Dynamic factors involved in common peroneal nerve entrapment neuropathy.

Abstract

Common peroneal nerve (CPN) entrapment neuropathy (CPNEN) is the most common peripheral neuropathy of the lower extremities. The pathological mechanisms underlying CPNEN remain unclear. We sought to identify dynamic factors involved in CPNEN by directly measuring the CPN pressure during stepwise CPNEN surgery. We enrolled seven patients whose CPNEN improved significantly after CPN neurolysis. All suffered intermittent claudication, and the repetitive plantar flexion test, used as a CPNEN provocation test, was positive. During decompression surgery we directly measured the CPN pressure during several decompression steps. Before CPN decompression, plantar flexion elicited a statistically significant increase in the CPN pressure (from 1.8 to 37.3, p<0.05), as did plantar extension (from 1.8 to 23.1, p<0.05). The CPN pressure gradually decreased during step-by-step surgery; it was lowest after resection of the peroneus longus muscle (PLM) fascia. Dynamic factors affect idiopathic CPNEN. The CPN pressure decreased at each surgical decompression step, and removal of the PLM fascia resulted in adequate decompression of the CPN. Our findings shed light on the etiology of idiopathic CPNEN and recommend adequate CPNEN decompression procedures.