Decompression of the superficial peroneal nerve: clinical outcomes and anatomical study

Abstract

OBJECTIVE The authors of this study sought to determine the outcomes of patients undergoing superficial peroneal nerve (SPN) release to treat lower-extremity pain and describe consistent anatomical landmarks to direct surgical planning. METHODS This retrospective cohort study examined 54 patients with pain in the SPN distribution who were treated with decompression between 2011 and 2014. Patients rated pain and the effect of pain on quality of life (QOL) on the visual analog scale (VAS) from 0 to 10. Scores were then converted to percentages. Linear regression analysis was performed to assess the impact of the preoperative effect of pain on QOL, age, body mass index (BMI), and preoperative duration of pain on the postoperative effect of pain on QOL. Measurements were made intraoperatively in 13 patients to determine the landmarks for identifying the SPN. RESULTS A higher BMI was a negative predictor for improvement in the effect of pain on QOL. A decrease in pain compared with the initial level of pain suggested a nonlinear relationship between these variables. A minority of patients (7 of 16) with a preoperative pain VAS score ≤ 60 reported less pain after surgery. A large majority (30 of 36 patients) of those with a preoperative pain VAS score > 60 reported improvement. Intraoperative measurements demonstrated that the SPN was consistently found to be 5 ± 1.1, 5 ± 1.1, and 6 ± 1.2 cm lateral to the tibia at 10, 15, and 20 cm proximal to the lateral malleolus, respectively. CONCLUSIONS A majority of patients with a preoperative pain VAS score > 60 showed a decrease in postoperative pain. A higher BMI was associated with less improvement in the effect of pain on QOL. This information can be useful when counseling patients on treatment options. Based on the intraoperative data, the authors found that the SPN can be located at reliable points in reference to the tibia and lateral malleolus.

Common diseases mimicking lumbar disc herniation and their treatment

“…The Tinel-like sign is diagnostically useful. [54][55][56][57] Tinel-like signs are occasionally observed at multiple compressed points along the SPN. [54] SPN block with lidocaine may provide transient pain relief.…”

“…Styf and Morbergfound SPN entrapment in 17 of 480 (3.5%) patients with chronic leg pain. [54] According to others, [55][56][57] SPN-EN was attributable to entrapment due to muscle herniation, trauma, compression by a mass lesion, (e.g. varicose veins or lipoma), or an idiopathic origin.…”

“…Diagnosis and treatment SPN-EN diagnosis is based on its symptomatology because it is difficult to diagnose on radiological and nerve conduction studies. [54][55][56][57] Its symptoms tend to be exacerbated by walking and exercise, and SPN-EN must be differentiated from other lumbar diseases. The Tinel-like sign is diagnostically useful.…”

“…[54] SPN block with lidocaine may provide transient pain relief. SPN-EN can co-exist with CPN-EN; Franco et al [56] reported that 78% of patients who underwent SPN-EN surgery had undergone CPN decompression surgery. In patients with muscle herniation, static palpitation and radiological studies may not identify the lesion, and the loaded posture may be necessary for a correct diagnosis.…”

Common Entrapment Neuropathies

“…65 Surgical decompression may help reduce pain in severe cases. 66 There is a lack of guidelines concerning the treatment of anterior tarsal syndrome. Currently, the approach is guided by the clinical condition and starts with conservative measures such as shoe modification and physical therapy.…”