The Intraseptal Course of the Superficial Peroneal Nerve: An Anatomic Study

Abstract

Background: Anatomic and clinical studies show many variants of the superficial peroneal nerve (SPN) course and branching within the compartments and at the suprafascial layer. The anatomy of the transition zone from the compartment to the subcutaneous layer has been occasionally described in the literature, mainly in studies reporting the intraseptal SPN variant in 6.6% to 13.6% of patients affected by the SPN entrapment syndrome. Despite the little evidence available, the knowledge of the transition zone is relevant to avoid iatrogenic lesions to the SPN during fasciotomy, open approaches to the leg and ankle, and SPN decompression. Our anatomic study aimed to describe the SPN transition site and to evaluate the occurrence of a peroneal tunnel and of an intraseptal SPN variant. Methods: According to the institutional ethics committee requirements, 15 fresh-frozen lower limbs were dissected to study the SPN course and its branching, focusing on the transition site to the suprafascial layer. Results: The SPN was located in the anterior compartment in 2 cases and in the lateral in 13. An intraseptal tunnel was present in 10 legs (66%), at a mean distance of 10.67 cm from the lateral malleolus. Its mean length was 2.63 cm. The tunnel allowed the passage of the main SPN in 8 cases and of its branches in two. In the remaining 5 legs (33%), the SPN pierced a crural fascia window. Conclusion: in our sample a higher rate than expected of intraseptal SPN variants was found. Clinical relevance: the knowledge of the anatomy of the SPN course and intraseptal variant is relevant to avoid iatrogenic lesions during operative dissection. Further studies are needed to evaluate the effective prevalence of an intraseptal tunnel, independently from the SPN entrapment syndrome, and how to avoid associated iatrogenic complications.

A Traumatic Neuroma Formation Following Fasciotomy for the Treatment of Tibialis Anterior Muscle Herniation: A Case Report

“…In the present case, traumatic neuroma of the SPN occurred after fasciotomy. Several studies have demonstrated that there are many variants of the course of the SPN and its branches within the compartment of the lower extremities [ 13 , 14 , 16 , 17 ]. Apaydin et al described three types of courses of the SPN: type 1 (71%), where the SPN runs entirely within the lateral compartment; type 2 (23.7%), where the SPN runs within the anterior compartment below 12.7 cm from the tip of the fibular head; and type 3 (5.3%), where the branches of the SPN run both in the anterior and lateral compartments [ 13 ].…”

Compartments of the crural fascia: clinically relevant ultrasound, anatomical and histological findings

“…Our results are similar to those of other articles that have measured the distance between the exit of the superficial fibular nerve from the crural fascia and of the lateral malleolus apex. For example, one study reported a distance of 10.33 cm for intraseptal cases and 11.28 cm for extraseptal cases [ 26 ], while another study reported 11.36 cm ± 4.39 cm [ 20 ]. However, as in those studies, we observed a great variability in the number of nerve divisions [ 28 ] and their trajectory [ 20 ].…”

Superficial Peroneal Nerve Entrapment in Female Collegiate Tennis Athlete: A Disablement Model Case Study

“…1 This nerve is originally part of the common peroneal nerve (CPN) before it is divided into the deep peroneal nerve (DPN) and the SPN just distal to the fibular head. 1,2 The SPN runs throughout the lateral compartment of the leg and is responsible for the motor innervation of the peroneus longus and peroneus brevis muscles, as well as the sensory innervation of the dorsal aspect of the foot and the lower leg. 1,2 Entrapment commonly occurs when the SPN is overstretched, typically caused by repetitive or forced inversion and plantarflexion (inversion ankle sprains), or actions of prolonged kneeling, squatting, leg crossing, and sitting.…”

“…1,2 The SPN runs throughout the lateral compartment of the leg and is responsible for the motor innervation of the peroneus longus and peroneus brevis muscles, as well as the sensory innervation of the dorsal aspect of the foot and the lower leg. 1,2 Entrapment commonly occurs when the SPN is overstretched, typically caused by repetitive or forced inversion and plantarflexion (inversion ankle sprains), or actions of prolonged kneeling, squatting, leg crossing, and sitting. Soft masses, peripheral injury, direct trauma, or variations in patient anatomy are also common forms of compression that can cause nerve entrapment and elicit symptoms.…”