The peroneal is one of the major nerves in your leg, and the most common injury symptom is weakness when raising your toes. Treating it depends on the underlying cause, but it can include physiotherapy or surgery.

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The common peroneal nerve (also called the common fibular nerve) is one of the two major nerves in your lower leg. This nerve and its branches provide sensation to the tops of your feet and the fronts and sides of your legs. It also allows you to point your toes upward and control muscles in the outer and front parts of your legs.

You can injure this common nerve by sudden injury, long-term compression, or complications from other conditions such as diabetes or childbirth.

Read on to learn more about peroneal nerve injuries including causes, risk factors, and treatment options.

A large nerve that originates in your lower spine called the sciatic nerve is responsible for much of the sensation and ability to move muscles in your lower body. Your sciatic nerve has two branches:

A peroneal nerve injury is damage to your common peroneal nerve or its branches. The common peroneal nerve is most vulnerable where it wraps around the top of your fibula. Your fibula is the smaller of the two bones in your lower leg.

The most common symptom of peroneal nerve injury is foot drop, which is weakness in your ability to dorsiflex your ankle. Dorsiflexion is when you move your toes up toward your shin.

Other symptoms of a peroneal nerve injury can include:

  • numbness, tingling, or loss of sensation in the top of your foot or outer part of your lower leg
  • changes to the way you walk, such as dragging your toes or walking with a higher-than-normal step
  • tripping more often than usual due to foot drop
  • weakness in foot eversion (rotating your sole outward)
  • flopping or slapping sounds when walking

Your common peroneal nerve can be damaged through:

Peroneal nerve injury during pregnancy

Nerves in your lower body can be damaged during labor from compression or stretching, especially during the pushing phase of childbirth. Nerve injury typically resolves within 6 months, but in rare cases can be permanent.

Peroneal nerve damage can occur when your feet are in stirrups with your knees flexed for prolonged periods. It may also happen when your knees rest against a hard surface such as a bed rail or from squeezing the area around your knee with your hand.

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Doctors, physiotherapists, and other healthcare professionals begin the diagnostic process by performing a physical exam and examining your medical history. They may order imaging tests to help find the source of your symptoms such as:

They may also order tests to evaluate your nerve function such as:

  • Nerve conduction studies: These studies measure how fast electricity moves through your nerves.
  • Electromyography: Electromyography measures the electrical activity of your muscles when you’re moving and resting.

Peroneal knee injury after a total knee replacement

Peroneal nerve injury is a potential risk of knee replacement surgery. In a 2020 review of studies, researchers found the rate of common peroneal nerve injury after total knee replacement was 0.4%.

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Treatment for a peroneal nerve injury can be surgical or nonsurgical. Nonsurgical options include orthotic footwear and physical therapy.

Your physical therapy program may include:

  • stretching
  • strengthening exercises
  • mobilization exercises
  • manual manipulation
  • balancing exercises
  • icing
  • ankle bracing
  • ankle taping

You may require surgery if you experience:

  • no signs of improvement within 3 months
  • a rapidly deteriorating lesion
  • an open wound with a severed nerve

A physical therapist or other healthcare professional can give you specific exercises to help you recover. The exercises they prescribe depends on the cause of your injury.

For example, they may have you perform exercises using resistance bands where you point your toes upwards against resistance if you have foot drop.

The recovery time for peroneal nerve injury depends on the underlying cause and severity of the injury.

In a 2020 review of studies, researchers reported complete recovery after 3.6 months in about 40% of cases caused by total knee replacement surgery. They reported incomplete recovery in about 55% of people.

About a third of cases of peroneal nerve injury not associated with an open wound heal by themselves.

A broken bone in your lower leg may take 4 to 6 months to heal. It could take longer if the bone broke your skin. Using tobacco products can slow your recovery.

Your common peroneal nerve can get injured due to a sudden injury, from chronic compression, or as a complication of another health condition. The most common symptom is a weakness when raising your toes.

Treatment for peroneal nerve injury depends on the underlying cause. Many people experience symptom relief with physiotherapy. More severe cases may require surgery.