Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
The common peroneal nerve and its branches — the superficial peroneal nerve (SPN) and deep peroneal nerve (DPN) — are the most commonly injured nerves during foot and ankle surgery, and their injury produces persistent numbness, dysesthesia, or foot drop that can be more debilitating to the patient than the original condition treated. Understanding the anatomical course of the peroneal nerve branches, the specific surgical procedures that place them at risk, and the preventive measures that reduce injury rates is essential for every foot and ankle surgeon.
Peroneal Nerve Anatomy and Risk Zones
Common peroneal nerve: courses around the fibular neck before dividing into superficial and deep branches — vulnerable to stretch injury during prolonged tourniquet application at the thigh, direct pressure from leg holder positioning, and traction during ankle arthroscopy portal placement. Superficial peroneal nerve: runs in the anterior compartment of the leg, exiting through the deep fascia approximately 10–15cm above the ankle at the anterolateral aspect of the leg; provides sensation to the dorsal foot except the first web space; cutaneous branch exits lateral to the fibula and is at risk during lateral ankle approaches, Brostrom-Gould repair, and peroneal tendon surgery. Deep peroneal nerve: travels with the anterior tibial artery between the EDL and EHL tendons to the dorsum of the foot; provides sensation to the first web space and motor innervation to the EDB; at risk during dorsal foot approaches, first MTP joint surgery, and talar neck procedures.
Prevention and Management of Injury
Prevention: SPN mapping before lateral ankle procedures — palpate or mark the SPN exit point (Trepman technique — plantarflex the ankle to tent the SPN under the skin); avoid retractors placed directly against the nerve; minimize traction. Tourniquet: thigh tourniquet pressure limited to 100 mmHg above systolic; time limited to 90 minutes with reperfusion intervals for longer cases; consider ankle tourniquet for distal procedures to reduce common peroneal stretch risk. Intraoperative neuromonitoring: somatosensory evoked potentials for high-risk reconstructions. Management of iatrogenic injury: immediate recognition and documentation; observation for 3 months (neurapraxia — bruising or stretch injury — recovers 90% by 3 months); if no recovery at 3 months: nerve conduction study/EMG; neurolysis for scar entrapment; nerve repair for transection; nerve grafting (sural graft) for gaps. Dr. Biernacki at Balance Foot & Ankle employs meticulous nerve-protective technique during all foot and ankle procedures at our Bloomfield Hills and Howell locations. Call (810) 206-1402 to schedule a surgical consultation.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
What is the best treatment for peripheral neuropathy in the feet?
Treatment depends on the cause. For diabetic neuropathy, blood sugar control is most important. Other options include B12 supplementation, MLS laser therapy, topical creams (capsaicin, lidocaine), and prescription medications like gabapentin or duloxetine. Our podiatrists tailor treatment to each patient’s specific type and severity.
Can neuropathy be reversed?
In some cases — particularly when caused by vitamin deficiencies or early-stage diabetes with good glucose control. However, long-standing nerve damage is often permanent. Treatment focuses on slowing progression, managing symptoms, and preventing dangerous foot complications like ulcers.
How often should I see a podiatrist if I have neuropathy?
Patients with peripheral neuropathy should have comprehensive foot exams every 3–6 months, or more frequently if they have diabetes, poor circulation, or a history of foot ulcers.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Peroneal Nerve Injury Treatment in Michigan
Balance Foot & Ankle diagnoses and manages peroneal nerve injuries causing foot drop and numbness. Our podiatrists use nerve testing, AFO bracing, and surgical tendon transfer when needed.
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Clinical References
- Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8(3):158-169.
- Baima J, Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med. 2008;1(2):147-153.
- Poage C, et al. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg. 2016;24(1):1-10.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)