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Schematic diagram showing high division of superficial peroneal nerve, lateral branch descending in the anterior intermuscular septum and variant cutaneous innervations of dorsum of the foot. CPN. Common peroneal nerve, DPN. Deep peroneal nerve, SPN. Superficial peroneal nerve, Mb. Medial branch, Lb. Lateral branch, Aims. Anterior intermuscular septum, SN. Sural nerve.
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The superficial peroneal nerve is a branch of common peroneal nerve. There are reports about the variant course and distribution of this nerve. The sural nerve arises from the tibial nerve in the popliteal fossa. The variations of the above nerves described here are unique and provide significant information to surgeons dissecting lower limb.
The p...
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The superficial peroneal nerve is one of the terminal branch of common peroneal nerve. There are reports in the available literature about the variant course and distribution of this nerve. The variations of the above nerve are important and provide important information to surgeons during dissection of lower limb. In the present case a rare higher...
Citations
... The SPN most commonly penetrates the crural fascia as a single branch and then divides into two terminal sensory branches: the intermediate cutaneous nerve (IDCN) and medial dorsal cutaneous nerve (61) . Anatomic variations include absence of either of the two terminal sensory branches, a course within the anterior compartment of the leg after piercing the intermuscular septum, or high division of the CPN prior to piercing the crural fascia (62) . ...
Lower extremity peripheral neuropathy is a commonly encountered neurologic disorder, which can lead to chronic pain, functional disability, and decreased quality of life for a patient. As diagnostic imaging modalities have improved, imaging has started to play an integral role in the detection and characterization of peripheral nerve abnormalities by non-invasively and accurately identifying abnormal nerves as well as potential causes of neuropathy, which ultimately leads to precise and timely treatment. Ultrasound, which has high spatial resolution and can quickly and comfortably characterize peripheral nerves in real time along with associated denervation muscle atrophy, and magnetic resonance neurography, which provides excellent contrast resolution between nerves and other tissues and between pathologic and normal seg- ments of peripheral nerves, in addition to assessing reversible and irreversible muscle denervation changes, are the two mainstay imaging modalities used in peripheral nerve assessment. These two modalities are complimentary, and one may be more useful than the other depending on the nerve and location of pathol- ogy. Imaging must be interpreted in the context of available clinical information and other diagnostic stud- ies, such as electrodiagnostic tests. Here, we offer a comprehensive overview of the role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of the peripheral nerves of the lower extremity and their associated neuropathies.
... A small artery and vein usually accompany the SPN. [4] An ultrasound image can visualize and confirm the presence of a small pulsatile artery near SPN [ Figure 1d and e]. Hence, regional anesthesiologists must be careful during SPNB to avoid inadvertent vessel injury and systemic injection of LA. ...
The superficial peroneal nerve (SPN, L4‐S1) is one of the
terminal branches of the common peroneal nerve (CPN). SPN
block (SPNB) is performed using either landmark‐guided or
ultrasound‐guided technique as a component of the ankle
block. Isolated SPNB is used to provide incision congruent
regional anesthesia/analgesia (RA) in surgeries involving the
dorsum of the foot. We write this letter to discuss some
anatomical facts about SPN and describe a novel peripheral
nerve stimulation (PNS)‐guided block technique.
... [15][16][17][18][19] The deep peroneal nerve innervates the muscles of the anterior compartment of the leg while the superficial peroneal nerve supplies the muscles of the lateral compartment of the leg. [20][21][22][23] ...
Abstract
Background: Nerve conduction studies (NCSs) are an invaluable aid to investigate and quantify the physiological activity of peripheral nerves. They include measurement of sensory and motor conduction velocities and latencies of peripheral nerves which might be influenced by anthropometric factors like age, sex, height, weight, temperature and (body mass index) BMI.
Objective: As mentioned in the companion paper, normative NCS parameters were lacking in Sudan, hence the aim of this study is to establish our own EMG normal neurophysiological values among adult Sudanese people.
Method: A descriptive, analytic, cross sectional study investigating 200 Peroneal nerves of 100 healthy Sudanese people was conducted in Elmagzoub Neuroscience Center; supported by the Faculty of Medicine, National Ribat University, Khartoum, Sudan.
Results: The normative neurophysiologic values of the Left and Right peroneal nerve CMAP (compound muscle action potential) in the whole sample of this work were shown as; latency (ms), amplitude (mV), duration (ms), area (mVms) and conduction velocity (m/s). The Left Peroneal values were 6.1±1.7, 2.6±0.5, 3.6±0.9, 13.8±6.1 and 46.5±2, respectively. The right peroneal values were 5.7±2.3, 3.6±0.9, 5.7±1.3, 15.7±7 and 48.3±4.5, respectively.
Conclusion: Most EMG laboratories worldwide depend on reference values originated in Caucasian populations. Consequently, this is a second of serial NCSs of common peripheral nerves, performed in Afro-Arab ethnic Sudanese population, aiming to determine if there are any diverse values between this group and the aforementioned. Eventually this work will allow us to have our own NCS reference parameters.
... 4,6 It is also stated in studies that the sural nerve originates directly from the sciatic nerve (ScN), CPN or TN. [6][7][8][9][10] In general, although the SN is a sensory nerve, the fact that it may variationally show motor function and contain motor fibers has been emphasized in studies. 2,4,11 For this reason, the SN is of clinical importance in the diagnostic evaluation of tissue biopsies, in nerve grafts, and in the identification of sensory losses that develop due to distal neuropathies, since mono-neuropathies pertaining to the sural nerve are stated to be quite rarely seen. ...
... 2,4,11 For this reason, the SN is of clinical importance in the diagnostic evaluation of tissue biopsies, in nerve grafts, and in the identification of sensory losses that develop due to distal neuropathies, since mono-neuropathies pertaining to the sural nerve are stated to be quite rarely seen. 4,9,[12][13][14] Separately, in human fetus studies conducted previously, there is some information in regard to the morphometric structure and anatomic variations of the SN. 15,16 In our study, we aimed to morphometrically investigate the anatomic and histological structures of the SN in human fetuses as well as its neighboring relations with the gastrocnemius muscle and calcaneal tendon. ...
... 2,4,11 Therefore, SN is of clinical importance in the diagnostic evaluation of tissue biopsies, in nerve grafts, and in the identification of sensory losses that develop due to distal neuropathies, since mono-neuropathies pertaining to the SN are stated to be quite rarely seen. 4,9,[12][13][14] In our study, we identified the morphometric measurements and histological characteristics of the SN and its branches in 46 legs of human fetuses through the anatomic dissection method and under the guidance of a surgical dissection microscope. During the study, firstly a longitudinal skin incision was made via a surgical dissection microscope on the posterior sides of 46 lower extremities from 23 fetuses, from the gluteal fold up to the protrusion of the heel along the mid-line. ...
Introduction
In our study, the aim was to anatomically and histologically investigate the morphometric structures of the branches involved in the sural nerve and sural nerve formation.
Method
The study was conducted on 46 lower extremities of 23 fetuses which were obtained from Izmir Katip Çelebi University, Atatürk Training and Research Hospital, with ages from 18 and 32 gestational weeks, without any external pathology or anomaly. During the study period, the posterior-side skin dissection of the lower extremity was performed with the aid of a surgical dissection microscope initially, and the structures forming the sural nerve and the sural nerve were exposed and made visible. Afterwards, sections were taken from these structures for morphometric measurements and histological examination.
Results
The mean values and standard deviations of morphometric measurements obtained were determined. Separately, it was determined that there was no statistical difference between right-left sides and genders in morphometric measurements (p > 0.05). The sural nerve was determined to be differentiated into 4 types as A, B, C and D according to the way the nerve branches forming sural nerve join. In addition, differing characteristics pertaining to the sural nerve and branches were determined.
Discussion
We are of the opinion that the data obtained in our study will be of use to neurologists, orthopedists and clinicians engaged in this region during interventional procedures.
... Comparison of the superficial peroneal, sural, and saphenous nerves suggested that recovery was fastest in the superficial peroneal nerve, possibly because of the promoting effects of the ramus communicans and the nerve distribution region. According to anatomical studies, the rami communicantes of the sural nerve and superficial peroneal nerve are abundant in the anterolateral part of the dorsalis pedis and metapedes (Nagabhooshana et al., 2009). Drizenko et al. (2004) demonstrated that 58% of rami communicantes were located approximately 4-5 cm from the lateral malleolus in 55 cases. ...
Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Patients received oral vitamin B12 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory function in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months.
... 36 In more detail, the MDCN branch is divided into two dorsal digital nerves that commonly supply the first metatarsal bone and the first and second interosseous spaces in 43.3% of the cases. 37 The possibility of an absent MDCN has also been reported in 0.8% of cases 38 ; in such cases, the saphenous nerve or the DPN supplies the MDCN sensory territory. The IDCN is usually smaller than the MDCN, 22,36,38 and after being bifurcated, it is distributed over the fourth metatarsal bone and the third and fourth interosseous spaces, in 55.5% of the cases. ...
... 37 The possibility of an absent MDCN has also been reported in 0.8% of cases 38 ; in such cases, the saphenous nerve or the DPN supplies the MDCN sensory territory. The IDCN is usually smaller than the MDCN, 22,36,38 and after being bifurcated, it is distributed over the fourth metatarsal bone and the third and fourth interosseous spaces, in 55.5% of the cases. 37 The IDCN was mentioned as absent or atrophic in the literature in up to 35% of the cases, 23 whereas the sural nerve substituted its sensory territory supply. ...
... Long course through the deep fascia of the SPN cutaneous terminal branches has also been described. 38,50 Exercise may lead to aggravation of symptoms. 50 It is hypothesized that the SPN course through the anterior leg compartment could induce vulnerability for compression 14 ; indeed, Styf 51 reported that this anatomical variability was found in six of his 21 patients with SPN entrapment. ...
Entrapment of the superficial peroneal nerve is an uncommon neuropathy that may occur because of mechanical compression of the nerve, usually at its exit from the crural fascia. The symptoms include sensory alterations over the distribution area of the superficial peroneal nerve. Clinical examination, electrophysiologic findings, and imaging techniques can establish the diagnosis. Variations in the superficial peroneal sensory innervation over the dorsum of the foot may lead to variable results during neurologic examination and variable symptomatology in patients with nerve entrapment or lesions. Knowledge of the nerve's anatomy at the lower leg, foot, and ankle is of essential significance for the neurologist and surgeon intervening in the area.
... 36 In more detail, the MDCN branch is divided into two dorsal digital nerves that commonly supply the first metatarsal bone and the first and second interosseous spaces in 43.3% of the cases. 37 The possibility of an absent MDCN has also been reported in 0.8% of cases 38 ; in such cases, the saphenous nerve or the DPN supplies the MDCN sensory territory. The IDCN is usually smaller than the MDCN, 22,36,38 and after being bifurcated, it is distributed over the fourth metatarsal bone and the third and fourth interosseous spaces, in 55.5% of the cases. ...
... 37 The possibility of an absent MDCN has also been reported in 0.8% of cases 38 ; in such cases, the saphenous nerve or the DPN supplies the MDCN sensory territory. The IDCN is usually smaller than the MDCN, 22,36,38 and after being bifurcated, it is distributed over the fourth metatarsal bone and the third and fourth interosseous spaces, in 55.5% of the cases. 37 The IDCN was mentioned as absent or atrophic in the literature in up to 35% of the cases, 23 whereas the sural nerve substituted its sensory territory supply. ...
... Long course through the deep fascia of the SPN cutaneous terminal branches has also been described. 38,50 Exercise may lead to aggravation of symptoms. 50 It is hypothesized that the SPN course through the anterior leg compartment could induce vulnerability for compression 14 ; indeed, Styf 51 reported that this anatomical variability was found in six of his 21 patients with SPN entrapment. ...
Entrapment of the superficial peroneal nerve is an uncommon neuropathy that may occur because of mechanical compression of the nerve, usually at its exit from the crural fascia. The symptoms include sensory alterations over the distribution area of the superficial peroneal nerve. Clinical examination, electrophysiologic findings, and imaging techniques can establish the diagnosis. Variations in the superficial peroneal sensory innervation over the dorsum of the foot may lead to variable results during neurologic examination and variable symptomatology in patients with nerve entrapment or lesions. Knowledge of the nerve's anatomy at the lower leg, foot, and ankle is of essential significance for the neurologist and surgeon intervening in the area.
... This finding concurs with descriptions reported by Anthong et al., who also suggested that the SFN bifurcated either before the crural fascia in 28.2% of cases. The SFN and its terminal branches can be impinged during its course through the deep fascia resulting in entrapment syndrome (Lowdon, 1985;Nagabhooshana et al., 2009). The reason for the different patterns and piercing levels of the aforementioned nerves may be the effect of the elongating extremity during aging that enforces the fascia and modifies its position with the nerve, which is a more stable structure (Kurtoglu et al., 2006). ...
The common fibular nerve (CFN), is a branch of the sciatic nerve (SN) that exits the popliteal fossa and is located at the tuberculum of the fibula. At the tuberculum of the fibula, the CFN bifurcates into deep (DFN) and superficial (SFN) fibular nerves. Forty fetuses were micro-dissected to (i) describe the course of the CFN in relation to the tuberculum and neck of the fibula in fetuses; (ii) describe the branches, distribution and relation of the DFN and SFN to muscles within the anterolateral compartment of the leg. The CFN, DFN and SFN were present in all specimens dissected; the CFN measured a mean length (mm) of 16.03 and 16.69 on the right and left sides respectively. Bifurcation of the CFN related to the tuberculum of fibula (right; left) - above 20/80 (25%); 14/80 (17.5%); below 6/80 (7.5%); 10/80 (12.5%) and at the tuberculum 54/80 (67.5%); 56/80 (70%). The DFN bifurcated into medial and lateral branches in 68/80 (85%) and 54/80 (67.5%) on the right and left sides, respectively. The SFN bifurcated into a medial branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively and a lateral branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively. The course and distribution of the CFN, DFN and SFN were consistent with the literature reviewed and descriptions found in standard anatomical textbooks. However, our findings show that the DFN has a variable number of branching patterns, which is unique to this fetal study and an intermediate branch of the SFN which was recorded in 3/80 cases.
... Many types of surgeries are performed in the region of the mid-third of the lateral leg, including fasciotomy, arthroscopy, and nerve decompressions (11), putting the SPN in jeopardy. So, a good knowledge of the anatomical relationships and common variations of the superficial peroneal nerve is required to prevent injuries during surgical procedures (16,17). A few studies on human fetuses (9) describe the course and branching pattern of SPN in the leg and foot. ...
... [6] Somayaji Nagabhooshana et al. found 1 case of Spn where it's both branches Mdn and Idn emerge separately and SN supply lateral 1½ digits on dorsum of foot which was similar to our type 4b. [9] Devi Sankar K et al. found 1 case of SN where it supplies lateral 1½ toes in our study we also found that in type 4. [10] Z Asli Aktan Ikiz et al. found that in 26.7% of cases SN supplies the lateral two and a half toes. In our study we got that in 35% of cases. ...
Cutaneous nerves on the dorsum of foot are at risk for iatrogenic damage while performing arthroscopy, local anaesthetic block, surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle. Hence the present study was undertaken to classify the different patterns of cutaneous innervation on the dorsum of foot of foetuses which will help in minimizing iatrogenic damage to the nerves.
A total of 40 lower limbs from 20 foetuses were dissected and the branching patterns of nerves were noted and specimens were photographed.
Four distinct patterns of innervation with additional subtypes were identified and designated as Type 1 a-g; 2 a-d; 3; 4 a-c.
Detailed knowledge about the pattern of cutaneous innervation of dorsum of foot may decrease the damage to these nerves during operative procedures near the foot and ankle.
