In the Peroneal paralysis the fibula nerve is damaged. Paresis is one of the nerve compression syndromes.
What is peroneal paralysis?
© Crystal light - stock.adobe.com Peroneal paralysis also the name Peroneal palsy. This means damage to the common fibula nerve (Common peroneal nerve). The paralysis is counted among the nerve compression syndromes that occur relatively frequently. Individual parts of the nerve as well as the entire nerve can be affected. The damage to the fibrous nerve becomes noticeable through paralysis of the muscles that are responsible for the active lifting and bending of the foot and toes. Of the Common peroneal nerve, also Common fibular nerve called, forms one of two main branches of the sciatic nerve (sciatic nerve). He has sensitive and motor parts. The second main branch is the tibial nerve (Tibial nerve), which is also equipped with sensitive and motor components.
The common peroneal nerve runs along the side of the knee and passes the fibula head in the back. It then divides into the deep fibular nerve and the superficial fibular nerve. The main function of the fibula nerve is to control the lower leg extensor muscles.
It pulls the foot inside the ankle joint in the upper direction and rotates the foot outward. At the same time, the nerve is also responsible for the dorsiflexion of the toes. Behind the fibular head, the common peroneal nerve is considered to be at risk of injury, as its course in this area is close to the surface.
causes
Peroneal paralysis is caused by mechanical pressure in the region of the fibular head, which is due to the sensitive position of the fibula nerve at this point. People who have little fat and muscle tissue are particularly at risk. It is not uncommon for peroneal paralysis to result from medical interventions.
This includes, for example, a plaster cast that was applied too tightly. The external pressure that increases as a result causes damage to the common peroneal nerve, which is restricted in its expansion. But the fibula nerve can also be affected during surgical interventions.
Because of the sensitive location of the nerve, it is often the victim of injuries such as a fibular head fracture. Incorrect positioning when bedridden can lead to paralysis of the fibula nerve. The same applies to work activities such as tiling or constantly crossing your legs.
In rare cases, aneurysms in the hollow of the knee, a ganglion on the tibiofibular joint or a Baker cyst are also responsible for peroneal palsy. Other conceivable indications are herniated discs and circulatory disorders due to acute occlusion of the leg artery.
Symptoms, ailments & signs
In the case of peroneal paralysis, the patient usually suffers from difficulty walking and from misalignments of the affected foot. If the deep branch of the fibular nerve, the fibular nerve, is damaged, this results in disturbances in the stretching process. Doctors then speak of a dorsiflexion weakness or an equinus foot, which lead to a stepper or stork walk.
The affected person pulls his knee up unusually so as not to let his toes drag along the floor. If the superficial fibular nerve is impaired, the lateral edge of the foot can no longer be actively lifted, which is due to a disruption of the inward rotation.
Both symptoms sometimes occur in combination, which depends on the level at which the nerve damage is located. Other possible symptoms of peroneal palsy are sensory disorders that show up on the back of the foot, the side of the foot or the front of the lower leg.
Diagnosis & course of disease
If peroneal paralysis is suspected, the doctor first looks at the patient's medical history and asks him about any previous injuries or previous illnesses. He then performs a physical exam in which he subjects the Achilles tendon reflexes and the peroneal reflexes to a test.
While the Achilles tendon reflex functions completely in peroneal palsy, the peroneal reflex turns out to be weakened. Electoneurography is another diagnostic option. The doctor measures how quickly an impulse is passed between two electrodes by the nerve. The procedure allows the exact location of the nerve damage to be determined.
The differential diagnosis also plays an important role. It is important to rule out L5 syndrome, as herniated discs can squeeze the 5th nerve root, which leads to deficits and numbness in the foot. However, in contrast to peroneal paralysis, pain usually occurs with L5 syndrome.
In most cases, peroneal palsy takes a positive course. The chances of recovery are assessed as good, especially in the case of pressure damage. To do this, however, the patient must quickly consult a doctor if he or she experiences symptoms, as this improves the chances of success.
Complications
In most cases, peroneal paralysis has a very negative effect on the movement of the person concerned. The affected person can experience various complaints when standing and walking, so that the patient's quality of life is considerably reduced. The affected person may also be dependent on walking aids due to the peroneal paralysis.
Likewise, the legs can no longer be properly stretched, so that the performance of various activities and sports is no longer possible for the patient without further ado. In children, peroneal paralysis can delay development. Paralyzes or other disorders of sensitivity can also occur in the calves or in the entire legs. Pain can also occur and make everyday life difficult.
Furthermore, the peroneal paralysis can also lead to psychological complaints or to depression, so that the patients are dependent on psychological treatment. The further course of the disease depends very much on the severity of the nerve damage. Treatment cannot be carried out in every case. However, there are no particular complications in the treatment. The life expectancy of the person affected is also not influenced by the peroneal paralysis.
When should you go to the doctor?
Fibula pain should be evaluated by a doctor if it persists for more than two to three days. If you have difficulty walking, abnormal sensations or severe pain, it is best to consult your family doctor on the same day. Peroneal paralysis occurs mainly after injuries or damage during medical interventions. If the symptoms mentioned occur after exercise or during physical therapy, you should speak to a doctor immediately.
If there is already damage to the fibula, for example after a fracture or an operation in the affected area, medical advice is also required. Peroneal palsy is treated by an orthopedic surgeon. Other contact points are sports medicine specialists, physiotherapists and specialists in nervous diseases. Severe paralysis must be treated surgically. After the initial treatment, the stability of the fibula must be strengthened through physiotherapy and other measures. Close consultation with the doctor is necessary so that the accompanying drug therapy can be adapted to the progress of recovery and any pain.
Treatment & Therapy
Treatment for peroneal palsy depends on how severe the nerve damage is. All triggering factors such as crossing your legs must be turned off. Therapy of paresis usually takes place conservatively. The muscles can be rebuilt as part of physiotherapy.
Sometimes a special peroneal spring is used, which is a dynamic foot lifter system that enables the patient to walk more easily. If the conservative therapy does not lead to an improvement, an operation is usually carried out to relieve the fibular head. If the peroneal palsy is caused by an underlying disease such as a tumor or a Baker's cyst, it is important to treat it first, which usually improves the paralysis.
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➔ Medicines for muscle crampsOutlook & forecast
A uniformly good prognosis cannot be given for peroneal paralysis. The cause and extent of damage to the common fibula nerve can vary. This influences the outcome of a medical or physiotherapeutic treatment.
First of all, the cause and extent of the peroneal paralysis must be determined. If the common fibular nerve was only exposed to pressure damage, the damage and paralysis can usually be remedied. It looks different, however, if the damage has caused permanent paralysis. In this case, the full functionality of the muscles and nerves often cannot be restored. The prognosis is worst when the common fibular nerve has been completely severed.
When treating peroneal paralysis, the first thing to do is to reduce the degree of paralysis as much as possible. This is the only way to improve the prognosis for those affected. The medical ideal is to restore full functionality. The secondary goal of treatment is to avoid possible complications. Such would be given, for example, by an equinus foot. Surgical procedures have unfortunately not proven effective in the case of peroneal paralysis. If necessary, a peroneal splint can make walking with an equinus foot easier.
The physicians achieve the most successful treatment results with functional electrical stimulation (FES) with a mobile foot lifter system. This can reduce the severity of a walking disability. In the long term, new nerve pathways can even form.
prevention
Preventing peroneal paralysis is not easy. In this way, triggering injuries to the fibrous nerve must be avoided.
Aftercare
Peroneal paralysis is a serious complaint and disease that must definitely be examined and treated by a doctor. Those affected should consult a doctor at the first symptoms and signs of the disease so that there are no further complications or other complaints.
The measures and the options for follow-up care are severely limited, with the further course very much depending on the time of diagnosis. Most patients with this disease are dependent on the measures of physiotherapy or physiotherapy. Many of the exercises from such therapies can also be repeated in your own home, which speeds up treatment and healing.
Many of those affected depend on the help and support of their own families. Loving conversations are very important to prevent depression or other psychological upsets from developing. If the peroneal paralysis is to be treated with an operation, those affected should rest after such an operation and take care of their bodies. You should refrain from unnecessary exertion or other physical activities in order not to unnecessarily stress the body.
You can do that yourself
A thorough differential diagnosis as quickly as possible is important for this disease. Only in this way can the causes of peroneal paralysis be found and even eliminated, especially if the disease occurred due to mechanical stimuli. Then, however, the chances are good that the peroneal paralysis will heal completely.
For example, if the paralysis was caused by a cast that was too tight, the attending physician will loosen the cast. However, if the patient - in this case usually very slim - constantly crosses his legs while sitting, an accompanying behavioral therapy must be considered. Only in this way can the patient get rid of this habit and find a healthier sitting posture.
If the disease is still acute, it can be very painful and significantly reduce the quality of life. In some cases the orthopedic surgeon or sports physician will advise you to have an operation. He will also prescribe physiotherapy, physiotherapy and medication such as pain relievers. The physiotherapy appointments in particular should be kept, even if they prove to be painful at first. Physiotherapy will stabilize the success of the treatment and rebuild the muscles. Then the patient should do moderate sport again. He may need support such as a peroneal pen or an assistant to walk, but walking or even hiking are good ways to train the muscles and prevent new diseases.
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