Superficial Peroneal Nerve Anatomic Variability Changes Surgical Technique

Entrapment of the superficial peroneal nerve is an uncommon occurrence in the setting of sports trauma or fracture/dislocation as the nerve comes under pressure between the underlying muscles and overlying fascia. While the superficial peroneal nerve is traditionally depicted as being within the lateral compartment, it has been found in the anterior compartment in some of the authors' patients. Their hypothesis was that patients with entrapment of the superficial peroneal nerve were more likely to have this anatomic variant than the normal population, and that surgical decompression of both compartments would improve clinical outcomes vs. the classic surgical approach of decompressing just the lateral compartment.

The authors retrospectively reviewed the location of the superficial peroneal nerve in a consecutive series of 35 limbs in 31 patients with entrapment of the superficial peroneal nerve. In addition, they performed dissections of the nerve in 60 cadaver legs.

Results demonstrated that the location of the superficial peroneal nerve in the clinical series was not significantly different from the reported normal variation based on chi-square analysis. However, the location of the nerve in the anterior compartment in 47% of the patients in this clinical series and in 40% of the cadaver dissections suggest that surgeons must explore both the anterior and lateral compartments in each patient with entrapment or neuroma of the superficial peroneal nerve.