■ ■ ■ Description

Superficial peroneal nerve entrapment is a nerve disorder in the foot and ankle that causes pain, tingling, and loss of feeling, most commonly on the top of the foot, the ankle, and lower third of the leg. It involves compression of the superficial peroneal nerve in the front of the lower leg, about 4 to 5 inches above the ankle. The nerve usually comes through thick ligament-like tissue in the lower third of the leg as it becomes superficial to give sensation to the skin.

​

​

​

■ ■ ■ Common Signs and Symptoms

• Pain, tingling, numbness, or burning on the top of the foot, ankle, or lower third of the leg

• Possibly, pain made worse with sports activities (walking, running, squatting)

​

​

​

■ ■ ■ Causes

Superficial peroneal nerve entrapment is caused by pressure on the superficial peroneal nerve 4 to 5 inches above the ankle. This occurs as it comes through the ligament-like tissue (fascia), by muscle that may also come through the same small space as the nerve through the fascia, and is the result of direct injury, stretching with recurrent ankle sprains, or increased pressure within the part of the leg before the nerve comes out through the fascia (chronic compartment syndrome).

​

​

​

■ ■ ■ Risk Increases With

• Recurrent ankle sprains

• Sports on uneven terrain that may result in ankle sprains or endurance sports such as running or jogging

• Direct pressure on the nerve, such as with tight-fitting boots or ski boots

• Poor physical conditioning (strength and flexibility)

​

​

​

​

■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Leg, foot, and ankle flexibility

  • Muscle strength and endurance

  • Cardiovascular fitness

• Wear proper equipment and ensure correct shoe fit.

​

​

​

​

■ ■ ■ Expected Outcome

• This condition is usually curable with appropriate treatment, and sometimes it heals spontaneously. Usually, surgery is necessary to relieve the pressure on the nerve.

​

​

​

■ ■ ■ Possible Complications

• Inability to compete due to pain

• Permanent pain, tingling, and numbness of the affected foot, ankle, and leg

​

​

​

​

■ ■ ■ General Treatment Conditions

Initial treatment consists of rest from the offending activity and medications and ice to help reduce pain and inflammation. Padding (moleskin) in high boots reduces pressure on the nerve. Strengthening and stretching exercises of the muscles of the foot and ankle may be useful. Chronic cases often require surgery to free the pinched nerve. Surgery may be performed on an outpatient basis (you go home the same day) to remove the source of compression. If this is associated with chronic exertional compartment syndrome, fascial release is recommended. If the nerve pressure is associated with recurrent ankle sprains, surgery to tighten the ankle ligaments is also recommended. This provides almost complete relief in most patients.

​

​

​

​

​

■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use only as directed and only as much as you need.

​

​

​

■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

​

​

​

■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)