Introduction 

Nerves play a crucial role in the human body's functioning. It allows communication between the brain and the rest of the body. It enables coordination, movement, sensation and reflexes to be carried out in daily functions. Damage to nerves can result in impairments such as motor dysfunctions and the diagnosis of mental health conditions.¹ For example, the peroneal nerve is a branch of the sciatic nerve that surrounds the fibular head near the knee. Typically, injuries to the nerves are caused by surgical complications, compression, trauma or prolonged immobility.²

Peroneal nerve injury is a common condition. To ensure effective preventative methods are carried out, a multidisciplinary approach should involve risk identification, ergonomic strategies, patient education, and proper medical practices. They aid with early detection, intervention and long-term success in improving and managing the injury. Therefore, it can help to prevent further complications from arising.

Anatomy and function of the peroneal nerve 

The peroneal nerve, also known as the common fibular nerve, is one of the two major branches of the sciatic nerve, arising in the posterior thigh. It travels laterally around the head of the fibula, a region where it lies superficially and is particularly susceptible to compression or trauma.³

The nerve splits into two main branches:⁴

• Deep peroneal nerve (DPN) - A nerve in the leg that is a terminal branch of the common fibular nerve. It supplies the extensors of the foot⁵
• Superficial peroneal nerve (SPN) - SPN controls the muscles on the outer side of the lower leg. It plays an important role in foot movement. It also provides sensation to the front and outer part of the lower leg and most of the top of the foot, except for the skin between the big toe and the second toe⁶

Motor function:

The peroneal nerve controls muscles involved in dorsiflexion (lifting the foot and toes upward) and eversion (turning the sole outward).

Sensory function:

It provides sensation to the lateral lower leg and the dorsum (top) of the foot, including the area between the first and second toes via the deep peroneal branch.

Implications of injury:

Injury to the peroneal nerve can result in foot drop (loss of dorsiflexion), sensory deficits in its distribution area, and gait disturbances such as a high-stepping or slapping gait. Early diagnosis and treatment help to prevent long-term dysfunction.⁷

Common injuries and symptoms:

• Complications when lifting the foot at the ankle 
• Affected walking patterns 
• Numbness or tingling
• Weakness in the toes and foot⁴

Risk factors for peroneal nerve injury

To carry out effective preventative strategies, it is crucial to understand the causes and the risk factors that contribute to and influence the injury from occurring.

• External compression is caused by activities such as prolonged leg crossing that can exert continuous pressure on the fibular head, where the peroneal nerve lies close to the surface. It is one of the most common causes. Other factors that can lead to compression are the usage of items that constrict the nerve and blood flow, such as tight bandages, casts, or braces, especially if not properly padded or monitored. Other factors can be post-surgery, where patients may be bedridden or have a lack of movement, enhancing sustained pressure and increasing the risk of injury to the nerve⁸
• Trauma and surgical interventions can directly injure the nerve. Traumas can include dislocation of the knee or fractures near the fibula. Furthermore, similar to external compression, surgeries may place the nerve at risk through stretching, compression, or accidental damage. Intraoperative positioning and surgical technique play a crucial role in either preventing or contributing to such injuries⁹
• Systemic conditions such as diabetes mellitus are associated with peripheral neuropathy. This makes nerves more vulnerable to injury. In addition, significant weight loss can reduce the protective fat cushion surrounding the nerve, increasing susceptibility to compression¹⁰
• Occupational and athletic risks are important considerations. Stressing and putting pressure on the knee, engaging in contact sports and activities with repetitive leg movements, can place stress on the peroneal nerve over time, increasing the chance of injury¹¹

Prevention in clinical and surgical settings

Multi-phase approaches involving preoperative, intraoperative, and postoperative measures are required to prevent peroneal nerve injury in clinical and surgical settings. 

Preoperative assessment:

Preoperative assessments are standard evaluations. Patients undergo a procedure involving anaesthesia, and this assessment is carried out to identify any vulnerabilities in the patient. By discovering vulnerability from conditions such as diabetes mellitus, obesity or previous lower limb injuries, tailored plans can be created. This can help reduce nerve injury risks.¹²

Intraoperative techniques:

This technique is used during an operation to enhance outcomes. They monitor patients' vital signs, blood oxygenation levels, fluid therapy, medication transfusion, anaesthesia, radiography, and retrieve samples for laboratory tests.¹³ It helps with patient positioning.

Excessive external rotation of the leg, prolonged pressure on the fibular head, and hyperflexion at the knee should be avoided. Strategic use of padding around the fibular head and limb supports can significantly reduce pressure. Limiting surgical duration when possible also minimises the exposure time to compression or traction injuries.

Postoperative care:

Postoperative care helps with smooth recovery by focusing on pain management, wound care and monitoring complications. It also helps with early detection. Neurovascular assessments should be conducted regularly to monitor for early signs of nerve dysfunction.¹⁴

Ergonomic and lifestyle modifications 

Ergonomic adjustments refer to changes that can be made while at your workplace to ensure that the individual is comfortable and safe when at a desk for hours in order to prevent injuries. These adjustments include: 

Workplace strategies:

A proper chair and desk are used to help reduce pressure on the legs and prevent prolonged leg-crossing. This is a common habit that can increase the risk of nerve compression. Therefore, it is important to constantly move and reposition the legs throughout the day to reduce sustained pressure on the fibular head, where the peroneal nerve is most vulnerable.¹⁵

Home and daily habits:

Changes in the house to reduce nerve compression, alongside changes at work, can play a crucial role in reducing injury risk. For instance, avoiding habitual leg-crossing and using cushions or supports when sitting or lying down can help to distribute pressure evenly and reduce strain. Furthermore, lifestyle habits that promote overall physical health contribute to nerve protection.¹⁶

Weight management and muscle conditioning:

Maintaining a healthy body weight reduces the risk of nerve compression, especially in individuals with significant weight loss or muscle atrophy. Incorporating leg-strengthening exercises into a daily routine also helps stabilise the knee and ankle, improving posture and muscle support around the nerve.¹⁷

Prevention through patient and public education 

Raising public awareness is crucial to prevent injuries from occurring, as individuals will understand how to make changes and manage their well-being. Educational materials tailored to at-risk populations, such as hospitalised patients, athletes, and individuals with limited mobility, can highlight everyday behaviours and positions that increase risk. Displaying posters and visual aids in clinics and hospitals reinforces these messages, helping patients recognise and adopt safer habits.

Self-monitoring also plays a key role in early intervention. Patients should be educated to identify warning signs of nerve compression, such as numbness, tingling, or sudden weakness in the foot or leg. Recognising these symptoms early and seeking timely medical advice can prevent permanent damage.

Finally, community outreach initiatives, including seminars and workshops, can promote a broader understanding of nerve health. These programs help the public learn how to prevent nerve injuries, maintain mobility, and improve their quality of life through simple, practical strategies.¹⁸

Emerging strategies and research 

Continuous research is being carried out to find more preventative methods for peroneal nerve injuries and to manage them. One strategy is to use wearable devices that help to monitor a person's posture. This will help prevent further worsening of the injury and ensure that the injury improves. They work by alerting the individual when in an uncomfortable and risky position that may cause symptoms.¹⁹

During surgeries, it is imperative to identify any high-risk patients to ensure that injuries do not occur when undergoing orthopaedic procedures. To avoid this, invasive techniques should be carried out during operations by surgeons to ensure greater precision occurs. This can help to reduce trauma to surrounding tissues, including peripheral nerves like the peroneal nerve.²⁰

Summary

• Preventing peroneal nerve injury requires individuals to know about the injury and be educated on how to manage and care for themselves. This can also help them to understand at what stage they can visit the clinical care
• It is important to make workplace and home habit changes to prevent the injury from forming over time
• Furthermore, by raising awareness, early detection can take place, which can help prevent the injury from worsening and maintain mobility and quality of life