Introduction: Common peroneal nerve (CPN) compressive neuropathy is the most common lower extremity entrapment neuropathy.

Methods: A retrospective review of a prospectively maintained single-institution database of all cases of CPN palsy that underwent decompression and neuroplasty over a five- year period was performed.

Results: Sixteen patients underwent neuroplasty of the CPN over the five years at our institution. The average age was 44 years with a male preponderance (56%). A neuropraxic injury following a prior unrelated surgical procedure was noted in 7 patients. In 8 patients, an injury to the ipsilateral extremity preceded the onset of CPN palsy. The most common presentation was weakness of CPN supplied muscles and loss of sensation in the distribution of the CPN. Pain was a presenting symptom in 9 patients. The most common muscles with diminished strength were the tibialis anterior and extensor halluces longus. Only five patients had a positive Tinel’s sign at the site of compression. Mean follow up was 28 months. Prone positioning provided excellent surgical exposure of the CPN from the distal thigh to the peroneal tunnel. Clinical improvement following surgery was noted in 14 of the 16 patients; two patients had no change in their exam. The most consistent improvement was noted in the TA (p=0.02) and EHL (p=0.03); a trend towards greater improvement with shorter time to surgery was noted. No complications related to the surgical site or CPN were encountered and no patient had a decline in neurological exam as a consequence of the surgery. One patient developed a positioning related right upper extremity brachial plexus neuropraxic injury following surgery that recovered completely.

Conclusions: Common peroneal neuropathy usually presents with a foot drop and decreased sensation or pain in the distribution of the CPN. Surgical neuroplasty of the CPN at the lateral fibular neck in a prone position allows decompression of the nerve from the distal thigh to the peroneal tunnel in the proximal leg. Significant improvement in motor strength following surgery, particularly of the TA and EHL may be noted. A trend towards greater recovery with decreased time to surgery is also noted.

Patient Care: It will allow clinicians to incorporate an easy and effective procedure into their practice

Learning Objectives: To help clinicians recognize the signs of common peroneal neuropathy and initial workup and management strategies including our technique for common peroneal neuroplasty

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