Knee / Ankle / Foot

Peroneal Neuralgia

Definition

Peroneal neuralgia is a neurological disorder due to a lesion or dysfunction of this nerve, and is accompanied by pain and neurological deficits in region of the peroneal nerve.

Aetiology

Traumatic lesions, tumours and metabolic diseases can cause peroneal neuralgia.

The nerve is particularly susceptible to damage around the hip (acetabulum fracture, incidence 16-33%), the head of the fibular bone (tibia plateau and fibular fractures, incidence 1%, knee prostheses), and the ankle (ankle surgery (ankle fracture), ankle distortion).

Extreme postoperative weight loss in combination with bed rest can cause neuropathy of the peroneal nerve.

Signs and symptoms

Patients with peroneal neuralgia complain of pain, sensory loss, hyperalgesia, and allodynia of the lateral side of the lower leg and dorsal foot. In addition, motor deficit, such as dorsal flexion paresis of the foot, can be present.

Diagnostics

Physical Examination

The characteristics of the sensory loss and motor deficit can provide information regarding the level at which the peroneal nerve is damaged.

In addition, neurological examination can show allodynia and hypoalgesia in the region of the peroneal nerve,

Additional Somatic Diagnostics

  • EMG
  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclic antidepressants
  • Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine and pregabaline.

Interventional Pain Treatment