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The gold standard for diagnosing peroneal neuropathies is electrodiagnostic testing, which includes both nerve conduction studies and needle electromyography. In peroneal neuropathy, both the deep and superficial nerves tend to be affected. In the case of a single branch being affected, deep peroneal neuropathy tends to be more common than superficial peroneal neuropathy. The peroneal nerve's most common compression site is found at the fibular head/neck, where the nerve is most superficial. This activity describes the electrodiagnostic findings of nerve conduction studies and needle electromyography studies, as well as highlighting how interprofessional teams are critical to evaluating and managing peroneal neuropathies over the longterm. Objectives: Identify the indications for electrodiagnostic testing of peroneal neuropathy. Describe the nerve conduction study findings in a patient with peroneal neuropathy. Review the electromyographic findings in a patient with peroneal neuropathy. Outline the importance of communication among the interprofessional team to enhance the delivery of care for patients with peripheral neuropathy. Access free multiple choice questions on this topic.

The fibular nerve has been historically referred to as the peroneal nerve because the fibula can also be referred to as the perone. It has recently become more commonplace to refer to the peroneal nerve as the fibular nerve to distinguish it from the similar-sounding perineal nerve. The fibular nerve terminology will be used in all parts of this article. Fibular neuropathy is considered the most common neuropathy in the lower extremities and tends to occur secondary to compression, entrapment, direct trauma, or ischemia.[1][2] In fibular neuropathy, both the deep and superficial nerves tend to be affected. If a single branch is being affected, the deep fibular nerve tends to be more frequently affected than the superficial fibular nerve.[2] This occurs as the deep fibular nerve fascicles are more superficial at the fibular head; thus, they are more exposed to trauma and compression. The fibular nerve's most common compression site is found at the fibular head/neck, where the nerve is most superficial.[2] Patients tend to present with either an acute or a gradual foot drop. Patients may give a history of falls and possibly tripping due to the foot drop. They may also complain of paresthesias or numbness in the lower leg's lateral portion and the foot's dorsum. Pain can be absent in many cases presenting with a foot drop.[3] However, pain can be an initial presenting symptom in patients without a foot drop but can show a slight weakness in ankle dorsiflexion only when carefully examined.[4] One-third of these patients can have normal electrodiagnostic tests.[4]

Patients tend to present with either an acute or a gradual foot drop. Patients may give a history of falls and possibly tripping due to the foot drop. They may also complain of paresthesias or numbness in the lower leg's lateral portion and the foot's dorsum. Pain can be absent in many cases presenting with a foot drop.[3] However, pain can be an initial presenting symptom in patients without a foot drop but can show a slight weakness in ankle dorsiflexion only when carefully examined.[4] One-third of these patients can have normal electrodiagnostic tests.[4] Injuries to the common fibular nerve can be due to compression from the prolonged crossing of legs, poor positioning during surgery (most common in acute settings), weight loss (most common in a subacute or chronic setting), poor application of a cast, prolonged squatting position (carpet layers, carpentry workers, farmworkers), or diabetes mellitus.[2][5] An isolated weakness of the ankle dorsiflexors and evertors can help clinicians differentiate a fibular neuropathy from L5 radiculopathy, which would also involve the ankle invertors.[5] Studies of the tibialis posterior or gluteus medius muscles, which are not supplied by the fibular nerve but have an L5 innervation, can differentiate L5 radiculopathy.[5] Fibular neuropathies can also be mistaken for lumbosacral plexopathy and sciatic neuropathy.[1] Sciatic neuropathy frequently shows a foot drop and can be confused with common fibular neuropathy.[2][6][7] Sciatic neuropathy is the second most common neuropathy in the lower extremity. Deep fibular neuropathy can occur by patients whose nerves are compressed by trauma (ankle sprains or fractures), footwear (high heeled shoes, tight shoes, or high boots), or intrinsic causes as the nerve passes under the extensor retinaculum (osteophytes, ganglion cysts, or lipomas). Pressure from an anterior compartment syndrome can cause an isolated injury to the deep branch.[5] The superficial fibular nerve can be injured by compression related to trauma, sprained ankles, or lipomas.

Fibular neuropathy is the most common lower extremity neuropathy. Physiatrists, neurologists, neurosurgeons, and orthopedists must recognize that further evaluation with electrodiagnostic testing is warranted when patients present with foot drop/slaps, steppage gait, weakness, or sensory deficits in areas of the lower extremity innervated by the fibular nerve. Doing so will help expedite a patient’s recovery process and improve their quality of life in the long term. Electrodiagnostic studies can prove to be an integral component for determining etiology and guiding management.[1] Once a fibular neuropathy diagnosis is made, an interprofessional team involved in the management should include physiatrists and therapists for physical/occupational rehabilitation. Nutritionists, social workers, and case managers from the inpatient standpoint must coordinate and ensure early mobilization with bedside therapy and aggressive multifaceted rehabilitation. Only through a well-coordinated effort between these multidisciplinary components will a patient achieve their best outcome.