Symptoms of common peroneal nerve injury and rehabilitation of common peroneal nerve injury

Because the common peroneal nerve is located at the neck of the fibula, superficially and on the surface of the bone, with little soft tissue around it, and is relatively fixed to the surrounding tissues, once it is injured, it has no room to evade or retreat, and is therefore often damaged. So what are the symptoms of common peroneal nerve injury?

Common peroneal nerve injury symptoms

1. The foot cannot dorsiflex or evert, and the toes cannot be straightened

2. Because the posterior calf muscles innervated by the tibial nerve lose antagonism, foot drop, foot inversion, and slight toe flexion will occur.

3. Atrophy of the anterior tibia and lateral calf muscles

4. Local numbness and tingling, decreased or absent sensation in the anterior and lateral areas of the lower leg and the dorsum of the foot, including the skin between the first toes;

Diagnostic tests

1. Percussion test (Tinel sign): local pressure or tapping of the nerve trunk will cause local tingling pain, and numbness and pain radiating to the area innervated by the nerve, which is positive and indicates the site of nerve damage.

2. Sweating test: after nerve damage, the skin in the innervated area becomes cold, sweat-free, smooth and atrophied. Apply 2% iodine solution on the palm side of the finger, apply a layer of starch after it dries, and then bake it with a lamp, or drink hot water and then exercise appropriately to make the patient sweat, which turns blue after sweating.

3. During electrophysiological examination, the conduction velocity of the common peroneal nerve on the affected side slowed down, the amplitude decreased, and the interwave interval prolonged, while the muscles innervated by the common peroneal nerve had no myoelectric potential.

Common causes of peroneal nerve injury

1. Caused by trauma such as impact, squeezing, freezing, electric shock, radiation injury, firearm injury, etc.;

2. Caused by metabolic disorders (diabetes), connective tissue diseases (polyarteritis nodosa) and leprosy;

3. Fracture of fibular head or fibular neck, posterior dislocation of fibular joint, etc.;

4. Iatrogenic nerve injury, such as too tight calf plaster fixation, traction, prolonged compression, etc.

Peroneal nerve injury rehabilitation

(1) Early rehabilitation

◆Exercise therapy can be performed. If the nerve damage is mild, active exercise training can be considered in the early stage. Passive exercise needs to be performed within the pain-free range and normal range of joint movement. The speed should be slow and it should be performed after sufficient fixation after surgery.

◆Take physical therapy, such as thermotherapy, laser therapy, hydrotherapy, etc.

◆Use orthotic treatment to keep the ankle at 90 degrees using a foot brace or orthotic shoes, such as a sling, AFO, ankle brace

(2) Rehabilitation during the recovery period

After the acute phase of inflammatory edema subsides, the recovery phase begins, which mainly promotes nerve regeneration, maintains muscle mass, increases muscle strength, and promotes the recovery of sensory function. Physical therapy includes nerve electric field therapy and pulsed electromagnetic field therapy; drug therapy includes the use of gangliosides, neurotrophic factors, etc. In terms of enhancing muscle strength and recovering motor function, the amount of exercise therapy needs to be gradually advanced from assisted exercise to active exercise and then to resistance exercise. The movements need to be slow and the range should be as large as possible. The effect will be better if combined with physical therapy.

◆When the muscle strength is at level 1-2, do assisted exercise, using pulley suspension belts, skateboards, and water buoyancy to reduce gravity

◆When the muscle strength is at level 2-3, use a wider range of assisted exercise and active exercise, and gradually reduce the auxiliary force, paying attention to excessive muscle fatigue;

◆When the muscle strength is at level 3-4, start resistance exercise, using dumbbells, sandbags, rubber strips, etc.