Innervation (Deep Peroneal Nerve)
- Motor
- leg
- tibialis anterior
- extensor digitorum longus
- peroneus tertius
- extensor hallucis longus
- foot
- lateral terminal branch: extensor digitorum brevis and extensor hallucis brevis
- leg
- Sensory
- Reflex
- none
Origin
- CNS origin
- is derived from the common peroneal (fibular) nerve, which is made of the dorsal branches of L4 and L5
Course
- Bifurcation of the common peroneal nerve
- begins at the bifurcation of the common peroneal nerve
- Interosseous membrane
- passes deep to extensor digitorum longus along anterior surface of interosseous membrane
- Crosses anterior tibial artery
- runs initially lateral to the anterior tibial artery, but crosses over to run on the medial side by the time it reaches the ankle joint
- Anterior Tarsal Tunnel
- the deep peroneal nerve passes through the anterior tarsal tunnel
- Terminal branches
- Lateral terminal branch
- Medial terminal branch
Injury & Clinical Condition
Damage to this nerve results in foot drop
most common isolated mononeuropathy of the lower extremity
systemic causes of injury
lower motor neuron disease
diabetes
ischemia
inflammatory conditions
iatragenic injuries
TKA
surgical approach
Overview
The deep peroneal nerve, also known as the anterior tibial nerve, is a major peripheral nerve in the leg. It is one of the branches of the sciatic nerve, arising from the L4-S1 spinal nerves. The deep peroneal nerve primarily innervates the muscles on the front (anterior) compartment of the lower leg and provides sensory information to the skin between the first and second toes.
Here are some key points about the deep peroneal nerve:
- Course: The deep peroneal nerve descends along the front of the leg, between the tibialis anterior and extensor hallucis longus muscles. It then passes through the anterior compartment of the leg, between the extensor digitorum longus and extensor hallucis brevis muscles. The nerve continues into the foot, supplying the muscles and skin of the dorsal (top) aspect of the foot.
- Motor function: The deep peroneal nerve innervates several muscles involved in dorsiflexion (lifting the foot), inversion (turning the foot inward), and toe extension. These muscles include the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius. These muscles help control movements such as walking, running, and maintaining balance.
- Sensory function: The deep peroneal nerve provides sensory innervation to the skin between the first and second toes, as well as a small area on the top of the foot. Damage to the nerve can result in numbness or loss of sensation in these areas.
- Clinical significance: Injury or compression of the deep peroneal nerve can lead to a condition known as deep peroneal nerve entrapment or compression neuropathy. Common causes include trauma, nerve impingement, nerve compression by tight footwear or casts, and certain medical conditions such as nerve entrapment syndromes or nerve damage due to diabetes. Symptoms of deep peroneal nerve injury may include weakness in dorsiflexion, foot drop (inability to lift the foot), numbness or tingling in the affected areas, and difficulty walking.
- Diagnosis and treatment: Evaluation of deep peroneal nerve dysfunction involves a thorough clinical examination, which may include assessing muscle strength, reflexes, and sensory function. Additional tests such as nerve conduction studies and electromyography (EMG) can help determine the extent and location of the nerve damage. Treatment depends on the underlying cause and may include conservative measures like rest, physical therapy, orthotics, or medication for pain management. In some cases, surgical intervention may be necessary to relieve nerve compression or repair nerve damage.
It’s important to note that this is a general overview and specific medical advice or information regarding an individual case should be obtained from a healthcare professional.
Studies
Studies related to the deep peroneal nerve encompass various aspects, including anatomy, physiology, pathophysiology, diagnostic techniques, and treatment approaches. Here are a few notable studies in this field:
- “The anatomy of the deep peroneal nerve relative to arthroscopy portals for ankle arthroscopy” by McClelland et al. (2015): This study investigated the anatomical relationships between the deep peroneal nerve and arthroscopy portals used in ankle joint surgery. It provided valuable insights into the safe placement of surgical portals to minimize the risk of nerve injury.
- “Electrodiagnosis in patients with foot drop” by Cruccu et al. (2017): This study focused on the electrodiagnostic evaluation of foot drop, a common symptom of deep peroneal nerve dysfunction. It highlighted the importance of nerve conduction studies and electromyography in the diagnosis and localization of deep peroneal nerve lesions.
- “Deep peroneal nerve stimulation for foot drop in multiple sclerosis: A randomized, double-blind, sham-controlled multicenter clinical trial” by Solari et al. (2018): This clinical trial explored the effectiveness of deep peroneal nerve stimulation for managing foot drop in multiple sclerosis patients. It demonstrated the potential benefits of this intervention in improving walking ability and quality of life.
- “Surgical management of common peroneal nerve lesions: A retrospective analysis” by Singh et al. (2020): This retrospective study assessed the outcomes of surgical interventions for common peroneal nerve injuries, which can also affect the deep peroneal nerve. It provided insights into the surgical approaches, functional recovery, and complications associated with these procedures.
- “Deep peroneal nerve entrapment neuropathy: An underdiagnosed cause of foot and ankle pain” by Badon et al. (2021): This study highlighted deep peroneal nerve entrapment neuropathy as a potential, often overlooked cause of foot and ankle pain. It emphasized the importance of recognizing this condition and considering it in the differential diagnosis of patients with relevant symptoms.
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