for aftercare are very limited, with the further course depending very much on the time of diagnosis. Most patients with this disease are dependent on the measures of physiotherapy or physiotherapy. Many of the exercises from such therapies can also be repeated at home, which speeds up treatment and healing.
Many of those affected also depend on the help and support of their own families. Loving conversations are very important to prevent the development of depression or other mental upsets. If the paralysis of the peroneus is to be treated by surgery, those affected should rest after such an operation and take care of their bodies. You should refrain from unnecessary exertion or other physical activities in order not to put unnecessary strain on the body.
You can do that yourself
In this disease, a conscientious differential diagnosis as quickly as possible is important. This is the only way to find and even eliminate the causes of peroneus paralysis, especially if the disease occurred due to mechanical stimuli. Then, however, the chances are good that the peroneus paralysis will heal completely.
For example, if the paralysis was caused by a cast that was too tight, the doctor treating you will loosen the cast. However, if the patient – in this case usually very slim – constantly crosses his legs while sitting, an accompanying behavioral therapy must be considered. This is the only way the patient can get rid of this habit and find a healthier sitting posture.
If the disease is still acute, it can be very painful and significantly reduce the quality of life. In some cases, the treating orthopedist or sports medicine doctor will recommend an operation. He will also do physiotherapy, physiotherapyand prescribe medications such as painkillers. The physiotherapy appointments in particular should be kept, even if they prove to be painful at first. Physiotherapy will stabilize the success of the treatment and rebuild the muscles. Then the patient should do moderate sports again. He may need support to walk, such as a peroneus spring or an assistant, but going for a walk or even hiking are good ways to train the muscle and prevent recurrence.
