Evidence in peroneal nerve entrapment: A scoping review

Abstract

Background and purpose Daily management of patients with foot drop due to peroneal nerve entrapment varies between a purely conservative treatment and early surgery, with no high‐quality evidence to guide current practice. Electrodiagnostic (EDX) prognostic features and the value of imaging in establishing and supplementing the diagnosis have not been clearly established. Methods We performed a literature search in the online databases MEDLINE, Embase, and the Cochrane Library. Of the 42 unique articles meeting the eligibility criteria, 10 discussed diagnostic performance of imaging, 11 reported EDX limits for abnormal values and/or the value of EDX in prognostication, and 26 focused on treatment outcome. Results Studies report high sensitivity and specificity of both ultrasound (varying respectively from 47.1% to 91% and from 53% to 100%) and magnetic resonance imaging (MRI; varying respectively from 31% to 100% and from 73% to 100%). One comparative trial favoured ultrasound over MRI. Variable criteria for a conduction block (>20%–≥50) were reported. A motor conduction block and any baseline compound motor action potential response were identified as predictors of good outcome. Based predominantly on case series, the percentage of patients with good outcome ranged 0%–100% after conservative treatment and 40%−100% after neurolysis. No study compared both treatments. Conclusions Ultrasound and MRI have good accuracy, and introducing imaging in the standard diagnostic workup should be considered. Further research should focus on the role of EDX in prognostication. No recommendation on the optimal treatment strategy of peroneal nerve entrapment can be made, warranting future randomized controlled trials.

A randomized controlled trial comparing conservative versus surgical treatment in patients with foot drop due to peroneal nerve entrapment: results of an internal feasibility pilot study

“…Peroneal neuropathy is a well-established cause of foot drop [ 1 ], often causing gait difficulties and increased risk of falling [ 2 ]. In previous research [ 3 ], we proposed to classify peroneal neuropathies as idiopathic, idiopathic with established risk factors (e.g., weight loss), and non-idiopathic peroneal neuropathies (e.g., trauma) to account for the wide variety of causes of peroneal neuropathy. We defined peroneal nerve entrapment as idiopathic neuropathies with and without risk factors.…”

“…Conservative treatment focuses on gait rehabilitation, proprioceptive training, strengthening of the dorsiflexion muscles of the ankle, passive mobilization of the ankle and foot and stretching of calf muscles (prevention of contractures). A central issue in the management of peroneal nerve entrapment is the lack of evidence to support either treatment strategy [ 3 ]. Furthermore, in an international survey among specialists, we documented important variations in daily management of these patients as a consequence of this lack of high-quality evidence [ 4 ].…”

“…Nevertheless, studies comparing surgery to no or delayed intervention are challenging. Little is known about the epidemiology of these patients [ 3 ], making the recruitment potential of a study uncertain. Taking physician bias into account [ 4 ], a no cross-over policy to surgery within the first 9 months after randomization may hamper optimal recruitment.…”

Useful functional recovery and quality of life after surgical treatment of peroneal nerve injuries

“…Peroneal nerve (PN) palsy presented as “foot drop”, is the most common mononeuropathy, but the majority of cases are related to radiculopathy and herniated discs, with favorable natural history and treatment outcomes ( 4 ), and rarely entrapment neuropathy or injury ( 5 ). Closed injuries to the PN may recover spontaneously, without specific treatment, in about a third of patients, but in the remaining 2/3, a permanent foot drop remains ( 6 , 7 ).…”

An overview of common peroneal nerve dysfunction and systematic assessment of its relation to falls

“…In milder cases, nerve conduction studies of the peroneal nerve are often normal, limiting the usefulness of electrodiagnostic testing [ 21 ]. Imaging, in the form of ultrasound and magnetic resonance neurography, is emerging as an additional tool to identify a swollen peroneal nerve [ 22 ]. Ultrasound holds promise as it already has been successfully used to diagnose other entrapment neuropathies such as carpal tunnel syndrome [ 23 ].…”