What's involved:

Peroneal Nerve

Location:

	Most frequently at the Head of the Fibula
	Could be just above or below it involving the Common Peroneal Nerve or the Deep or Superficial branches selectively

Common symptoms:

	Foot drop
	Patient unable to pull foot or toes up
	Usually unilateral, could be bilateral
	No associated pain
	Main complaint is tripping, falling
	Occasional leg/top of foot numbness
	Symptoms always present, no night/day preference

Risk factors:

	No gender preference
	Diabetes or family history of Diabetes, Alcoholism or other occupational or nutritional causes of Neuropathies, HIV infection
	Can be seen following rapid weight loss from a drastic diet
	Usually from leg crossing
	Can be from knees leaning against a sharp edge (desk, waste basket under desk)

Exam:

	When first seen, weakness but no muscle atrophy
	Patient unable to pull foot or toes up
	Check for non-Peroneal muscles involvement such as Posterior Tibialis or Flexor Digitroum Longus to make sure this is not a root lesion
	May have positive Tinel (tingling upon tapping nerve) sign at the Fibular Head

Localization:

Check the Peroneus Longus by foot eversion, Tibialis Anterior by foot dorsiflexion and sensation over dorsum of foot:  If Peroneus Longus + Tibialis Anterior involved + decreased dorsum foot sensation à Common Peroneal lesion at or above Fibualr Head If Peroneus Longus involved + decreased dorsum foot sensation but Tibialis Anterior spared à Superficial Peroneal lesion usually below Fibualr Head If Peroneus Longus spared and dorsum foot sensation preserved but Tibialis Anterior involved à Deep Peroneal lesion usually below Fibualr Head

EMG:

	Very Good for localization across the Fibular Head
	Very Good for Prognostic value: In pure myelin lesions (conduction block), recovery may occur after three weeks to a month In moderate/severe axonal lesions, recovery may take from 6 months to a year  In mixed lesions, somewhere in between
	Shows slowing and/or drop in Extensor Digitorum Brevis amplitude across compression area in myelin lesions (slowing seen in segmental demyelination, amplitude drop seen in conduction block)
	Diffuse drop in Extensor Digitorum Brevis amplitude with or without slowing in axonal lesions
	Mixture of above in mixed lesions
	Superficial Peroneal sensory spared in lesions of the Deep Peroneal, affected in lesions of the Comon Peroneal Nerve
	Always check to make sure non-Peroneal muscles (such as Posterior Tibialis and or Flexor Digitorum Longus) were sampled to rule out a root lesion

Recommendations:

	Symptomatic treatment
	Stop/decrease cause, change/stop diet
	Leg brace (plastic) to maintain heel in dorsal flexion and prevent falls,  also to help prevent tightening of Achilles tendon which will make recovery difficult
	Brace specially useful in moderate to severe axonal lesions which take longer to recover
	Passive foot, toes Range of Motion by PT

What else could it be:

Can be a severe long standing Neuropathy