Common peroneal nerve injury

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Case
A 16-year-old club player presented approximately two weeks after an inversion injury to his right foot, sustained during a slide tackle. He was able to limp off the field but was unable to continue. Over the next few days he developed progressive weakness in his right foot. On examination he was unable to dorsiflex the ankle, extend the toes, invert the foot, or evert against gravity. There was loss of light touch perception in the distribution of the deep peroneal nerve and mild alteration of perception to light touch in the distribution of the superficial peroneal nerve. There was moderate tenderness over the common peroneal nerve at the fibular neck and quite significant tenderness in the junction of the proximal and middle thirds of the anterior compartment of the leg.

Findings
Ultrasound imaging performed shortly after the injury showed a tear in the peroneus longus muscle. The MRI images confirm an injury to the proximal peroneus longus. There is a ‘grade 3’ muscular tear with a 4 cm intramuscular haematoma and retraction of the central tendon. The haematoma is associated with bulging of the peroneus musculature within the axial plane, which likely causes mechanical pressure on the common peroneal nerve at the fibular neck.

Discussion
This patient was treated with a temporary ankle-foot orthosis (AFO) to manage his foot drop. Consideration was given to aspirating the haematoma however this was not done. His strength progressively recovered over a three month period and he was able to return to football without any ongoing disability.

The common peroneal, superficial peroneal, and saphenous nerves are the most common nerves at risk of compression (or other injury) in the lower leg. This is most commonly related to trauma. Common peroneal nerve entrapment can be caused by external compressive sources which include poorly fitting plaster casts and knee braces. “Internal” compressive sources include osteophytes, proximal tibiofibular joint ganglion cysts and haematomas (as seen in this case). The nerve can also be affected following an ankle sprain/inversion injury where a traction-type mechanism occurs. The common peroneal nerve can also be injured after repetitive exercises involving inversion and eversion, such as running and cycling. Finally, knee surgery is a documented cause of injury.

Imaging studies can be useful to assess for a mechanical cause of compression. MRI and ultrasound are the most commonly used modalities for this assessment. Nerve conduction studies can also be useful where the diagnosis is in doubt, or to assess the potential for recovery when the symptoms have been more prolonged.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Ayo Abolarin
27 June 2019 13:19

In this kind of injury electrical muscle stimulation will be of help in reducing the heamatoma and strengthening the dorsi flexors and invertors.

Chris Lipp
27 June 2019 16:51

Great case. Thanks for writing it up and sharing!

Bangoura
Bangoura
30 June 2019 15:37

Une déchirure grade3 du muscle peronier long peut entraîner une compression du nerf peronier commun synonyme d une blessure par inversion.LIRM et L ÉCHOGRAPHIE soit des imagerie de predilection.La présence d un hématome rend le travail plus compliqué.Faire des seancespar ELECTROSTIMULATEUR et ULTRASONTHERAPIE pour faciliter le drainage
Orthese avec un repos de12semaines avant la reprise sportive.Eviter de faire des plantages trop serrees pour éviter des dommages du nerf

Fifa
03 July 2019 19:02

La Inmediata aplicación de compresas analgésicas heladas, en el momento de la lesión, previene la formación de Hematomas.

Truth
04 July 2019 17:34

In a such condition,i would organize a rehab.programme which will include ;mm s trengthening,co ordination,balance as well as joint stability exs,

FAIZAN SAIFI
05 July 2019 5:05

Thanks for giving a good knowledge

John Frezghi
08 July 2019 12:26

Thank you for sharing your experiences since it will be helpful in managing such cases of calf injuries with includes distal nerve systemic injuries in football players.