Common peroneal nerve. Sciatic nerve, posterior femoral cutaneous nerve, common peroneal nerve, superficial peroneal nerve, deep peroneal nerve, tibial nerve

1. Internal obturator nerve, n. obturatorius internus, departs from the lumbosacral trunk and the anterior branch of the first sacral nerve (SI). Coming out of the pelvis under the piriformis muscle, the nerve goes around the sciatic spine, approaches the obturator internus muscle, sometimes giving a small branch to the gemellus superior muscle.

2. Piriformis nerve, n. piriformis, formed by two trunks extending from the posterior surface of the anterior branches of the first and second sacral nerves (SI, SII); the common trunk of the nerve approaches the piriformis muscle and innervates it.

3. Nerve of the square muscle of the thigh, n. quadratus femoris, departs from the anterior surface of the lumbosacral trunk and the first sacral nerve. Coming out of the pelvis under the piriformis muscle, it gives the final branches to the square muscle of the thigh. Descending somewhat in front of the sciatic nerve, it sends branches to the twin muscles and capsule hip joint.

4. Superior gluteal nerve, n. gluteus superior(LIV, LV, SI), leaves the cavity of the small pelvis, accompanied by the vessels of the same name through the gap above the piriformis muscle and, bending around the greater sciatic notch, lies between the middle and small gluteal muscles, heading arcuately forward. Having given the branches to the indicated muscles, the nerve is distributed by its terminal branches in the thickness of the tensor fascia lata.

5. Lower gluteal nerve, n. gluteus inferior(LV, SI, SII), exits the pelvic cavity through the gap under the piriformis muscle into the gluteal region under the gluteus maximus muscle along with the pudendal nerve (lateral to it), the sciatic nerve and the posterior cutaneous nerve of the thigh (medially to them). It branches in the thickness of the gluteus maximus muscle, also innervating the capsule of the hip joint. Sometimes the nerve takes part in the innervation of the obturator internus, gemelus and quadratus femoris muscles.

6. Posterior cutaneous nerve of the thigh, n. Cutaneus femoris posterior, initially adjacent to the lower gluteal nerve or goes with it in a common trunk; exits the pelvic cavity through a gap under the piriformis muscle medial to the sciatic nerve and lies under the gluteus maximus muscle, located almost in the middle between the ischial tuberosity and the greater trochanter of the thigh, descends to the back of the thigh. Here it is located immediately under the wide fascia, corresponding to the groove between the semitendinosus and biceps muscles of the thigh; heading down, gives branches that extend on both sides of the main trunk and perforate the fascia along the back of the thigh. The branches branch out in the skin of the posterior and especially the medial surfaces of the thigh, reaching the skin of the popliteal fossa.

Branches of the posterior femoral cutaneous nerve:

1) lower nerves of the buttocks, nn. clunium inferiores, moving away from the main trunk with 2-3 branches, they bend around or pierce the lower edge of the gluteus maximus muscle, go up and branch out in the skin of the gluteal region;

2) perineal branches, rr. perineales, only 1-2, sometimes more - thin nerves, depart from the main trunk, go down and, bending around the ischial tuberosity, follow anteriorly, branching in the skin of the medial surface of the scrotum (large labia) and perineum. These branches connect with the same name branches of the pudendal nerve.

7. Sciatic nerve, n. ischiadicus(LIV, LV, SI - SIII) - the thickest nerve not only of the lumbosacral plexus, but of the whole body; is a direct continuation of all the roots of the sacral plexus. Upon exiting through the gap under the piriformis muscle, the sciatic nerve is located lateral to all the nerves and vessels passing through this hole, and lies between the gluteus maximus muscle on one side and the twin, obturator internus and quadratus femoris muscles on the other, almost in the middle of the line drawn between the ischial tuberosity and the greater trochanter of the thigh. Even before exiting through the fissure, the articular branch departs from the sciatic nerve to the capsule of the hip joint.

Coming out from under the lower edge of the gluteus maximus muscle, the sciatic nerve is located in the region of the gluteal fold close to the wide fascia of the thigh; further down, it is covered by the long head of the biceps femoris muscle, located between it and the large adductor muscle. In the middle of the thigh, a long head crosses it; below it is located between the semimembranosus muscle medially and the biceps femoris muscle laterally and reaches the popliteal fossa, where in its upper corner it is divided into two branches: the thicker medial - the tibial nerve and the thinner lateral - the common peroneal nerve.

The division of the sciatic nerve into these two branches can sometimes occur above the popliteal fossa, even directly at the sacral plexus itself. In this case, from the cavity of the small pelvis, the tibial nerve passes under the piriformis muscle, and the common peroneal nerve can perforate this muscle or pass over it. Both of these branches throughout the entire sciatic nerve lie in a common connective tissue sheath, opening which, it is easy to separate them to the sacral plexus. The artery that accompanies the sciatic nerve passes along the line of contact between the tibial and common peroneal nerves.

Branches of the sciatic nerve:

1) muscular branches, rr. musculares, branch out in the following muscles: m. obturatorius interims, mm. gemelli superior et inferior, m. quadratus femoris.

Muscular branches depart either before the passage of the sciatic nerve through the opening under the piriformis muscle, or within it. In addition, the muscle branches in the thigh region depart from the tibial part of the sciatic nerve to m. biceps femoris (caput longum), m. semitendinosus, m. semimembranosus, m. adductor magnus. From the peroneal part of the sciatic nerve, the muscle branches go to m. biceps femoris (caput breve);

2) articular branches depart from the tibial and peroneal parts of the sciatic nerve to joint capsule knee joint;

3) common peroneal nerve, n. fibularis communis(LIV, Lv, SI, SII), from the proximal top of the popliteal fossa, it goes to its lateral side and is located under the medial edge of the biceps femoris muscle, between it and the lateral head of the gastrocnemius muscle, spirally goes around the head of the fibula, being covered here only by fascia and skin .

In this area, non-permanent articular branches depart from the nerve trunk to the lateral parts of the capsule of the knee joint, as well as to the tibiofibular joint. Distal to this area, it penetrates into the thickness of the initial part of the long peroneal muscle, where it divides into its two terminal branches - the superficial peroneal nerve and the deep peroneal nerve.

Branches from the common peroneal nerve:

a) lateral cutaneous nerve of the calf, n. cutaneus surae lateralis, departs in the popliteal fossa, goes to the lateral head of the gastrocnemius muscle and, perforating the fascia of the lower leg in this place, branches out in the skin of the lateral surface of the lower leg, reaching the region of the lateral malleolus;

b) peroneal connecting branch, r. communicans fibularis, can start from the main trunk or from the lateral cutaneous nerve of the lower leg, follows the lateral head of the gastrocnemius muscle, located between it and the fascia of the lower leg, perforates the latter and, branching in the skin, connects to the medial cutaneous nerve of the lower leg;

c) superficial peroneal nerve, n. fibularis superficialis, passes between the heads of the long peroneal muscle, follows down, located at some distance between both peroneal muscles. Having passed to the medial surface of the short peroneal muscle, the nerve perforates in the area lower third lower leg fascia of the lower leg and branches into its terminal branches: the dorsal medial and intermediate cutaneous nerves (foot).

Branches of the superficial peroneal nerve:

muscle branches, rr. musculares, innervate the long peroneal muscle (2-4 branches from the proximal parts of the trunk) and the short peroneal muscle (1-2 branches from the trunk in the region of the middle third of the leg);

medial dorsal cutaneous nerve, m. cutaneus dorsalis medialis,- one of the two terminal branches of the superficial peroneal nerve. It follows for some distance over the fascia of the lower leg, goes to the medial edge of the rear of the foot, gives off branches to the skin of the medial ankle, where it connects with the branches of the saphenous nerve of the leg, after which it divides into two branches. One of them, medial, branches in the skin of the medial edge of the foot and thumb to the distal phalanx and connects in the region of the first interosseous space with the deep peroneal nerve. Another branch, lateral, connects with the terminal branch of the deep peroneal nerve and goes to the region of the second interosseous space, where it branches in the surfaces of the II and III fingers facing one another, giving here the dorsal digital nerves of the foot, nn. digitales dorsales pedis;

d) intermediate dorsal cutaneous nerve, n. cutaneus dorsalis intermedius, as well as the medial dorsal cutaneous nerve, is located on top of the fascia of the lower leg and follows the anterolateral surface of the rear of the foot. Having given branches to the skin of the region of the lateral ankle, which are connected to the branches of the sural nerve, it is divided into two branches, of which one, going medially, branches in the skin of the surfaces of III and IV fingers facing one another. The other, lying more lateral, goes to the skin of the surfaces of the IV finger and little finger facing each other and to the lateral surface of the little finger, forming here a connection with the terminal branch of the sural nerve. All these branches are called the dorsal digital nerves of the foot, nn. digitales dorsales pedis;

e) deep peroneal nerve, n. fibularis (peroneus) profundus, penetrating the thickness primary departments long peroneal muscle, anterior intermuscular septum of the leg and long extensor of the fingers, lies on the anterior surface of the interosseous membrane, located on the lateral side of the anterior tibial vessels.

Further, the nerve passes to the anterior, and then to the medial surface of the vascular bundle, is located in the upper sections of the leg between the long extensor of the fingers and the anterior tibialis muscle, and in the lower sections - between the anterior tibial muscle and the long extensor of the big toe, innervating them. The deep peroneal nerve has intermittent connecting branches with the superficial peroneal nerve.

When moving to the rear of the foot, the nerve passes first under the upper extensor retinaculum, giving off a non-permanent articular branch to the ankle joint capsule, and then under the lower extensor retinaculum and the tendon of the long extensor of the big toe and is divided into two branches: lateral and medial.

The first is shorter, most of its branches go to the short extensors of the fingers. The second branch is longer, accompanied by the dorsal artery of the foot, reaches the region of the first interosseous space, where, passing under the tendon of the short extensor of the big toe together with the first dorsal metatarsal artery, it is divided into two terminal branches, branching in the skin of the dorsal surface of sides I and II fingers. Together with them, an inconstant number of thin branches depart, suitable for the capsules of the metatarsophalangeal and interphalangeal joints of the I and II fingers from the side of their back surface.

Branches of the deep peroneal nerve:

a) muscle branches, rr. musculares, in the shin area are sent to the following muscles: m. tibialis anterior - 3 branches that enter the upper, middle and lower parts of the muscle, to m. extensor digitorum longus and m. extensor hallucis longus - 2 branches each, which enter the upper, middle and lower parts of the muscles. In the area of ​​the rear of the foot, the muscle branches approach m. extensor digitorum brevis and m. extensor hallucis brevis;

b) dorsal digital nerves, nn. digitales dorsales, - terminal branches of the deep peroneal nerve. They are divided into two nerves: the lateral nerve of the big toe (branching in the skin of the back surface of the first finger from the side of its lateral edge) and medial nerve II finger (innervates the skin of the dorsum of the finger from its medial edge);

4) tibial nerve, n. tibialis(LIV, Lv, SI, SII, SIII), being in its direction a continuation of the sciatic nerve, it is much thicker than its second branch - the common peroneal nerve. It starts at the top of the popliteal fossa, follows almost vertically to its distal angle, located in the area of ​​the fossa directly under the fascia, between it and the popliteal vessels.

Further, following between both heads of the gastrocnemius muscle, it lies on the posterior surface of the popliteal muscle and, accompanied by the posterior tibial vessels, passes under the tendon arch of the soleus muscle, being covered by this muscle here.

Heading further down under the deep sheet of the fascia of the lower leg between the lateral edge of the long flexor of the fingers and the medial edge of the long flexor of the big toe, the tibial nerve reaches the posterior surface of the medial malleolus, where it is located midway between it and the calcaneal tendon. After passing under the flexor retinaculum, the nerve divides into its two terminal branches: the medial plantar nerve and the lateral plantar nerve.

Branches of the tibial nerve:

a) muscle branches rr. musculares, sent to the following muscles: to the heads of the gastrocnemius muscle (the branch of the medial head is thicker than the lateral); to the soleus muscle (anterior and posterior branches); to the popliteal muscle, to the plantar muscle. Branches suitable for the popliteal muscle send branches to the capsule of the knee joint and the periosteum of the tibia;

b) interosseous nerve of the leg, n. interosseus cruris- a rather long nerve, from which, before it enters the thickness of the interosseous membrane, branches are directed to the wall of the tibial vessels, and after leaving the interosseous membrane - to the periosteum of the bones of the leg, their distal connection and to the capsule of the ankle joint, to the posterior tibial muscle, long flexor big toe, long flexor of fingers;

c) medial cutaneous nerve of the calf, n. cutaneus surae medialis, departs in the region of the popliteal fossa from the posterior surface of the tibial nerve, follows under the fascia, accompanied by the medial saphenous vein between the heads of the gastrocnemius muscle. Having reached the middle of the lower leg, approximately at the level of the beginning of the calcaneal tendon, sometimes higher, it pierces the fascia, after which it connects to the peroneal connecting branch, r. communicans peroneus (fubularis), in one trunk - sural nerve, n. suralis.

The latter is directed along the lateral edge of the calcaneal tendon, accompanied medially by the small saphenous vein, and reaches the posterior edge of the lateral malleolus, where it sends lateral calcaneal branches, rr, to the skin of this area. calcanei laterales, as well as branches to the capsule of the ankle joint.

Further, the sural nerve goes around the ankle and passes to the lateral surface of the foot in the form of a lateral dorsal cutaneous nerve, n. cutaneus dorsalis lateraslis, which branches in the skin of the rear and lateral edge of the foot and the back surface of the fifth finger and gives a connecting branch to the intermediate dorsal cutaneous nerve of the foot;

d) medial calcaneal branches, rr. calcanei mediates, penetrate through the fascia in the region of the ankle groove, sometimes in the form of a single nerve, and branch out in the skin of the heel and the medial edge of the sole;

e) medial plantar nerve, n. plantaris medialis, - one of the two terminal branches of the tibial nerve. The initial sections of the nerve are located medial to the posterior tibial artery, in the canal between the superficial and deep sheets of the flexor retinaculum. After passing the canal, the nerve is sent, accompanied by the medial plantar artery under the abductor muscle of the big toe. Following further forward between this muscle and the short flexor of the fingers, it is divided into two parts - medial and lateral.

The medial plantar nerve gives off several cutaneous branches to the skin of the medial surface of the sole:

muscle branches to m. abductor hallucis, m. flexor digitorum brevis, m. flexor hallucis brevis and common plantar digital nerves I, II, III, nn. digitales plantares communes I, II, III. The latter are accompanied by the metatarsal plantar arteries, send muscle branches to the first and second (sometimes to the third) worm-like muscles and pierce the plantar aponeurosis at the level of the distal end of the interosseous spaces. Having given here thin branches to the skin of the sole, they are divided into their own plantar digital nerves, nn. digitales plantares proprii, branching in the skin of the sides of the plantar surface of I and II, II and III, III and IV fingers facing one another, and passing to the back surface of their distal phalanges;

e) lateral plantar nerve, n. plantaris lateralis - the second terminal branch of the tibial nerve, much thinner than the medial plantar nerve. Passing on the sole, accompanied by the lateral plantar artery between the square plantar muscle and the short flexor of the fingers, lies closer to the lateral edge of the foot between the short flexor of the little finger and the muscle that removes the little finger, where it divides into its terminal branches: superficial and deep.

Branches of the lateral plantar nerve:

muscle branches depart from the main trunk before dividing it into terminal branches and go to the square muscle of the sole and to the muscle that removes the little finger;

superficial branch, r. superficialis, having given several branches to the skin of the sole, it is divided into medial and lateral branches. medial branch- common plantar digital nerve, n. digitalis plantaris communis (IV and V fingers), which, accompanied by the metatarsal plantar artery, passes in the fourth interosseous space. Approaching the metatarsophalangeal joint and sending a connecting branch to the medial plantar nerve, it divides into two own plantar digital nerves, nn. digitales plantares proprii. The latter branch out in the skin of the sides of the IV and V fingers facing one another and pass to the back surface of their nail phalanges. Lateral branch- own plantar nerve of the fifth finger, which branches in the skin of the plantar surface and the lateral side of the fifth finger. This nerve often gives muscle branches to the interosseous muscles of the fourth intermetatarsal space and to the short flexor of the little finger;

deep branch, r. profundus, accompanied by the plantar artery of the arc, is located between the layer of interosseous muscles on one side and the long flexor of the fingers and the oblique head of the adductor muscle of the big toe on the other. It gives muscle branches to these muscles, to the worm-like muscles (II, III, IV) and the short flexor of the big toe (to its lateral head).
In addition to these nerves, the superficial and deep branches of the lateral plantar nerve send nerves to the capsules of the metatarsal joints and to the periosteum. metatarsal bones and phalanges.

8. Sexual nerve, n. pudendus(SI-SIV), represents the caudal part of the sacral plexus and is connected with it by several branches. The nerve lies under the lower edge of the piriformis muscle on the anterior surface of the coccygeal muscle; along its anterior surface, the lateral sacral vessels pass in the longitudinal direction.

Nerves, arteries and veins of a woman's perineum; bottom view.

The pudendal nerve is also connected with the coccygeal plexus and with the vegetative lower hypogastric plexus, due to which, with its branches, it takes part in the innervation of the internal organs of the pelvic cavity (rectum, bladder, vagina, etc.), external genital organs, as well as the muscles of the pelvic diaphragm: the muscle that lifts the anus, and the coccygeal muscle - and the skin of the perineum.

Nerves, arteries and veins of the perineum of a man; bottom view.

The pudendal nerve emerges from the pelvic cavity, accompanied by the internal genital vessels medially lying from it, through the gap under the piriformis muscle. Then it lies on the back surface of the sciatic spine, goes around it and, having passed through the small sciatic foramen, returns to the pelvic cavity, located below the levator ani muscle, in the ischio-anal fossa, where it goes along its lateral wall, in the thickness of the internal fascia obturator muscle.

In the ischio-anal fossa, the pudendal nerve divides into its branches:

1) lower rectal nerves, nn. rectal inferiores, are located most medially, follow the perineal part of the rectum, the external sphincter anus and to the skin of the anus;

2) perineal nerves, nn. perineates, followed by the vessels of the perineum and are the most superficial of the terminal branches of the pudendal nerve. Muscular branches depart from the perineal nerves to the anterior sections of the external sphincter of the anus, to the superficial transverse perineal muscle, bulbous-spongy muscle, sciatic-cavernous muscle and posterior scrotal nerves, nn. scrotales posteriores (posterior labial nerves, nn. labiates posteriores, - in women), - a superficially lying group of branches.

These nerves go to the skin of the perineum and to the skin of the posterior surface of the scrotum (labia majora in women); connect with the lower rectal nerves, as well as with the perineal branches of the posterior cutaneous nerve of the thigh;

3) dorsal nerve of the penis (dorsal nerve of the clitoris in women), n. dorsalis penis (n. dorsalis clitoridis), is upper branch genital nerve. It follows, accompanied by the artery of the penis, along the inner surface of the lower branch of the ischium and pubic bones and, passing through the urogenital diaphragm, lies along with the dorsal artery of the penis on the back of the penis (the clitoris in women), where it branches into its terminal branches in the skin and in cavernous bodies of the penis, reaching its head (in women it reaches the large and small labia).

On its way, the nerve sends branches to the deep transverse perineal muscle, the sphincter of the urethra, and to the neural cavernous plexus of the penis (clitoris).

9248 0

Peroneal neuropathy syndromecharacterized by the phenomena of irritation and prolapse in the zone of innervation of the peroneal nerve and neuroosteofibrosis at the beginning of the peroneal muscle, where the nerve is subjected to compression.

About vulnerability peroneal nervehas been known for a long time. In the 19th century, when studying paralysis of the legs in parturient women, attention was drawn to the predominant suffering of the muscles innervated by the peroneal nerve (Basedow V., 1938; Valleix K, 1841; Romberg M., 1853, etc.). Levebre (1876), and then Hunermann (1892) explained this susceptibility to anatomical features: the motor fibers of the peroneal nerve are part of the 1_4 and L5 nerves, located almost directly on the sharp innominate line and easily squeezed by the fetal head. Here, compression of the internal iliac artery with its branches supplying the sciatic nerve is also possible.

However, such paralysis is still rare. Sometimes paralysis of the muscles innervated by the peroneal nerve was observed during reduction of the dislocation of the hip joint, and preliminary stretching of the shortened leg prevents such a complication (Hoffa A., 1900; Lorenz L., 1900; Hartung H., 1906). But these paralysis occur in very rare cases. The role of a high level of branching of the peroneal nerve was also assumed (Dorion, 1884; Kunepeac I.P., Miller L.G., 1971), its vulnerability in general, for example, in neuropathies (Kutner R., 1905). It has long been known about the frequent involvement of the peroneal nerve in "sciatica", "sciatica".

This feature has long been pointed out by D.Cotugno (1764), and later by J.Guinon and E.Parmentier (1890), E.Remark (1892), N.Chiray and E.Roger (1930) - Pointe's symptom, F. F. Ogienko (1970), D. T. Shamburov (1966), V. I. Samosyuk, F. A. Khabirov et al. (1979) etc. G.S. Topprover (1931) during the operation of stretching the sciatic nerve by blood in almost all cases noted appearance of a lung paresis of the peroneal nerve.

When squeezing the entire sciatic nerve or under chemical action on it, for example, turpentine (Gerard R., 1927), the resulting paralysis mainly captures the muscles innervated by the peroneal nerve. In the described observations of damage to the sciatic nerve after unsuccessful injections of medicinal substances (Fedorova A.B., 1959, 1975, etc.), the predominant localization of the phenomena of prolapse and irritation in the zone of innervation of the peroneal fibers of the nerve is also emphasized.

Hypoalgesia of the skin on the outer surface of the lower leg in patients with vertebrogenic piriformis syndrome makes it difficult differential diagnosis between this syndrome and Si root compression (Kipervas IP, 1971). The bundles from which the greater and peroneal nerves are formed are supplied with blood in different ways. All arteries of the sciatic nerve, both branching off from the inferior gluteal artery (sometimes from the internal artery), and coming from the middle circumflex of the femur and from the perforating arteries, enter the proximal tibial nerve in pairs of longitudinal trunks (Hoffmann M., 1903). In contrast, the blood supply to the peroneal nerve is carried out by a single thin trunk branching off from the inferior gluteal artery. The rest of the blood supply to this nerve goes through the branches of the vessels that feed the tibial nerve through a chain of anastomoses. The fibers of the tibial nerve are surrounded by an abundant network of relatively large diameter blood vessels, which is not the case with the fibers of the peroneal nerve. If you cause a violation of the blood supply to the nerve by stretching it, it resumes much faster in the tibial nerve.

It is clear that under mechanical influences, the fibers of the peroneal rather than the tibial nerve will be the first to suffer. However, the fibers of the peroneal nerve are somewhat more extensible (Lorenz L., 1890). Especially great importance have different histological features of the fibers of the peroneal nerve, thicker and with more myelin lining compared to thinner tibial fibers (Shargorodsky L.Ya., 1946; Doinikov B.S., 1955; Thomas P. et ai, 1955; Erlanger J., Gasser H., 1937). In pathology, thick fibers are the first to be affected, requiring a more intensive metabolism and less resistant to anoxia. Not surprisingly, after the death of animals, electrical excitability disappears earlier in the muscles innervated by the peroneal than by the tibial nerve (Gerard R., 1927).

Thus, most authors associate frequent lesions of the peroneal nerve in general and in discogenic processes in particular with damage to the fibers of this nerve not on the lower leg, but in the proximal section - where they pass as part of the sciatic nerve, or even more proximal. Especially insist on this J.\acek et al. (1965), who described the clinical and electromyographic picture of five such patients. This point of view does not take into account the observations of clinicians about the compression of the peroneal nerve itself under the biceps tendon, especially in persons whose work requires squatting, kneeling (Guillain G. et al., 1934; Jong J., 1947; Nagler S., Rangel L., 1947; Kaminsky V., 1947; Wright V., Braatzl, 1953; Staal A. et al., 1965; Seppalainen A. et ai, 1977; Popelyansky Ya. Yu., 1983). The predisposition to such compressions is transmitted in an autosomal dominant manner. Family cases of this syndrome are also described (German DG et al., 1989). Acute injuries of the same type are also possible. Here is one of our observations.

Patient V.B., 31 years old, tractor driver.
Three months before admission to the department, the right leg, bent at an angle of 10-15° at the knee, was sandwiched between two logs for 30-50 minutes. He experienced moderate pain at the site of compression - in the lower third of the thigh and in the upper parts of the lower leg. The next day I did not experience pain, but the foot and lower leg became swollen, the foot hung: when walking, I had to raise my leg high. After 20 days, the edema subsided, there were wiggling of the fingers except for the thumb, a sensation of the passage of an electric current to the thumb from the middle of the lower leg. In the future, the same paresis remained. Experienced minor constant pain below the patella. No pathology was found in the somatic status, but in the blood: leukocytes. - 17,000; fell. - 9; l. - eleven; m. - 9; ROE - 20 mm/h; three weeks later: leukocytes. - 12,000; fell. - four; limf. - fourteen; class Turk - 1:100; ROE - 16 mm/h. In the region of the inner surface of the lower third of the right thigh - a strangulation furrow of 103 cm, on the outer surface - 32 cm.

In the region of the tibial crest there is a purple-blue spot 2.5 x 2.5 cm. There are no radiological changes in the lower leg and foot. Walks high right leg: the foot sags, cannot stand on the heel, but stands freely on the toe. Impossible extension and almost impossible (only 5°) abduction of the foot; finger extension is minimal. Very mild hypotrophy of the peroneal muscle group of the right leg. Hypoesthesia in the gap between the 1st and 2nd toes of the right foot. Vibration sensitivity of the lateral condyle is 8-9°, the medial one is 4-5°, the Achilles reflex is not elicited on the right, the foot and lower leg on the right feel slightly colder than on the left. According to electrophysiological studies, damage to the right peroneal nerve and related muscles.

This is the picture of compression of the peroneal nerve under the biceps tendon. Conditions for its compression are also available in the more distal zone (Fig. 4.29).
The common peroneal nerve at the lateral angle of the popliteal fossa pierces the beginning of the lateral head of the gastrocnemius muscle, and then goes around the neck of the fibula from the outside. Here it passes between the bundles of the initial part of the long peroneal muscle through the muscular-peroneal canal rich in fibrous cords (Marwah V., 1964). In this fibrous ring, the nerve is divided into three branches: deep, superficial, recurrent. When a muscle is stretched during forced movement of the foot, the nerve can be stretched as well as compressed between that muscle and the bone (Koppel B., Thompson W., 1960). Compression and tension of the nerve at this level occur naturally and independently of vertebrogenic mechanisms. Apparently, in some patients with lumbar osteochondrosis, the mechanism of local compression of the peroneal nerve on the lower leg cannot be excluded.


Nerve compression in this canal may begin after an awkward movement in the ankle joint or with vicarious hyperfunction of the muscle. We often noted its postural overload, described by A. Briigger (1967) in symphysis-sternal syndrome. There is pain in the lateral sections of the lower leg and dorsal - foot. Pain increases with movements in the ankle joint, which is why it is often mistakenly diagnosed as supractal synovitis or tendon sprain in this area. In this regard, pain in the area of ​​​​the outer ankle, in the projection of the articulation of the fibula with the talus, can also be considered. O. Jungo (1984) suggests the term "talo-peroneal syndrome" for such manifestations.

In our clinic, it was shown that a decrease in the speed of nerve impulse conduction along the peroneal nerve occurs with radicular compression and is not detected in non-radicular lumboischialgia, including piriformis syndrome (Usmanova A.I., 1971). Decreased speed was determined by an average of 10% in the peroneal nerve with normal speed in the tibial nerve. This happened during compression of both L5 and Si roots. During stimulation of the peroneal nerve in the lateral part of the popliteal fossa, behind the head of the fibula and along the intermalleolar line on the anterior surface of the ankle joint, we recorded action currents from the short extensor of the fingers.

In addition, the speed of impulse conduction along the fibers of the peroneal nerve, which goes as part of the sciatic nerve, was measured in the segment located between the exit point of the sciatic nerve into the superficial layers of the thigh (on the border of the upper and middle thirds of it) and the proximal points of stimulation of the lower leg (Rapoport G.M. ., 1973). In the control group, a relative constancy of the velocity of excitation propagation throughout the entire length of the peroneal nerve, including its proximal fibers as part of the sciatic nerve, was revealed (fluctuations within 1-3 m/s with a tendency to increase in velocity in areas located above the stimulation points on the lower leg). In patients with lumbar osteochondrosis, these separate (above and below the knee) indicators turned out to be different for various syndromes (Table 4.5).

The table shows that in cases where extensor paresis is due to radicular lesion, the speed of impulse conduction along the peroneal nerve is reduced to the same extent in the proximal and distal parts of the corresponding fibers. When there is weakness of the foot extensors due to non-radicular pathology, a decrease in the speed of impulse conduction distal to the head of the fibula is detected. We are talking about patients with paralytic sciatica or patients with pain in the long peroneal muscle just below the head of the fibula at the site of the peroneal nerve.

In the last group, a detailed study of sensitivity revealed hypoesthesia not in Si, this zone did not extend above the dermatome of the leg and did not capture the fifth finger. It was the outer edge of the lower leg and the rear of the foot - the zone of the peroneal nerve, which is affected in conditions of myoadaptive formed myofibrosis of the peroneal muscle. Here we emphasize the importance of local, in the area of ​​the head of the fibula, tissue pathology and local pathology of the peroneal nerve. Because it is unlikely that local changes in the nerve were primary, one should think about the presence of changes in the tissues at the head of the fibula and, accordingly. about secondary changes in the nerve passing through them. The described site coincides with the point for acupuncture Zu San-Li.

The defeat of the peroneal nerve is quite common in the clinic. neurological diseases. Its defeat, both due to neuropathy, and due to injuries and compression-ischemic syndromes, is in the first place, along with damage to the radial nerve.

human anatomy

In order to understand how this neuropathy manifests itself, let us recall the human anatomy. The largest nerve plexus human body- this is the sacrum. Connecting with each other, the nerves of this plexus form a thick sciatic nerve, which is the longest and thickest nerve in the human body. In addition to the sciatic nerve, short branches also depart from the plexus, which innervate the pelvic muscles, gluteal muscles, as well as the perineum and genitals (pudendal nerve).

As for the sciatic nerve, it is, as it were, a direct continuation of the sacral plexus itself, and contains all its constituent roots and nerve fibers. It exits the pelvis through the large sciatic foramen, and is covered from above by the gluteus maximus muscle.

Then this nerve descends almost vertically, hiding under the muscles - hip flexors, along its back surface.

Having reached the fossa poplitea, or popliteal fossa, it branches into two main branches: the tibial nerve lying more towards the center, and the thin branch lying more outward. It is she who is called the common peroneal nerve.

The common peroneal nerve, continuing to descend down the lower leg, itself divides into two branches: superficial and deep. Even before separation, it gives off small skin branches that innervate the lateral (outer) part of the lower leg and give it sensitivity. In addition, these branches, uniting with others, on the foot provide sensitivity to its outer edge along with the little finger.

The superficial part of the peroneal nerve is both a muscular (motor) and cutaneous (sensory) nerve. It, again, dividing in half, innervates the cirrus muscles of the leg, and the skin branches go to the big toe, as well as to the edges of the 2nd and 3rd toes facing each other. A separate branch of the external peroneal nerve innervates the rear of the foot in the region of 2-5 fingers.

The deep branch of the peroneal nerve goes along with the tibial artery, and provides movement for the anterior tibial muscle, the common long extensor of the fingers, the extensor of the thumb, and also gives branches to the ankle joint. After "wandering" along the lower leg, this nerve, together with the vessel, goes to the rear of the foot, provides innervation to the short extensor fingers, and the skin of fingers 1 and 2.

Such a whimsical course of the long peroneal nerve makes it vulnerable along the way. How is this nerve affected?

Symptoms of neuropathy

As it has already become clear, since its main function is the extension of the foot, it is it that is violated, as well as raising the inner edge of the foot. It is difficult to extend the toes of the foot, its abduction with a simultaneous attempt to lift it outward.

The foot hangs, the fingers are bent at the metatarsophalangeal joints (horse foot). Due to the impossibility of straightening it, there is a steppage, or "cock's gait", in which the foot must rise high at the expense of the knee and be placed from a vertical position.

When the peroneal nerve is damaged, there is a violation of sensitivity on the outer surface of the lower leg (numbness, tingling, crawling sensation). As a rule, the patient does not notice pain during the development of polyneuropathy.

Highly hallmark defeat of the peroneal nerve is the inability to stand up, and even more so to walk on the heels, because for this you need to unbend the toes. With a long course of the pathological process, it is possible to notice emaciation and hypotrophy of the extensors of the toes, which are located on its rear. This is manifested by pronounced contours of the tendons. The dorsum of the foot on the affected leg appears "ribbed".

Characteristic, in addition, violations of sensitivity in the interdigital space, between 1 and 2 fingers. Reflexes (Achilles) with damage to the peroneal nerve are usually preserved.

Causes of damage to the peroneal nerve

It is worth dwelling on the causes of damage to the peroneal nerve:

• neuritis or neuropathy. In this case, sometimes in the upper third of the lower leg may occur pain, but the main signs will be the loss of the function of movement and sensitivity;

• compression-ischemic neuropathy. The nerve is pinched on the back of the thigh under the biceps tendon. It is the deep branch of the peroneal nerve, the “manager” of the foot, that is affected;

• it is also possible to damage the superficial branch of the peroneal nerve, this occurs in the region of the upper head of the fibula. This causes pain in the leg when walking. Frequent squatting, prolonged stay in the “foot to foot” position, etc. lead to such manifestations.

• in addition, spondylogenic tunnel syndrome may occur. This is "guilty" intervertebral disc in the lumbar spine, which caused ischemia in the basin of the Deprodge-Gotteron artery, which supplies the spinal cord. As a result, radiculo-epiconus appears - cone syndrome.

In addition to these "local" causes, symmetrical nerve damage can occur, and one of the causes is chronic alcoholism. Another reason is diabetes. This results in a toxic effect on the nerves. In the first case - ethanol, and in the second - glucose. In this case, there is a lesion of the type of "socks" and "gloves", with a violation of sensitivity and motor disorders, which is symmetrical.

In the diagnosis of damage to the peroneal nerve, electroneuromyography is of great importance, by which it is possible to judge the processes that caused disturbances in the functioning of the nerve.

Of course, a neurologist should examine, and even more so, prescribe treatment, sometimes he works together with an endocrinologist or a narcologist. But even for a simple person who does not have any medical education, it is easy to remember that if it is impossible to stand on the heels, then the peroneal is affected, and if on the toes, then the tibial nerve, since they innervate the muscles - antagonists, that is, performing opposite functions.

Therefore, if you are in doubt whether the lesion of the peroneal nerve is progressing or not, just walk on your heels. If it becomes more and more difficult to do, then you need to see a doctor.

It is important to understand that often the progression of peroneal neuropathy in discogenic lesions occurs gradually, and that is especially dangerous - it can occur with little or no pain. People tend to tolerate these violations, in the hope that everything will pass by itself. But, as a rule, nothing goes away on its own, and a person turns to doctors when the leg already begins to interfere with walking, and gait disturbance becomes noticeable to others.

In the event that a year or two has passed since the onset of pronounced changes, then the chances that the nerve will recover are very small. Therefore, a doctor should be consulted with the most minimal signs of a gait disorder, or a violation of sensitivity in the shin area.

A test for the presence of pathology can be carried out by standing on your heels: if you easily hold on to them, there is no reason for concern, otherwise you should learn more about NMN. Note that the terms neuropathy, neuropathy, neuritis are different names for the same pathology.

Anatomical reference

Neuropathy is a disease that is characterized by nerve damage that is non-inflammatory in nature. The disease is caused by degenerative processes, injuries or squeezing in lower limbs. In addition to NMN, there is tibial neuropathy. Depending on the damage to the motor or sensory fibers, they are also divided into motor and sensory neuropathy.

Neuropathy of the peroneal nerve leads in terms of prevalence among the listed pathologies.

Consider the anatomy of the peroneal nerve - the main part of the sacral plexus, the fibers of which are part of the sciatic nerve, departing from it at the level of the lower third of the femoral part of the leg. The popliteal fossa is where these elements separate into the common peroneal nerve. The head of the fibula bends around him along a spiral trajectory. This part of the "path" of the nerve runs along the surface. Therefore, it is only protected skin, and therefore is under the influence of external negative factors that affect it.

Then there is a division of the peroneal nerve, as a result of which its superficial and deep branches appear. The “responsibility” of the first includes the innervation of muscle structures, the rotation of the foot and the sensitivity of its back.

The deep peroneal nerve serves to extend the fingers, thanks to which we are able to feel pain and touch. Squeezing any of the branches violates the sensitivity of the foot and its fingers, a person cannot unbend their phalanges. The task of the sural nerve is to innervate the posterior outer part of the lower third of the lower leg, the heel and the outer edge of the foot.

ICD-10 code

The term "ICD-10" is an acronym International classification diseases, which was subjected to the next - tenth - revision in 2010. The document contains codes used to designate all diseases known to modern medical science. Neuropathy in it is represented by damage to various nerves of a non-inflammatory nature. In ICD-10, NMN belongs to class 6 - diseases nervous system, and specifically - to mononeuropathy, its code is G57.8.

Causes and varieties

The disease owes its occurrence and development to many reasons:

• various injuries: a fracture can lead to a pinched nerve;
• falls and bumps;
• violation of metabolic processes;
• squeezing MN throughout its length;
• various infections against which NMN can develop;
• severe general diseases, for example, osteoarthritis, when inflamed joints compress the nerve, which leads to the development of neuropathy;
• malignant neoplasms of any localization that can compress the trunks of nerves;
• incorrect position of the legs when a person is immobilized due to a serious illness or prolonged surgical intervention;
• toxic nerve damage caused by renal failure, severe forms of diabetes mellitus, alcoholism, drug addiction;
• lifestyle: representatives of certain professions - farmers, agricultural workers, layers of floors, pipes, etc. - spend a lot of time in a bent state and risk getting compression (squeezing) of the nerve;
• circulatory disorders MN.

Neuropathy can develop if a person wears uncomfortable shoes and often sits with one foot crossed.

Peroneal nerve lesions are either primary or secondary.

1. The primary type is characterized by an inflammatory reaction that occurs regardless of other pathological processes occurring in the body. Conditions occur in people who regularly load one leg, for example, when performing certain sports exercises.
2. Lesions of the secondary type are complications of diseases already existing in humans. Most often, the peroneal nerve is affected as a result of compression caused by a number of pathologies: fractures and dislocations of the ankle joint, tendovaginitis, post-traumatic arthrosis, inflammation of the joint bag, deforming osteoarthritis, etc. The secondary type includes neuropathy and neuralgia MN.

Symptoms and signs

For clinical picture The disease is characterized by varying degrees of loss of sensitivity of the affected limb. Signs and symptoms of neuropathy include:

• dysfunction of the limb - the impossibility of normal flexion and extension of the fingers;
• slight concavity of the leg inward;
• the inability to stand on the heels, go to them;
• edema;
• loss of sensation in parts of the legs - feet, calves, thighs, the area between the thumb and forefinger;
• pain that gets worse when a person tries to sit down;
• weakness in one or both legs;
• burning in different parts of the foot - it can be fingers or calf muscles;
• a feeling of change from heat to cold in the lower part of the body;
• atrophy of the muscles of the affected limb in the later stages of the disease, etc.

A characteristic symptom of NMN is a change in gait due to the “hanging” of the leg, the inability to stand on it, and strong bending of the knees while walking.

Diagnostics

Identification of any disease, including neuropathy of the peroneal nerve, is the prerogative of a neuropathologist or traumatologist if the development of the disease is provoked by a fracture. During the examination, the injured leg of the patient is examined, then its sensitivity and performance are checked to identify the area in which the nerve is affected.

The diagnosis is confirmed and refined through a number of examinations:

• ultrasound procedure;
• electromyography - to determine muscle activity;
• electroneurography - to check the speed of nerve impulses;
• radiography, which is carried out in the presence of appropriate indications;
• therapeutic and diagnostic blockade of trigenic points with the introduction of appropriate medications to identify the affected areas of the nerves;
• computed and magnetic resonance imaging - these precise highly informative techniques reveal pathological changes in controversial cases.

Treatment

Treatment of neuropathy of the peroneal nerve is carried out by conservative and surgical methods.

The use of a complex of methods demonstrates great efficiency: this is a prerequisite for obtaining a pronounced effect. We are talking about medical, physiotherapeutic and surgical methods of treatment. It is important to follow the recommendations of doctors.

Medicines

Drug therapy involves the patient receiving:

• non-steroidal anti-inflammatory drugs: Diclofenac, Nimesulide, Xefocam - designed to reduce swelling, inflammation and pain. In most cases, they are prescribed for axonal neuropathy (axonopathy) of the peroneal nerve;
• B vitamins;
• antioxidants represented by drugs Berlition, Thiogamma;
• medicines designed to improve the conduction of impulses along the nerve: Prozerin, Neuromidin;
• therapeutic agents that restore blood circulation in the affected area: Caviton, Trental.

It is forbidden to constantly use painkillers, which, with prolonged use, will aggravate the situation!

Physiotherapy procedures

Physiotherapy that demonstrates high efficiency in the treatment of neuropathy:

• massage, incl. Chinese dot;
• magnetotherapy;
• electrical stimulation;
• reflexology;
• exercise therapy. The first classes should be conducted with the participation of an experienced trainer, after which the patient will be able to do therapeutic exercises on their own at home;
• electrophoresis;
• thermotherapy.

Massage for neuropathy of the peroneal nerve is the prerogative of a specialist, and therefore it is forbidden to do it yourself!

Surgical intervention

If conservative methods do not give the expected results, they resort to surgery. The operation is prescribed for traumatic rupture of the nerve fiber. It is possible to carry out:

After surgery, a person needs a long recovery. During this period, his physical activity is limited, including the exercise of exercise therapy.

A daily examination of the operated limb is carried out to identify wounds and cracks, upon detection of which the leg is provided with peace - the patient moves with special crutches. If there are wounds, they are treated with antiseptic agents.

Folk remedies

The necessary assistance in the treatment of neuropathy of the peroneal nerve is provided by traditional medicine, which has a significant number of recipes.

1. Blue and green clay have properties that are useful in the treatment of disease. Roll up the raw materials in the form of small balls and dry in the sun, store in a jar under a closed lid. Before use, dilute a portion of the clay using water at room temperature until a mushy consistency is obtained. Apply several layers to the fabric and apply to the skin over the damaged nerve. Wait until the clay is completely dry. After use, the bandage must be buried in the ground - this is what healers advise. For each procedure, use a new clay ball.
2. Unlike the first recipe, the second one involves the preparation of a substance for oral administration: ripe dates, after being pitted, are ground with a meat grinder, the resulting mass is consumed 2-3 teaspoons three times a day after meals. If desired, the dates are diluted with milk. The course of treatment is designed for approximately 30 days.
3. Greater efficiency is inherent in compresses using goat's milk, with which gauze is wetted, after which it is applied for a couple of minutes to the skin area above the affected nerve. The procedure is done several times during the day until recovery.
4. It will help in the treatment of NMN and garlic. Grind 4 cloves with a rolling pin, cover with water and bring to a boil. After removing the decoction from the heat, inhale the steam from each nostril for 5-10 minutes.
5. Wash your face using natural apple cider vinegar, being careful not to get it in your eyes.
6. Pour 6 sheets of "lavrushka" with a glass of boiling water, then cook over low heat for 10 minutes. With the resulting decoction, bury your nose 3 times during the day until the condition improves.
7. With a remedy obtained by carefully mixing 2 and 3 tablespoons of turpentine and water, respectively, pour over a piece of bread and apply it to the affected area of ​​\u200b\u200bthe leg for 7 minutes. Do this before bed to immediately warm up your leg and get into bed. The frequency of the procedures is 1 time in two days until complete recovery. The effectiveness of the recipe is that turpentine is an excellent warming agent.
8. Tie the peel of peeled lemons, previously lubricated with olive oil, to the foot of the affected leg at night.

Recipes traditional medicine- one of the parts of the complex of events, and therefore should not be neglected traditional treatment NMN.

Consequences and prevention

NMN is a serious disease that requires timely adequate treatment, otherwise a bleak future awaits a person. A possible scenario for the development of events is disability with partial disability, since often a complication of NMN is paresis, manifested by a decrease in the strength of the limbs. However, if a person goes through all stages of treatment, then the situation improves significantly.

Neuropathy of the tibial nerve occurs due to different reasons so it's best to prevent it.

1. People who are actively involved in sports should regularly see a doctor for the timely detection of pathology, incl. tunnel syndrome, also called compression-ischemic neuropathy. It is called compression, because. when passing nerve trunks through a narrow tunnel they are compressed, and ischemic - due to malnutrition of the nerves.
2. You need to train in special comfortable shoes.
3. Weight reduction to reduce the load on the shins and feet in order to prevent their deformation.
4. Women who prefer shoes with high heels should give their feet a break by removing them during the day and taking time therapeutic gymnastics to normalize the process of blood circulation in the limbs.

Attentive and caring attitude to your health is a guarantee that peroneal nerve neuropathy will bypass you.

How does peroneal neuropathy manifest?

The nervous system is one of the main complex in the human body. It includes the brain and spinal cord, branches. Thanks to the latter, a rapid exchange of impulses is carried out throughout the body. Failures of one section have almost no effect on the entire system, but can cause a deterioration in the performance of some sections. Neuropathy of the peroneal nerve is a disease caused by a non-inflammatory process.

The tibial nerve is also damaged, which requires effective treatment. The disease appears due to degenerative processes, injuries or compression. The peroneal nerve is considered one of the main ones in the entire system, so its pinching leads to illness. Usually the legs are affected. The disease is divided into the following types:

• neuropathy of the peroneal nerve;
• neuropathy of the tibial nerve;
• sensory pathology.

All types of diseases are interesting to doctors from the point of view of science. They are included in the Neuralgia section. Importance has a peroneal nerve, which should be discussed in more detail.

Features of the disease

The disease is also called "neuropathy of the peroneal nerve." The disease is characterized as dangling foot syndrome. All this gives a load to the lower leg and other parts of the limbs. Since the peroneal nerve contains thick fibers with myelin sheath, then it is he who is affected by metabolic disorders.

Based on statistics, pathology manifests itself in 60% of people who are in traumatology, and only 30% is associated with nerve damage. The doctor is studying anatomical features disease, because it allows you to determine the cause of the pathology. And when there is no timely help, paralysis of the limbs may appear.

Anatomical features

The peroneal nerve is part of the sciatic nerve and is located at the bottom of the thigh. It is made up of many fibers. In the region of the popliteal fossa, all its parts are fixed to the peroneal nerve. It is covered only with skin, and therefore various external influences are unfavorable for it.

Then it is divided into 2 parts: superficial and deep. The first serves for the innervation of the muscular system, rotation of the foot, its sensitivity. A deep nerve is necessary for the extension of the fingers, as well as the sensitivity of this part of the body.

Infringement of any part of it leads to a deterioration in the sensitivity of different parts of the foot, lower leg, which makes it impossible to unbend the phalanges.

Therefore, peroneal neuropathy may have various symptoms It all depends on the area of ​​damage. Often, knowledge of the anatomical structure allows you to set the level of pathology before visiting a doctor. If professional help is not provided on time, then there is a risk of developing a tumor called a neuroma.

Why does the disease occur

The appearance of pathology is associated with various factors. The main ones include:

• compression of the nerve section, which occurs due to pressure on the structures of the vascular bundle;
• uncomfortable postures in which a person is for a long period;
• squeezing in the area of ​​​​its transition to the foot;
• deterioration of blood supply to the limb;
• infections;
• trauma;
• oncology;
• toxic pathologies;
• systemic diseases.

Because of these same factors, the tibial nerve is damaged. The causes of the appearance of pathology are varied, but in any case, treatment and recovery are necessary. Will not allow the nerve to be pinched further.

Symptoms

Peroneal neuropathy includes various signs depending on the pathology, the location of the painful area. All symptoms are major and concomitant. The first group includes the deterioration of the sensitivity of the painful limb. And the second signs are different in different situations, but usually appear:

• swelling of the legs;
• the appearance of discomfort;
• spasms and convulsions;
• pain on movement.

For example, disease of the common trunk is characterized by difficulty in flexing the foot, and therefore it becomes drooping. When moving, the person bends the leg at the knee so that the foot does not damage the floor. He puts his foot first on his fingers, and then gradually on the whole foot. Motor damage is observed along with sensory. Patients often experience pain on the outer part of the lower leg, which becomes worse with squatting. Muscle atrophy gradually appears, and paresis of the peroneal nerve may occur.

If the deep branch is damaged, the drooping of the foot is not very noticeable. But in this situation, too, there are various violations. If the disease is not treated, then there will be a complication in the form of atrophy of the small muscles. With neuropathy of the peroneal nerve, symptoms can manifest as a deterioration in sensitivity and the appearance of pain. On examination, a person has weakness in the pronation of the foot.

Features of diagnostics

With neuropathy of the peroneal nerve, treatment depends on the diagnosis performed. Timely identification of the pathology and treatment of the main ailment are necessary for high-quality therapy. The first step is to take a patient history. During this procedure, the doctor gets acquainted with the map of diseases and conducts a survey on symptoms, complaints, and well-being. This will determine if there is tibial neuropathy.

Then the specialist uses instrumental methods of examination. The procedures will determine whether there is neuritis of the peroneal nerve. Special tests will help determine muscle strength, and a skin sensitivity analysis is performed with a needle. It is also necessary to use electromyography and electroneurography. With the help of these procedures it will be possible to determine the degree of damage.

An effective method of examination is ultrasound, in which the doctor examines the painful areas. It is important to screen for additional disorders that have similar symptoms and causes. For this, additional procedures are assigned. With them, neuritis of the tibial nerve is determined.

After completing all the diagnostic work, the doctor prescribes necessary funds. It could be like healing procedures as well as drugs. The passage of the entire course of treatment gives excellent results.

Therapy Rules

The principles of treatment are based on determining the cause. In some cases, you only need to change the plaster cast, due to which the nerve is compressed. If this is due to uncomfortable shoes, then you need to replace it with a new, comfortable one. With paralysis, electrical stimulation of the peroneal nerve is necessary.

Often people go to the doctor with a large number of ailments. Neuropathy of the tibial nerve or peroneal may appear due to diabetes, oncology, kidney failure. Therefore, it is important to eliminate the disease due to which the disease appeared. The remaining procedures will act as additional ones.

Drug therapy

Drug treatment is often prescribed. The main drugs used to treat neuropathy are anti-inflammatory drugs. When choosing a tool, the specialist takes into account the results of the survey. Doctors prescribe Diclofenac, Nimesulide, Xefocam. They are needed to reduce swelling and pain, eliminate the symptoms of the disease.

Also needed are B vitamins, antioxidants, for example, Berlition, Thiogamma. Preparations for restoring the passage of impulses along the nerve: Prozerin, Neuromidin. To improve blood circulation, Caviton and Trental are used. You should not self-medicate, all medicines should be prescribed by a doctor.

Physiotherapy

If the sural nerve or other part of the limb is affected, physiotherapy is used. The following procedures are used:

• magnetotherapy;
• electrical stimulation;
• massage;
• reflexology;
• Exercise therapy for paresis of the peroneal nerve.

Often, activities are carried out in a complex, which gives excellent results. An effective procedure is massotherapy. It is not worth doing it at home, you need to contact a specialist. Otherwise, you can not only slow down the treatment, but also worsen the condition. The same applies to LFC. The first procedures should be carried out under the supervision of a specialist, and then they can be performed at home.

Surgical methods

When traditional methods do not help, the doctor performs an operation. Usually it is required for trauma to the nervous system. Often, it is necessary to perform nerve decompression, neurolysis, and plasty.

When the operation is completed, rehabilitation is needed. At this time, gymnastics by the patient can be performed in a limited amount. It is important to constantly inspect the painful area so that cracks or wounds do not appear there. If they appear, then antiseptic drugs are used for treatment. Special crutches are also used. The doctor provides other recommendations individually.

Effects

With damage to the peroneal nerve, recovery is affected by treatment. If the therapy is performed in a timely manner, as well as the doctor's prescriptions, then there will be a positive trend in the condition. The complicated course of the disease and late measures lead to a deterioration in working capacity.

The disease is one of the most difficult. It may be associated with vascular disorders, intoxication, toxic effects. But an important cause of pathology are injuries. It is manifested by difficulty in motor activity, and therapeutic measures are performed depending on the factors that led to the disease. Procedures are prescribed by the doctor individually.

Nervus fibularis communis recovers quite quickly

The common peroneal nerve, whose Latin name is Nervus fibularis communis, is a nerve of the sacral plexus. It is formed as a continuation of the sciatic nerve, the field of division of the latter in the zone of the popliteal fossa.

Where is the peroneal nerve

The peroneal nerve from the proximal apex in the popliteal fossa takes the direction to its lateral side. It is located directly under the medial edge of the femoral biceps muscle, between the lateral head of the calf muscle and it. The nerve spirally bends around the fibula in the region of its head, being covered here only by the skin and fascia.

In this part, articular non-permanent branches depart from the trunk of the peroneal nerve, going to the lateral parts of the capsule in the knee joint. Distally, the peroneal nerve passes through the thickness of the initial segment of the long peroneal muscle, where it divides into its two terminal branches - the superficial and the deep.

Thus, the common peroneal nerve branches off to:

• lateral cutaneous nerve;
• fibular connective;
• superficial peroneal nerve;
• deep peroneal nerve.

The lateral cutaneous nerve on the calf, which has the Latin name Nervus cutaneus surae lateralis: it departs in the popliteal fossa, after which it goes to the lateral heads of the calf muscles, having perforated the fascia of the legs in these places, branches in the skin of the lateral surfaces of the legs, reaching the lateral ankles.

The peroneal connective nerve, which in Latin is called Ramus communicans fibularis, can start from the trunk of the common peroneal nerve, sometimes from the lateral cutaneous, then, following the gastrocnemius muscle, it is located in the space between it and the calf fascia, perforating the latter, after, branching out in the skin , combines with the medial cutaneous tibial nerve.

The superficial peroneal nerve, the Latin name of which is Nervus fibularis superficialis, passing between the heads of the long peroneal muscles, follows down at some distance. Passing to the medial surface in the zone of the short peroneal muscle, this branch of the nerve perforates the fascia in the region of the lower third of the lower leg, branching into its terminal components:

The function of the branches of the superficial peroneal nerve is to innervate the long and short peroneal muscles;

The deep peroneal nerve, called in Latin Nervus fibularis profundus, pierces the thicknesses of the initial sections of the long peroneal muscles, the anterior intermuscular septa of the legs and the long extensor of the fingers, then lies on the anterior surface of the interosseous membranes, located on the lateral sides of the tibial anterior vessels.

The deep peroneal nerve has the following functions:

• it innervates the muscles that extend the foot and toes;
• provides a sensation of touch or pain in the first space between the fingers.

Peroneal nerve - symptoms of damage

Since the small tibial nerve in some places passes superficially, covered only by skin and fascia, the likelihood that compression or damage to the peroneal nerve may occur is quite high.

Such damage is accompanied by the following symptoms:

• inability to abduct the foot outward;
• inability to straighten the foot and fingers;
• sensory disturbance in different parts of the foot.

Accordingly, in the course of irrigation of the nerve fibers, depending on the place of compression, the degree of damage, the symptoms will be somewhat different. And only a superficial knowledge of the characteristics of the peroneal nerve, its innervation of individual muscles or areas on the skin will help a person to establish that there is compression of the peroneal nerve even before going to the doctor for research.

Neuropathy of the peroneal nerve

In the clinic of such a disease as neuropathy, neuropathy of the peroneal nerve is a fairly common pathology. Damage to the peroneal nerve, both as a neuropathy, and as a result of an injury, and as a compression-ischemic syndrome, ranks first according to statistics.

Neuropathy of the peroneal nerve can occur due to the following reasons:

• injuries - most often this cause is relevant during injuries of the upper outer section on the lower leg, where the nerve passes superficially next to the bone: a bone fracture in this area can lead to damage to the nerve by bone fragments, moreover, neuropathy of the peroneal nerve can even appear from exposure to a plaster cast;
• when the tibial nerve is compressed at any stage of its passage - experts call this phenomenon tunnel syndrome - upper and lower: usually upper tunnel syndrome develops in people who have certain professions and are forced to maintain certain postures for quite a long time, for example, in harvesters of vegetables and berries , in parquet installers from the squatting position, while inferior tunnel neuropathy develops from compression of the deep peroneal nerve on the back of the ankle joint, just below the ligament;
• disturbances in the process of blood supply to the peroneal nerve - with ischemia of the nerve, as if a "stroke" of the nerve;
• incorrect position of the leg during a long operation or as a result of a serious condition of the patient, which is accompanied by immobility: in this case, the nerve is compressed at the site of its closest location to the surface;
• severe infections that enter the nerve fibers as a result of an intramuscular injection in the buttock area, at the place where the peroneal nerve is still a component of the sciatic nerve;
• severe infections that are accompanied by damage to numerous nerves, including the peroneal nerve;
• toxic damage, for example, as a result of severe kidney failure or severe diabetes mellitus, from the use of drugs or alcohol;
• oncological diseases that have metastasis and compression of the nerve by tumor nodes.

Naturally, the first two causes are actually much more common, however, the remaining causes of peroneal nerve neuropathy, although very rare, provoke this pathology, so they should not be discounted.

Signs of neuropathy

The clinical symptoms of neuropathy of the peroneal nerve primarily depend on the location of its lesion along the route and, of course, on how deep the lesion is.

For example, with a sudden injury, for example, with a fracture of the fibula, followed by displacement of its fragments, from which the nerve fibers are damaged, all the symptoms of neuropathy occur simultaneously, although in the first days the patient may not pay attention to them due to severe pain and immobility of the affected limb.

Whereas the gradual damage to the peroneal nerve, for example, while squatting, wearing uncomfortable shoes and other detailed situations, and the symptoms are gradually emerging, over a certain long period of time.

Experts divided all the symptoms into:

Their combinations depend on the level of the lesion. Depending on the degree of damage, the neuropathy of Nervus fibularis communis has various symptoms. For example,

• High compression causes the following damage:
• the sensitivity of the anterior-lateral shin or dorsal surface of the foot is disturbed - there may be a lack of any sensation from touch, the inability to distinguish pain irritations and just touches, heat from cold;
• pain syndrome on the lateral surfaces of the lower leg and foot, aggravated by squatting;
• the process of unbending the foot or its fingers is disrupted, up to the complete impossibility of making such movements;
• weakness or complete inability to take the outer edge of the foot, lift it;
• the inability to stand on the heels and walk on them;
• forced raising of the leg when walking: the patient has to do this so that the fingers do not cling, in addition, when lowering the foot, the fingers first fall on the floor surface and only then the sole, and the leg bends too much at the hip and knee joints when walking (this gait is called "cock "," horse ", as well as peroneal or steppage;
• the foot takes on a “horse” appearance: it hangs down and is, as it were, turned inward, and the fingers are bent;
• if neuropathy is not treated long enough, then weight loss or atrophy of the calf muscles along the anterior-lateral surface may develop;
• compression of the external cutaneous tibial nerve leads exclusively to sensitive changes - a decrease in sensitivity on the outer surface, moreover, this pathology may not be very noticeable, since the external cutaneous tibial nerve is connected to a branch of the tibial nerve, the fibers of which, as it were, take on the role of innervation.

Damage to the superficial peroneal nerve is characterized by the following symptoms:

• pain with a touch of burning on the lower part of the shin lateral surface, on the back of the foot and on the first four toes;
• decreased sensitivity in the same areas;
• weakness in abduction or elevation of the outer part of the foot.

The defeat of the deep branch of the peroneal nerve is accompanied by the following symptoms:

• slight drooping of the foot;
• weakness in the extension of the foot and fingers;
• violation of the degree of sensitivity on the back of the foot in the area between the first and second toes;
• with a long process, neuropathy can lead to atrophy of the small muscles of the back of the foot: this becomes noticeable only when comparing a diseased and healthy foot, when the bones of the first one protrude more clearly, and the interdigital spaces noticeably sink down.

Thus, the neuropathy of Nervus fibularis communis, depending on the degree of damage, is clearly defined by certain symptoms. In some cases, there is a selective violation of the process of extension of the foot or fingers, in others - raising the outer edge of the foot, and sometimes neuropathy leads only to sensory disorders.

Treatment of neuropathy of the peroneal nerve

Treatment of neuropathy of this nerve is largely determined by the cause from which it arises. Sometimes even a banal replacement of a plaster cast that compresses the small tibial nerve can be a treatment. If the cause was uncomfortable shoes, then changing them also contributes to recovery. If the cause is the patient's comorbidity, for example, diabetes, an oncological disease, then in this case it is necessary to treat the underlying disease first of all, and the rest of the measures will go to the restoration of the peroneal nerve and will be, although mandatory, but already indirect.

Main medications, with the help of which specialists treat neuropathy of the peroneal nerve, the following:

• non-steroidal anti-inflammatory drugs such as Diclofenac, Ibuprofen, Xefocam, Nimesulide and others - they are used for any neuralgia, including when the tertiary nerve is inflamed: they help reduce pain, relieve swelling and remove inflammation;
• B vitamins such as Milgamma, Neurorubin, and Kombilipen, etc.;
• such drugs that improve nerve conduction - we are talking about Neuromidin, Galantamine, Prozerin and others;
• the drugs needed to improve the blood supply to Nervus fibularis communis are Trental, Cavinton, as well as Pentoxifylline and others;
• antioxidants - Espa-Lipon, Berlition, Thiogamma, etc.

Recovery

Comprehensive treatment is intended not only drug therapy but also physical therapy. The latter includes the following methods of physiotherapy:

• ultrasound;
• amplipulse;
• electrophoresis with medicinal substances;
• magnetotherapy;
• electrical stimulation.

Recovery is not only drug treatment and physiotherapy, but also massage and acupuncture. In any case, the small tibial nerve is treated individually, with the selection medicines and taking into account the patient's contraindications.

The tibial nerve can also be restored by physiotherapy exercises, which the attending physician will recommend. To correct the "cock" gait, experts recommend using special orthoses that fix the foot in the correct position so as not to let it hang down.

When conservative treatment does not bring the desired effect, doctors may resort to surgical intervention. Most often, the operation has to be done during a traumatic injury, when the fibers of Nervus fibularis communis are damaged, especially with prolonged damage.

When nerve regeneration is not carried out, treatment with conservative methods is useless. In such cases, it is necessary to restore the anatomical integrity of Nervus fibularis communis. The sooner the operative surgical intervention, the more effective the treatment will be and the better the prognosis will be for the restoration of the functions of Nervus fibularis communis disturbed by the pathology.

In some relatively mild cases of damage, treatment with folk remedies is also possible.

Neuropathy of the peroneal nerve is manifested by weakness of the extensors of the foot and fingers (drooping foot). Sensitivity disorders are detected along the outer surface of the lower leg and on the rear of the foot, with damage to the deep branch of the nerve - only in the first interdigital space. Pain syndrome is not typical. Tendon reflexes remain intact.

The cause of nerve damage is most often external compression at the level of the head and neck of the fibula.

This can occur during deep sleep, anesthesia, coma, and also due to a tight cast. Predisposes to nerve compression rapid decline body weight (including cancer cachexia). At this level, the nerve can be compressed in people who have the habit of sitting for a long time, crossing their legs, or forced to squat for a long time (for example, when harvesting potatoes). The nerve can also be compressed by a ganglion or cyst in the area of ​​the knee joint, a lipoma, a tumor of the fibula.

Treatment primarily consists of fixing the foot and preventing contracture through passive and active movements. With demyelination of the nerve, recovery can be expected within a few weeks, with axonal damage, recovery occurs within several months and may be incomplete. With slowly increasing paresis, surgical decompression is indicated.

Symptoms of neuropathy of the peroneal nerve

Muscles innervated by the peroneal nerve:

1) long peroneal muscle, m. peroneus longus;

2) short peroneal muscle, m. peroneus brevis;

3) anterior tibial muscle, m. tibialis anterior;

4) long extensor of fingers, m. extensor digitorum longus;

5) short extensor of fingers, m. extensor digitorum brevis;

6) long extensor of the thumb, m. extensor hallucis longus;

7) short extensor of the thumb, m. extensor hallucis brevis.

The motor function of the common peroneal nerve includes extension of the foot, extension of the fingers, abduction of the foot and elevation of its outer edge (pronation). The reflex from the calcaneal tendon is preserved.

The zone of sensitive innervation of the nerve is the outer surface of the lower leg, the back surface of the foot and fingers. Joint-muscular feeling is usually not disturbed. Unlike the sciatic and tibial nerves, the peroneal nerve is not characterized by severe pain, significant vegetative-trophic disorders.

Symptoms of damage to the peroneal nerve at different levels. With high compression of the peroneal nerve (superior tunnel syndrome: in the popliteal fossa at the neck of the fibula, the nerve is tightly attached to the bone, and the fibrous band of the muscle is located above it), extension of the foot and fingers, abduction and rotation of the foot are impossible. The foot sags and is turned inward (supinated), the toes are bent at the proximal phalanges (pes equino varus, "horse foot"). When walking, the leg rises high, when lowering, first the fingers touch the floor, then the entire sole (“cock's gait”). The patient cannot stand or walk on his heels. Muscle atrophy is determined along the anteroexternal surface of the lower leg. Sensitivity disorders cover the outer surface of the lower leg and the rear of the foot.

Such a syndrome can also develop with compression by a plaster cast, with an injury to the ankle joint with tucking the foot inward and bending it.

A variant of compressive neuropathy of the peroneal nerve (compression of the nerve between the femur and fibula) is widespread with a prolonged certain posture - “squatting”, “leg to foot” (planting and picking vegetables, fruits, berries; scraping parquet, laying pipes, work of fashion models, seamstress, etc.).

In the popliteal fossa, the lateral cutaneous nerve of the calf (n. cutaneus surae lateralis) is separated from the nerve trunk, and the common peroneal nerve is divided into two branches: superficial (n. peroneus superficialis) and deep (n. peroneus profundus) peroneal nerves. Therefore, distal nerve damage is more often accompanied by a violation of the innervation of one of the three branches.

Functional insufficiency of the external cutaneous nerve is accompanied by hypesthesia (anesthesia) along the outer surface of the lower leg. The superficial peroneal nerve mainly determines the rotation and abduction of the foot, the sensitive innervation of the rear of the foot.

The defeat of the deep peroneal nerve is associated with the development of weakness in the extension of the foot and fingers, impaired sensitivity in the first interdigital space.

A fairly common variant of damage to the deep peroneal nerve is in the ankle joint (lower tunnel syndrome - on the back of the foot, the nerve is located under the extensor ligaments and is vulnerable to compression). Compression can be caused by a plaster cast, tight shoes; possible direct injury. Clinically, the syndrome is characterized by pain and paresthesia in the I–II fingers, impaired sensitivity in this area, and weakened extension of the fingers.

Examination of the functions of the peroneal nerve

1. The patient, lying on his back, is offered to unbend (unbend and rotate outwards) the foot, overcoming the resistance of the doctor.

2. The patient is offered to unbend the toes (without resistance and overcoming resistance).

3. The patient is offered to walk on his heels.

4. Appreciate appearance feet ("horse foot"), gait ("cock").

5. Document the zone of sensory disturbances (the outer surface of the lower leg, the back surface of the foot and fingers), the preservation of the reflex from the calcaneal tendon, the absence of pronounced autonomic-trophic disorders.

Consultation on treatment with traditional oriental medicine (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug methods of treatment) is carried out in the Central District of St. Petersburg (7-10 minutes walk from the metro station "Vladimirskaya / Dostoevskaya"), With 9.00 to 21.00, without lunch and days off.

It has long been known that best effect in the treatment of diseases is achieved with the combined use of "Western" and "Eastern" approaches. Significantly reduce the duration of treatment, reduces the likelihood of recurrence of the disease. Since the "eastern" approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the "cleansing" of blood, lymph, blood vessels, digestive tract, thoughts, etc. - often this is even a necessary condition.

The consultation is free of charge and does not obligate you to anything. On her highly desirable all the data of your laboratory and instrumental methods research over the last 3-5 years. After spending only 30-40 minutes of your time, you will learn about alternative methods treatment, find out how to improve the effectiveness of already prescribed therapy and, most importantly, about how you can fight the disease yourself. You may be surprised - how everything will be logically built, and understanding the essence and causes - the first step to successful problem solving!