Deep Peroneal Nerve Entrapment

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Topic updated on 05/09/13 9:41pm
Introduction
  • Caused by impingement of DPN by distal margin of inferior extensor retinaculum
    • also known as anterior Anterior Tarsal Tunnel Syndrome
  • Causes of impingement include
    • dorsal osteophytes over apex of medial longitudinal arch
    • ganglion cyst
    • tight laces or ski boots
  • Anatomy
    • anterior tarsal tunnel contains 
      • EDL
      • EHL
      • Tibialis anterior
      • Deep peroneal nerve
      • dorsalis pedis artery
Presentation
  • Symptoms
    • dysesthesia and paresthesias on dorsal foot and first web space are most common
    • vague foot pain
  • Physical exam
    • Tinel sign with symptoms in first web space
Treatment
  • Nonoperative
    • shoe modifications
      • indications
        • first line of treatment
      • techniques
        • well padded tongue on shoe
        • full length rocker-sole steel shank
  • Operative
    • surgical release of DPN by releasing retinaculum and osteophyte / ganglion resection
      • indications
        • failure of nonoperative treatment
        • symptoms of RSD are a contraindication to release
      • technique
        • start distal, identify nerve, and release it proximally (nerve lies lateral to EHB)
        • warn patient that recovery is prolonged

 


 

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