Peroneal Nerve Palsy S84.10XA 956.3

Cutaneous Innervation LE

Sensory / Motor Root Lesions

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms: drop foot

Peroneal Nerve Palsy ICD-10

A- initial encounter

D- subsequent encounter

S- sequela

Peroneal Nerve Palsy ICD-9

  •  956.3 Injury to peripheral nerve: peroneal nerve

Peroneal Nerve Palsy Etiology / Epidemiology / Natural History

  • Associated with knee dislocations
  • Superficial peroneal nerve palsy may occur during inversion ankle sprains (O'Neal PJ, JBJS 2007;89A:979)
  • May occur after TKA; mainly in patients with severe valgus deformity. 

Peroneal Nerve Palsy Anatomy

  • Peroneal nerve is superficial to the lateral head of the gastrocnemius.
  • Mean distance from the bony posterolateral corner of the tibia to the nerve is 1.49 cm, with no distance less than 0.9 cm. Clarke HD, J Arthroplasty 2004;19:40-44)
  • Distance from the posterolateral tibia to nerve is greater in larger legs.

Peroneal Nerve Palsy Clinical Evaluation


Peroneal Nerve Palsy Xray / Diagnositc Tests


Peroneal Nerve Palsy Classification / Treatment

  • Acute laceration: nerve repair
  • Initial treatment: ankle-foot-orthosis
  • Chronic peroneal nerve palsy / foot drop: transfer of the tibialis posterior to the dorsum of the foot. (Wagenaar FC, Louwerens JW. Posterior tibial tendon transfer: results of fixation to the dorsiflexors proximal to the ankle joint. Foot Ankle Int. 2007 Nov;28(11):1128-42)
  • Peroneal Nerve Decompression CPT-64708
  • TKA in patient with large valgus deformity and flexion contracture has increased risk for peroneal nerve injury.   Treatment: remove tight dressings, flex knee and extend the hip to decrease peroneal nerve tension.

Peroneal Nerve Palsy Associated Injuries / Differential Diagnosis


Peroneal Nerve Palsy Complications

Peroneal Nerve Palsy Follow-up Care


Peroneal Nerve Palsy Review References

  • Garozzo D, Ferraresi S, Buffatti P. Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases. J Neurosurg Sci. 2004 Sep;48(3):105-12 
  • Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br. 2005 May;87(5):664-7. 
  • Ozkan T, Tuncer S, Ozturk K, Aydin A, Ozkan S. Tibialis posterior tendon transfer for persistent drop foot after peroneal nerve repair. J Reconstr Microsurg. 2009 Mar;25(3):157-64. Epub 2008 Nov 26. View Abstract at PubMed
  • Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Prestini G. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res. 2008 Jun;466(6):1454-66
  • Schinsky MF, Macaulay W, Parks ML, et al: Nerve injury after primary total knee arthroplasty. J Arthroplasty 2001;16:1048-1054. 

  • Asp JP, Rand JA: Peroneal nerve palsy after total knee arthroplasty. Clin Orthop Relat Res 1990;261:233-237. 

  • Clarke HD, Schwartz JB, Math KR, Scuderi GR: Anatomic risk of peroneal nerve injury with the "pie crust" technique for valgus release in total knee arthroplasty. J Arthroplasty 2004;19(1):40-44.