peroneal nerve entrapment exercises pdf

hvjt,2pNakSl{S]$sS\YIV;TFv'X Learn more about our online scheduling and schedule an appointment with your primary care provider today. WebThe injection technique described is extremely effective in treating the pain of pes anserine bursitis. To test for the motor involvement of the superficial peroneal nerve and deep peroneal nerve, one must assess foot eversion (SPN) and foot/toe dorsiflexion (DPN). The nerves that These nerve roots travel through the lumbosacral plexus to form the sciatic nerve.4 The sciatic nerve courses through the posterior thigh, where it branches into the tibial and common peroneal nerves.1 The common peroneal nerve then wraps around the bony prominence of the fibula, a location that is susceptible to compression. Multiple cases involved muscle herniation leading to SPN compression; 12 cases of peroneus brevis herniation, and one of tibialis anterior herniation, all of which were treated with surgical nerve decompression via fasciotomy.5658 Another case reported nerve entrapment due to herniation, but in this case, the SPN herniated with the peroneal muscles through a fascial tear, requiring surgical fasciotomy to release the intrafascial septum.59, SPN compression due to ganglion cysts were seen in a case report of a young female dancer, requiring surgical cyst removal and nerve decompression to enable the patient to return to dancing.60 Another case report described entrapment due to an SPN schwannoma, in which surgical removal of the schwannoma resulted in symptom resolution. Modifications: You can increase the difficulty of this exercise by standing on different, softer surfaces or raising up onto the toes of your foot. 0000004963 00000 n WebPeroneal Nerve Entrapment. CXws@0dCY6tgmtP!(-L^JbMVX rM\FP5$BF2O\$PtYff WebStrengthening Exercises for Peroneal Muscles Our assessment has shown that the peroneal muscles in one or both of your lower legs is weakened, and may be contributing to any foot, ankle or lower limb pain that you may be experiencing. Unlike electrodiagnostic studies alone, ultrasound can detect anatomic causes such as scarring, lesions, bone fragments infiltration, and movement tethering nerves. A broken bone in your lower leg may take 4 to 6 months to heal. Although large studies reporting outcomes from treatment with this modality are lacking, the development of new percutaneous PNS systems and the use of ultrasound for lead implantation have rapidly expanded and offered a potential treatment option.29, When CPN entrapment is either refractory to nonsurgical treatment options or causes a severe reduction in conduction such as a secondary mass effect or laceration, surgical decompression or repair is the mainstay treatment option.30 CPN decompression has been shown to rapidly and significantly improve drop foot and increase ankle stability in those suffering from entrapment.31 Decompression is typically performed under a microscope by carefully transecting the two layers of fascia surrounding the nerve proximally and distally to the fibular neck, where CPN injury most commonly occurs.2,3133, In a prospective study consisting of 15 patients with CPN entrapment, 14 patients underwent surgical decompression after the failure of medical management.32 Of the 14 patients who underwent surgical decompression, 13 improved motor function immediately after surgery and at 1, 6, and 12 months postoperatively. You dont even need a quarter, but it does help you to focus on engaging the peroneus longus. Compressive peroneal neuropathy by an intraneural ganglion cyst combined with L5 radiculopathy: A case report. The exercises they prescribe depends on the cause of your injury. Bregman PJ, Schuenke MJ. Our bodies' nerve cells are important for transmitting electrical and chemical information between different parts of the brain and the nervous system. If a person experiences significant pain at any point while doing these exercises, they should immediately discontinue the activity. Foresti M. Superficial peroneal nerve compression due to peroneus brevis muscle herniation. Our state-of-the-art surgical facilities are equipped with advanced 3D imaging technology, which allows our neurosurgeons to use minimally invasive techniques that reduce pain and scarring, improve surgicaloutcomesand speed up recovery time. Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. The peroneal nerve is the nerve that communicates to the muscles that lift the foot. Peroneal Point the toes on the extended leg away from the body, then slowly flex the ankle by pulling the toes toward the shin. Variable anatomy produces a spectrum of symptoms and diagnostic findings. R After the resting phase of recovery, exercises that work the peroneal muscles may help improve and strengthen the area. 0000060606 00000 n They reported the incidence of common peroneal nerve injury and dysfunction after total knee arthroplasty (TKA) is 0.4 % and found that 66% of cases with incomplete CPNP after TKA went on to complete recovery without surgical intervention. Certain foot and leg stretches can speed up recovery and relieve the pain of plantar fasciitis. 0000049129 00000 n Do two or three of these on each side. Peroneal Nerve If the muscle weakness is severe, electrical stimulation can assist in the contraction of the weakened muscles.19 Orthotic intervention is another option for isolated SPN neuropathies and includes a lateral wedge shoe insert to decrease supination of the foot. [5] After the division of the common peroneal nerve into the deep and superficial branches, the SPN travels in the lateral compartment of the leg. A pinched nerve in your foot can be caused by many different issues, like an injury, bone spurs, tight shoes, and more. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, Benefits of exercises for peroneal tendonitis, https://www.acefitness.org/education-and-resources/lifestyle/exercise-library/23/ankle-flexion/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161709/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/, https://www.foothealthfacts.org/conditions/peroneal-tendon-injuries, https://www.acefitness.org/education-and-resources/lifestyle/exercise-library/152/standing-dorsi-flexion-calf-stretch/, https://www.ncbi.nlm.nih.gov/books/NBK544354/, New clues to slow aging? Inspira Health Network. The two peroneal tendons run side by side behind the outer ankle bone. Entrapment Neuropathy About the Foot / rB0P!>u#[ix,?0MdN3(r9t'q|O2i8Lg02bh;I#cI3C& A compression injury to the nerve then occurs, which will lead to tingling and numbness in the distal distribution of the nerve. Your fibula is the smaller of the two bones in your lower leg. Step 1: Sit with legs straight in front of you. They will also require either a foam roller, tennis ball, or food can. WebExercises for Peripheral Neuropathy Sciatic Nerve Glide 1. An Update on Peroneal Nerve Entrapment and Neuropathy. In a 2020 review of studies, researchers found the rate of common peroneal nerve injury after total knee replacement was 0.4%. HWn}_1ToaZ8@4`pMYJ$RXSU33W powu-N]8eOsJ_=GE|^~_.zxvyxnE~Iwf.^|x}uGnW5}owMg~*;=fgW7g6n_{uu~x>9G)?LJ GGgzt|+pnfdpnCd_$%9x%=^#`z:SooK00g@37:;0kfO>`-Q=q >x!q}lp World class care is in your backyard. We avoid using tertiary references. 2023 Healthline Media UK Ltd, Brighton, UK. However, weakness with foot eversion will likely be present.1 Decreased or abnormal sensation in the lower lateral leg, and the dorsum of the foot indicates involvement of the SPN or the portion of the sciatic nerve in those areas.20 Alternatively, there may be burning pain at the anterolateral leg and dorsum of the foot, with pressure at the entrapment point eliciting retrograde pain. 1 0 obj Risk factors for peroneal neuropathy are most commonly secondary to traumatic causes, followed by behavioral causes.1 Traumatic causes of peroneal neuropathy, such as knee dislocations and fibular fractures, cause direct injury to the nerve with poorer overall outcomes. Morimoto D, Isu T, Kim K, et al. (2022). Behavioral causes such as prolonged maintenance of a crossed-leg posture or repetitive stretch from squatting may produce a peroneal nerve palsy with an acute presentation.3 Weight loss also may induce peroneal neuropathy as one case series found that 20% of 150 subjects who experienced a mean of 10.9 kilograms (kg) of weight loss experienced peroneal nerve neuropathy.8 Bilateral peroneal mononeuropathy was seen in patients undergoing extreme weight loss, and it was also noted in 10% of World War II prisoners that had lost 5-11 kg.9, Surgeries including total knee arthroplasty, especially in the setting of a preoperative valgus knee, commonly report postoperative peroneal symptoms. The common peroneal nerve (also called the common fibular nerve) is one of the two major nerves in your lower leg. (n.d.). Surgical treatment is often required when entrapment is refractory to conservative management.30 Surgical treatment involves neurolysis via release of the overlying facial planes and should be tailored to address the entrapments etiology and the specific location.65 Surgical decompression reported positive outcomes in the cases we studied, with most studies showing improvement in at least 80% of patients who underwent surgical decompression.3236,38 Overall, a diagnosis of peroneal nerve entrapment is associated with a good prognosis, in which most patients experience a full return of nerve function after necessary treatment, whether that be conservative management or surgery. Hobson-Webb LD, Juel VC. exercises What increases your risk of a peroneal nerve injury? 0000055603 00000 n PERONEAL NERVE ENTRAPMENT What's to know about peroneal tendonitis? The peroneus longus helps stabilize the body, and balancing on one foot can help you work the muscle. At the same time, 7 also reported full recovery of motor function at 12 months postoperatively.32 A retrospective review of a prospective database of patients with CPN palsy due to various etiologies showed clinical improvement in 28 of 30 patients who underwent neuroplasty and decompression.33 Another study that reviewed subjects with CPN compression and foot drop secondary to weight loss showed an 85% success rate in patients receiving external neurolysis at the fibular head.34 A recent retrospective analysis of 35 patients undergoing microneurolysis and nerve decompression resulted in only 1 poor outcome, indicated by the inability to dorsiflex the ankle to 90 degrees.35 Overall, surgical decompression effectively treats CPN entrapment, with some studies showing a positive correlation between decreased time to surgery and improved outcomes.32, SPN entrapment is less common than CPN entrapment, and studies show that most patients who undergo decompressive surgery for SPN entrapment have previously undergone surgery for CPN entrapment.36 SPN entrapment is a commonly missed diagnosis; therefore, surgeons working distally to the knee must be aware of the technical maneuvers and be familiar with the anatomy of the peripheral nerves in the lower extremity.37 Decompression of the SPN is performed where the nerve exits the lateral compartment and should extend to include its terminal nerve branches.2,38, A small study of 5 patients, previously treated with surgical decompression of CPN entrapment, all showed improvement of symptoms immediately after SPN surgical decompression.36 Of these 5 patients, entrapment symptoms recurred in one patient who required additional complete nerve decompression with no further return of symptoms.36 A more extensive study of 54 patients undergoing SPN decompression showed 69% of subjects reported some improvement in the effect of pain on quality of life, with a positive correlation between pain severity and improvement with surgery.39 An additional study reported an 85% success rate with SPN nerve decompression.38 The authors note that failure of surgical decompression in those with chronic nerve pain may be secondary to the centralization of pain over time.38 In these cases, pain management specialists and biopsychologists are recommended to improve the success of surgical decompression.38, Compression of the DPN, known as ATTS, can be surgically treated with either an open or arthroscopic approach.40 Surgical approach involves an incision in the dorsum of the foot and releasing the nerve from the inferior extensor retinaculum to its entry into the deep fascia. 0000086531 00000 n Physical Exercise for Peroneal Nerve Dysfunction In a 2020 review of studies, researchers reported complete recovery after 3.6 months in about 40% of cases caused by total knee replacement surgery. (2022). If a person is recovering from peroneal tendonitis, they will need to introduce exercise and stretching slowly. The telltale symptoms of sciatic nerve pain are severe pain in your back, buttocks, and legs. The average time from the onset of symptoms to the operation was fourteen months (range, one to 120 months), primarily because of delayed referrals. Melorheostosis Causing Compression of Common Peroneal Nerve at Fibular Tunnel. The recovery time for peroneal nerve injury depends on the underlying cause and severity of the injury. Peroneal tendonitis is an inflammation of one of the tendons in the back of the foot. Nirenberg MS. A simple test to assist with the diagnosis of common fibular nerve entrapment and predict outcomes of surgical decompression. Many people experience symptom relief with physiotherapy. The pain can be so excruciating that you dont even want. Deep Peroneal Nerve Entrapment, also called Anterior Tarsal Tunnel Syndrome, is a rare compression neuropathy affecting the deep peroneal nerve, most commonly at the fibro-osseous tunnel formed by the inferior extensor retinaculum. Exercises can strengthen your leg muscles and help you maintain the range of motion in your knee and ankle. Modifications: As with the quarter heel raise, you can perform this exercise on both feet at once or in a seated position. Peroneal neuropathy is the most common compressive neuropathy of the lower extremity.4 It is also the third most common focal neuropathy overall, after median and ulnar neuropathies. Learn about the cause and treatment. * _J\[dt]1~Eem6{\=K =bzQp;H1naGnCmi^E;T,3J8>["O -4\LmX.qA#NNaHOhyMa~%K1`v\ec}0l_&2{xbM+$xc0 EI~BVc4A8C&lEK* lluk y : A\Hp0jp9,pN!\RVCnSJj G&s&aeYB[f8Ne1I18(@dTYH*iDKY>kT^l z&_^ST;%'r5. Role of sonography in the diagnosis and treatment of common peroneal neuropathy secondary to fabellae. Nerve pain can be mild, severe, transient, or chronic but there's likely a medication that can bring you relief. More severe cases may require surgery. Forced inversion and foot plantar flexion could lead to SPN overstretching and injury at its exiting point through the deep fascia. Learn the best exercises to strengthen these muscles and prevent or recover from associated injuries. But what can you do when it leads to tingling and numbness in your foot? In this article, we provide a visual guide to, Plantar flexion is a term that describes the motion of pointing the foot downwards. Knee or leg fracture. Carender CN, Bedard NA, An Q, Brown TS. Our neurosurgeons treat patients around South Jersey from several convenient locations. Move your foot up and down as if you were pushing down or letting up on a gas pedal in a car. For starters, talk to your doctor in case you have underlying issues. Is the ketogenic diet right for autoimmune conditions? 452 0 obj <>stream As you raise your heel, keep your knee over your ankle and your ankle straight and steady, and push down with your foot. Inspiras skilled neurologists and neurosurgeons are standing by to answer your questions. WebPeroneal nerve glides Begin in seated position with knee straight. So, what can you do? }l!jG,c.>Aw2?Gmuu6N+_u?/p2Z1B}t28=0P9LVfNF|CcPP(\&~n1HWcDch "}!J$vvv7hh6ql6ih/ACIcCwuL#epoNSX904i i]ysoeuHvQ#>l %%EOF 0 Using tobacco products can slow your recovery. A physical exam analyzing strength, sensation, and gait can localize the specific nerves affected. Deep Peroneal Nerve Entrapment As the most common compressive neuropathy of the lower extremity, peroneal neuropathy, also known as fibular neuropathy, is a consideration for any differential diagnosis involving foot drop, the pain of the lower extremity, or numbness of the lower extremity.1 Commonly, it affects athletes and may hinder athletic performance.2 Peroneal neuropathy also affects the quality of life for those in occupations requiring significant squatting or kneeling.3 Understanding the origin, prevalence, and causes of peroneal neuropathy is imperative to holistic care for all patients experiencing lower extremity pain or weakness. Although you cant replace damaged nerves, you can prevent further nerve damage and relieve the pain you do have. Best stretches and exercises for plantar fasciitis and heel pain, Everything you need to know about plantar flexion, regularly stretching the calf, ankle, and peroneal muscles, wearing footwear that appropriately supports the foot, maintaining proper form when doing exercises that involve the calf, ankle, or peroneal muscles, increasing the intensity of any weight-bearing exercises, such as running, walking, or jogging, gradually. Make this a regular practice, going a little deeper into the tight tissues each time. Beller J, Trockel U, Lukoschek M. Peronuslsionen nach KTEP-implantation unter verwendung einer postoperativ fortgefhrten periduralen analgesie. When your peroneal nerve is injured, you may experience symptoms including: To prevent further damage to the peroneal nerve, padding, knee braces and splints can help restrict movement and encourage healing. Immobilization: You might need a soft cast or boot to immobilize your foot and take weight off your tendons so they can heal. A tendon is a cord-like structure that connects a muscle to a bone. Current concepts in muscle stretching for exercise and rehabilitation. A finding of weakness of both foot eversion as well as foot/toe dorsiflexion suggests a lesion involving the common peroneal nerve. Before incorporating any stretches or exercises into their daily routine, a person who is recovering from peroneal tendonitis should discuss this with their doctor or physical therapist. Anderson JC. Exercises to Strengthen the Peroneus Longus. The peroneal nerve arises from the L4, L5, S1, and S2 nerve roots. You can learn more about how we ensure our content is accurate and current by reading our. Peroneal Nerve Entrapment They may order imaging tests to help find the source of your symptoms such as: They may also order tests to evaluate your nerve function such as: Peroneal nerve injury is a potential risk of knee replacement surgery. Step 3: Raise your heel, keeping the ankle straight and resisting the pressure to invert the foot as it comes off the floor. WebAbstract. Robin F, Kuchenbuch M, Sauleau P, et al. The GIF below shows each movement separately but when you put them together at the same time, its exactly the kind of push off that occurs when running up a hill. Bouche P. Compression and entrapment neuropathies. Nonsurgical options include orthotic footwear and physical therapy. Then do the same on the other foot. Bilateral Common Peroneal Nerve Entrapment After Excessive Weight Loss: Case Report and Review of the Literature. Motor nerve conduction studies, electromyography studies, and diagnostic nerve blocks can also assist in diagnosis and prognosis. Point foot/ankle (ankle plantarflexion) 3. This is exactly what happened to fellow Overhauler Terry recently. Roll the foot back and forth over the object for 1 minute. To help regain strength in the peroneal muscles and aid recovery from peroneal tendonitis, a person may consider doing exercises and stretches that target the affected area and surrounding muscles. Piriformis can be stressed due to poor body posture chronically or some acute injury that results in a sudden and strong internal rotation of the hip. Argyriou C, Drosos G, Tottas S, Tasopoulou KM, Kougioumtzis I, Georgiadis GS. Talonavicular osteophytosis, localized edema, high-heeled shoes, and ganglion cysts are other possible contributors to this syndrome.18. %PDF-1.5 Step 3: Raise your heel, keeping the ankle straight. Peroneal Nerve Gkku K, Atmaca H, Sata E, Saylik M, Aydin AT. The clinical presentation of peroneal neuropathy varies depending on the location of nerve injury or compression. Ankle foot orthosis is also indicated for DPN neuropathy and ankle dorsiflexor weakness.26, An alternative treatment to consider before surgical intervention includes hydrodissection.27 Treatment involves injecting a nonirritating solution around the nerve to reduce the pressure from surrounding structures. The nerve wraps from the back of the knee to the front of the shin and sits closely to the surface, making it easy to damage. Poage C, Roth C, Scott B. Peroneal Nerve Palsy. Exercises 2023 Lineage Medical, Inc. All rights reserved, Foot & AnkleDeep Peroneal Nerve Entrapment. endstream endobj 451 0 obj <>/Filter/FlateDecode/Index[58 355]/Length 34/Size 413/Type/XRef/W[1 1 1]>>stream This is a normal part of motion for many people, but certain, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. A person will need to sit on a chair for this stretch. Enter the URL below into your favorite RSS reader. WebSTRENGTHENING EXERCISES Superficial Peroneal Nerve Entrapment (Anterolateral Compartment Syndrome) These are some of the initial exercises you may start your rehabilitation program with until you see your physician, physical therapist, or athletic trainer again or until your symptoms are resolved. Pomeroy G, Wilton J, Anthony S. Entrapment neuropathy about the foot and ankle: An update. Useful functional recovery and quality of life after surgical treatment of peroneal nerve injuries. 0000003885 00000 n Peripheral Nerve Stimulation for the 21st Century: Sural, Superficial Peroneal, and Tibial Nerves. Here, it passes anteroinferior between the peroneus longus, peroneus brevis, and extensor digitorum longus muscles. What was the situation? The use of peripheral nerve blocks at the level of the lateral and medial malleoli, also known as an ankle block, can be performed using a landmark approach and/or with ultrasound guidance. This tightening can cause it to tear, which may lead to inflammation and irritation. Idusuyi OB, Morrey BF. Lower extremity nerve injury in childbirth. Websummary. It starts at the top of the fibula before running down the outside of the leg and connecting to the foot with the peroneus longus tendon. Examples include: Crossing the legs. Achilles stretch: Stand with the ball of one foot on a stair. <]/Prev 365257/XRefStm 1430>> Meadows JR, Finnoff JT. The most common symptom of peroneal nerve injury is foot drop, which is weakness in your ability to dorsiflex your ankle. Nerve injury typically resolves within 6 months, but in rare cases can be permanent. Peroneal neuropathy is the most common compressive neuropathy of the lower extremity. 0000005771 00000 n Do this _____ times. The peroneus longus muscle everts and plantar flexes the ankle. Ankle and leg stretches are extremely important for a normal gait. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. zGr(_EJgYtV8+JgYtV8+Jge1K* 4`\TYl!1L{whb[ ? <> The peroneal tendon can become damaged or injured due to sudden contraction. All rights reserved, See all locations for Neurology & Neurosurgery, Numbness or tingling in the top of the foot or leg, Slapping gait, in which each step taken results in a slapping sound, Muscle weakness around the ankles or feet. H\0Xwtc&]Ehpl%54Q}5 8akftw~60G?s?t{h9K?$ya^)I6a8IUg|xxdMk3}kC%|cX9ai}hO,~jSOv:TrkWZuEJ Kodaira M, Sekijima Y, Ohashi N, et al. A chair, countertop, or table is necessary for this exercise. Lower extremity nerve entrapments in athletes. Electrodiagnostic evaluation of peroneal neuropathy. 0000057139 00000 n Tinel's sign (palpation or tapping of the nerve)round the fibular head may also reproduce symptoms. Wisner K, et al. The issue appears during or right after a specific activity and is described as tingling, numbness or a burning sensation. Acute bilateral drop foot as a complication of prolonged squatting due to haemorrhoid. Carender CN, et al. 4 0 obj A large nerve that originates in your lower spine called the sciatic nerve is responsible for much of the sensation and ability to move muscles in your lower body. 0000059744 00000 n Entrapment of the tibial nerve within the tarsal tunnel can result in neuropathic symptoms at the medial ankle and the planter foot. This exercise is similar to the quarter heel raise but requires the use of a resistance band. Intra-articular Injections of the Ankle and Foot - Springer The most common entrapment neuropathy in the lower extremity is common peroneal mononeuropathy, accounting for approximately 15% of all mononeuropathies in adults [].Most injuries occur at the fibular head and can be the result of many factors including chronic low grade infection [], varicose veins [], schwannoma [], nerve Repeat the movement up to 10 times. WebStep 1: Identify the Nerve. Damage to the peroneal nerve is the most common cause of foot drop. Tibialis anterior muscle herniation with superficial peroneal nerve involvement: Ultrasound role for diagnosis and treatment. If youre using a resistance band, you can perform repetitions of this exercise in a way thats similar to the exercises above. We avoid using tertiary references. Sciatica is a sensation in which you feel a moderate to intense pain in your back, buttocks, and legs. Symptoms may initially be masked by concomitant trauma or recovery from surgical procedures. Puffer RC, Sabbag OD, Logli AL, Spinner RJ, Rose PS. Zeng X, Xie L, Qiu Z, Sun K. Compression neuropathy of common peroneal nerve caused by a popliteal cyst: A case report. As the most common compressive neuropathy of the lower extremity, peroneal neuropathy, also known as fibular neuropathy, is a consideration for any differential diagnosis involving foot drop, the pain of the lower extremity, or numbness of the lower extremity. Yassin M, Garti A, Weissbrot M, Heller E, Robinson D. Treatment of anterior tarsal tunnel syndrome through an endoscopic or open technique. Sensation deficits in the first dorsal web space and fifth toe are spared in SPN mononeuropathy.16, DPN mononeuropathy is unique in that it may present with few symptoms or none at all.18 The DPN innervates the tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius, and extensor digitorum brevis muscles. They reported incomplete recovery in about 55% of people. While entrapment neuropathies are relatively uncommon in the lower extremities, peroneal nerve entrapment is the most frequently encountered lower limb neuropathy.1,65 Due to the relative infrequency of lower limb neuropathies, diagnosis can be difficult and often overlooked.65 Providers must have a level of suspicion when patients present with chronic leg pain, foot drop, or ankle instability that has not responded to conservative medical management.65 Peroneal nerve entrapment is most commonly at or around the fibular head but can also occur in the calf, ankle, or foot.1 Electrodiagnostic studies have shown to be helpful in the diagnosis of nerve entrapment and in determining the type of injury and the level at which the entrapment occurs.1 First-line treatment usually includes removing anything that may be causing external compression, providing stability to any unstable joints that may be putting tension on the nerve, and reducing inflammation.65 Although many peroneal nerve entrapments will resolve with less invasive treatment. The severe inability to dorsiflex and evert the foot is known as foot drop. The peroneal nerve controls the muscles that lift your foot. Conservative initial treatment is indicated, including physical therapy, appropriate footwear, limited injections, and rehabilitation for ankle instability.17 For injuries that include muscle weakness, strengthening of the dorsiflexors and evertors is indicated. In contrast, the other ganglion cyst case was treated with ultrasound-guided aspiration. Treating it depends on the underlying cause, but it can include physiotherapy or surgery. Park JH, Restrepo C, Norton R, Mandel S, Sharkey PF, Parvizi J. Accurate and timely diagnosis of any peroneal neuropathy is essential to avoid symptoms or irreversible nerve damage progression.21 Diagnosis is made by patient history and clinical examination, which may vary depending on the location and nerve involved. Can diet help improve depression symptoms?