Common fibular (peroneal) nerve
By : Amna MohammedDefinition
Is one of the basic nerves that supply the posterior & lateral sides of the leg & reach the foot region.
Origin
Its fibers arise from the posterior division of the anterior rami of the ( L4 - S2 ) of the lumbosacral plexus , which is the lateral and a small essential branch of the sciatic nerve .
Note: there is a difference at the point that the nerve arises from the sciatic nerve. In some cases, the sciatic nerve divides at the pelvis in the gluteal region.
Termination
It terminates by bifurcating into two branches:
1. Superficial fibular nerve
2. Deep fibular nerve
1. Superficial fibular nerve
2. Deep fibular nerve
lumbosacral plexus
anterior view, right side.
Course
1.It arises from the sciatic nerve at the lower third of the thigh, specifically at the upper angle of the popliteal fossa’s rhombus shape.
2.Then, it descends downward at the popliteal fossa near to the biceps femoris m. (medial border) through the superolateral aspect of the fossa boundary.
3.It leaves the popliteal fossa by passing superficial to the gastrocnemius m. head of the lateral side.
4.Then, it enters the leg region back to the fibula bone’s head & continues its path by turning around the bone neck laterally.
5.It penetrates the fibularis (peroneal) longus m. to terminate into superficial & deep fibular nerves.
2.Then, it descends downward at the popliteal fossa near to the biceps femoris m. (medial border) through the superolateral aspect of the fossa boundary.
3.It leaves the popliteal fossa by passing superficial to the gastrocnemius m. head of the lateral side.
4.Then, it enters the leg region back to the fibula bone’s head & continues its path by turning around the bone neck laterally.
5.It penetrates the fibularis (peroneal) longus m. to terminate into superficial & deep fibular nerves.
Posterior view
right lower limb.
Branches
The common fibular nerve has motor & sensory fibers which are distributed in the leg region:
• Muscular branch: to the short head of the biceps femoris m.
• Articular branch: to the knee joint.
• Cutaneous branches: the common fibular nerve gives two sensory branches:
1. The sural communicating branch: which unites with the sural nerve and innervates the posterior & posterolateral side of the leg.
2. The lateral cutaneous nerve of the calf: which innervates the lateral side of the leg back.
• Muscular branch: to the short head of the biceps femoris m.
• Articular branch: to the knee joint.
• Cutaneous branches: the common fibular nerve gives two sensory branches:
1. The sural communicating branch: which unites with the sural nerve and innervates the posterior & posterolateral side of the leg.
2. The lateral cutaneous nerve of the calf: which innervates the lateral side of the leg back.
Right lower limb.
Clinical Note
The clinical importance of the common fibular nerve is that exposed to injury at its location when is turned around the neck of the fibula bone due:
• It's more superficial position at this point than other points on its way, it lies in the subcutaneous layer.
• It's closely relation to the fibula bone neck, as any effect on the bone also affects the nerve at this point.
• It's more superficial position at this point than other points on its way, it lies in the subcutaneous layer.
• It's closely relation to the fibula bone neck, as any effect on the bone also affects the nerve at this point.
Anterior view
right lower limb.
Possible Causes
1. The lateral fibers of the sciatic nerve which are the common fibular
nerve at the lower level of the lower limb are exhibition to injury due the fracture of the femur bone, acetabular, or during the treatment of these fractures.
2. Knee dislocation may cause an effect on the sciatic nerve that reachs it or during knee surgery.
3. The tibia or fibula fracture, precisely the proximal end of the fibula.
4. A Tight cast may cause pressure on the nerve at the level below the knee.
5. A long time rests in the bed after surgery or stays in the intensive care room for a long time with hip external rotation & knee flexion position that causes compression on the nerve that leads to nerve palsy.
6. The ankle sprain because of the foot inversion may cause nerve traction due the peroneal muscles extending.
7. The external factors like gunshots, shrapnel & hurtful tools. etc.
nerve at the lower level of the lower limb are exhibition to injury due the fracture of the femur bone, acetabular, or during the treatment of these fractures.
2. Knee dislocation may cause an effect on the sciatic nerve that reachs it or during knee surgery.
3. The tibia or fibula fracture, precisely the proximal end of the fibula.
4. A Tight cast may cause pressure on the nerve at the level below the knee.
5. A long time rests in the bed after surgery or stays in the intensive care room for a long time with hip external rotation & knee flexion position that causes compression on the nerve that leads to nerve palsy.
6. The ankle sprain because of the foot inversion may cause nerve traction due the peroneal muscles extending.
7. The external factors like gunshots, shrapnel & hurtful tools. etc.
Note: the big weight loss is contribute to the injury of the nerve, because the nerve loss an amount of the fat around it, where this fat was working as a protection layer.
Symptoms
1. The foot and toes dorsiflexion Inability, due the anterior
compartment muscles of the leg is paralyzed, this condition is called “foot drop” .
2. The foot eversion inability, due the lateral compartment muscles of the leg being paralyzed.
3. lose of sensation of the skin over the posterolateral and lateral surfaces of the leg and the dorsum of the foot.
compartment muscles of the leg is paralyzed, this condition is called “foot drop” .
2. The foot eversion inability, due the lateral compartment muscles of the leg being paralyzed.
3. lose of sensation of the skin over the posterolateral and lateral surfaces of the leg and the dorsum of the foot.
Foot dorsiflexion
lateral view, right lower
Note: the foot drop isn’t a disease, is a sign of some diseases that the lower limb gets.
The foot drop is the foot and toes dorsiflexion Inability, due the deactivation of the flexion muscles group.
That is a sign to the deep fibular nerve or common fibular nerve damage. The foot drop patient is unable to begin the gait by stick down the heel on the ground, On the contrary, the foot slaps the ground strongly, the patient is also unable to flex his foot & toes during the swing phase of the gait cycle.
The foot drop is the foot and toes dorsiflexion Inability, due the deactivation of the flexion muscles group.
That is a sign to the deep fibular nerve or common fibular nerve damage. The foot drop patient is unable to begin the gait by stick down the heel on the ground, On the contrary, the foot slaps the ground strongly, the patient is also unable to flex his foot & toes during the swing phase of the gait cycle.
The foot drop condition
anterior view.
Diagnosis
1. The specialist examines the patient's walk to make sure how much the flexor group muscles of the leg work normally and to check the sensation over the skin of the lateral and the posterolateral sides of the leg ascending down to the dorsum of the foot.
2. The specialist examines the response and action of the nerve and the response between nerve-muscle using conduction velocity (NCV) and electromyography tests (EMG).
3. The specialist uses ultrasound, MRI, CT scans and plain radiography to scrutiny test the tissues and the bones that are related to the nerve.
2. The specialist examines the response and action of the nerve and the response between nerve-muscle using conduction velocity (NCV) and electromyography tests (EMG).
3. The specialist uses ultrasound, MRI, CT scans and plain radiography to scrutiny test the tissues and the bones that are related to the nerve.
The sketch show the normal gait cycle
the foot drop is being clear at the swing phase.
Treatment
The treatment varies depending on the location of the injury at the nerve and how much is severe
1. If the condition isn't acute, maybe the suitable treatment is the physical therapy, splints that fit the Injured foot to help the patient to move easily, in addition to the use of medicines will help to reduce the pain and speed up the recovery.
2. If the injury is advanced, the surgeon may suggest surgical intervention. The surgeon removes the pressure on the nerve or transports the muscle tendon or repairs the damage that hits the nerve, so the surgeon removes the injure cause.
1. If the condition isn't acute, maybe the suitable treatment is the physical therapy, splints that fit the Injured foot to help the patient to move easily, in addition to the use of medicines will help to reduce the pain and speed up the recovery.
2. If the injury is advanced, the surgeon may suggest surgical intervention. The surgeon removes the pressure on the nerve or transports the muscle tendon or repairs the damage that hits the nerve, so the surgeon removes the injure cause.
References
1.Snell’s Clinical Anatomy By Regions (20th Edition) 1286,1336,132
2.Moore-Clinically Oriented Anatomy (7th Edition) 593,605-606
3.Neurology in Clinical Practice (4th Edition)-453-454.
4.Peripheral nerve injuries in the athlete -PubMed-
https://pubmed.ncbi.nlm.nih.gov/9421863/
5.Peroneal Nerve Injury (Foot Drop)- Johns Hopkins Medicine- https://www.hopkinsmedicine.org/peripheral_nerve_surgery/conditions/peroneal- nerve-injury.html
6.Peroneal Nerve Palsy: Evaluation and Management- PubMed-
https://pubmed.ncbi.nlm.nih.gov/26700629/
7.Fibula Fractures- PubMed- https://pubmed.ncbi.nlm.nih.gov/32310599/
8.Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates-
PubMed- https://pubmed.ncbi.nlm.nih.gov/23177035/
9.Evaluation and treatment of peroneal neuropathy- Jennifer Baima and Lisa Krivickas- PubMed- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684217/
10.Peroneal Nerve Injury- Lezak B, Massel DH, Varacallo M- Books- https://www.ncbi.nlm.nih.gov/books/NBK549859/
Figures
Netter-Atlas Of Human Anatomy (6th Edition)-529
Gray’s Atlas Of Anatomy (2nd Edition)-13,328,366-367
The foot drop condition- https://www.sciencephoto.com/media/264640/view/foot-drop
Foot dorsiflexion- https://www.researchgate.net/figure/Ankle-joint-representing- dorsiflexion-and-plantar-flexion_fig1_261995964
The gait cycle- https://www.researchgate.net/figure/Functional-divisions-of-the- gait-cycle-according-to-Perry-and-Burnfield-2010_fig2_278963725
2.Moore-Clinically Oriented Anatomy (7th Edition) 593,605-606
3.Neurology in Clinical Practice (4th Edition)-453-454.
4.Peripheral nerve injuries in the athlete -PubMed-
https://pubmed.ncbi.nlm.nih.gov/9421863/
5.Peroneal Nerve Injury (Foot Drop)- Johns Hopkins Medicine- https://www.hopkinsmedicine.org/peripheral_nerve_surgery/conditions/peroneal- nerve-injury.html
6.Peroneal Nerve Palsy: Evaluation and Management- PubMed-
https://pubmed.ncbi.nlm.nih.gov/26700629/
7.Fibula Fractures- PubMed- https://pubmed.ncbi.nlm.nih.gov/32310599/
8.Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates-
PubMed- https://pubmed.ncbi.nlm.nih.gov/23177035/
9.Evaluation and treatment of peroneal neuropathy- Jennifer Baima and Lisa Krivickas- PubMed- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684217/
10.Peroneal Nerve Injury- Lezak B, Massel DH, Varacallo M- Books- https://www.ncbi.nlm.nih.gov/books/NBK549859/
Figures
Netter-Atlas Of Human Anatomy (6th Edition)-529
Gray’s Atlas Of Anatomy (2nd Edition)-13,328,366-367
The foot drop condition- https://www.sciencephoto.com/media/264640/view/foot-drop
Foot dorsiflexion- https://www.researchgate.net/figure/Ankle-joint-representing- dorsiflexion-and-plantar-flexion_fig1_261995964
The gait cycle- https://www.researchgate.net/figure/Functional-divisions-of-the- gait-cycle-according-to-Perry-and-Burnfield-2010_fig2_278963725
