The nervous system is a complex complex in the human body. It consists of the brain and spinal cord, as well as numerous branches. The latter provide an instant exchange of impulses throughout the body. Disruption of one nerve practically does not affect the functioning of the whole network. However, it may entail a deterioration in the performance of certain parts of the body.
Neuropathy is a disease characterized by non-inflammatory nerve damage. Its development can be promoted by degenerative processes, injuries or compression. The main target of the pathological process is usually the lower limbs.
The so-called foot neuropathy is divided into the following varieties:
- pathology of the peroneal nerve;
- tibial nerve;
- sensory.
Each of the forms of the disease is of great interest among physicians. Among all peripheral pathologies, neuropathy of the peroneal nerve occupies a special place. It is about her that will be discussed later in the article.
Disease Description
By peroneal nerve neuropathy is understood a pathological disorder accompanied by a dangling foot syndrome. In the specialized literature you can find another name for this disease - peroneal neuropathy.
Since the peroneal nerve consists of thick fibers with an impressive layer of the myelin sheath, it is more susceptible to metabolic disorders. Most likely, it is this moment that determines the widespread prevalence of the disease. According to reports, manifestations of the pathological process are noted in 60% of patients in the trauma departments, and only in 30% of cases it is associated with primary nerve damage.
Next, we consider the anatomical features of the structure described in the article. This is necessary in order to understand why the neuropathy of the peroneal nerve develops (ICD-10 assigned the disease code G57.8).
Anatomical reference
The peroneal nerve departs from the sciatic at the level of the lower third of the thigh. Its structure is represented by various fibers. At the level of the popliteal fossa, these elements separate into the common peroneal nerve. He spirals around the head of the same bone. In this place, the nerve lies on the surface and is covered only by the skin, which is why any external factors can exert pressure on it.
Then the peroneal nerve is divided into two branches: superficial and deep. These elements are named for their direction. The superficial branch is responsible for the innervation of muscle structures, rotation of the foot and the sensitivity of its back. The deep peroneal nerve provides extension of the fingers, as well as a sensation of pain and touch in this area.
Compression of one or another branch is accompanied by a violation of sensitivity in various zones of the foot, and the inability to expand the phalanges. Therefore, the symptoms of neuropathy can vary depending on which part of the structure is damaged. In some cases, knowledge of its anatomical features allows you to determine the degree of the pathological process before going to the doctor.
The main causes of the disease
The development of the pathological process can be due to many factors. Among them, doctors distinguish the following:
- Compression of a nerve in any of its sections. This is the so-called tunnel neuropathy of the peroneal nerve. It is divided into two groups. Upper syndrome develops against the background of pressure on the structure of the vascular bundle. The disease is most often diagnosed in people whose work is associated with a long stay in an uncomfortable position. These are berry pickers, parquet handlers, seamstresses. The lower tunnel syndrome develops as a result of compression of the deep peroneal nerve in the area of its exit to the foot. This clinical picture is typical for people who prefer uncomfortable shoes.
- Violation of blood supply to the limbs.
- Improper position of the legs due to prolonged surgery or a serious condition of the patient, accompanied by immobilization.
- Getting into the nerve fibers during intramuscular injection in the gluteal region.
- Severe infectious diseases.
- Injuries (broken leg, dislocation of the foot, tendon damage, sprain). As a result of a severe bruise, edema occurs. It leads to compression of the nerve and impairment of the conductivity of the pulses. A distinctive feature of this form of the disease is the defeat of only one limb. Otherwise, it is called post-traumatic neuropathy of the peroneal nerve.
- Oncological lesions with metastasis.
- Toxic pathologies (diabetes mellitus, renal failure).
- Systemic diseases characterized by proliferation of connective tissue (osteoarthrosis, gout, rheumatoid arthritis).
All causes of the development of the pathological process can be classified in five directions: trauma, compression, vascular disorders, infectious and toxic lesions. Regardless of which group of triggers the neuropathy of the peroneal nerve belongs to, the ICD-10 code for this disease is the same - G57.8.
What are the symptoms of the disease?
The clinical manifestations of the disease depend on the degree of neglect of the pathological process and the place of nerve damage. All symptoms can be divided into main and related. The first group includes a violation of sensitivity in the affected limb. Concomitant symptoms may vary in each case. However, most often patients complain of:
- swelling in the legs;
- periodic sensation of "goosebumps";
- cramping and cramping;
- discomfort when walking.
It was noted a little higher that the clinical picture of the disease also depends on the location of the nerve damage. For example, damage to the common trunk is manifested by a violation of the process of extension of the foot. Because of this, she begins to hang down. The patient, when walking, is forced to constantly bend his leg at the knee so as not to catch his foot on the floor. When it is lowered, it first becomes on the fingers, then transfers the weight to the lateral sole of the edge and only then lowers the heel. This manner of movement resembles a cockerel or horse, and therefore bears similar names.
Movement disorders are combined with sensory disturbances. Patients often notice the appearance of pain on the outer surface of the lower leg, which only intensifies when squatting. Over time, muscle atrophy develops in the affected area . This symptom of the disease is clearly distinguishable, especially when compared with a healthy limb.
What are the symptoms of peroneal neuropathy with deep branch lesions? In this case, the drooping of the foot is less pronounced. However, sensory and motor impairments are also present. If the disease is not treated, it is complicated by atrophy of the small muscles.
Neuropathy of the peroneal nerve with damage to the superficial branch is accompanied by a violation of sensitivity and severe pain in the lower leg. During the examination, patients are often diagnosed with a weakening of pronation of the foot.
Diagnostic Methods
Timely identification of the pathological process and elimination of the underlying disease - these two factors are the key to successful therapy. How is neuropathy diagnosed?
First, the doctor collects the patient's history. During this procedure, he examines his disease map and conducts a survey in order to clarify the information. Then the doctor moves on to instrumental diagnostic methods. To assess muscle strength, certain tests are performed, and the analysis of skin sensitivity is carried out using a special needle. Additionally, electromyography and electroneurography are used. These procedures allow you to determine the degree of nerve damage. An ultrasound is considered to be a no less informative method of examination, during which the doctor can examine the damaged structures.
Peroneal neuropathy always requires differential diagnosis with other disorders with similar clinical manifestations. These include Charcot-Marie-Tooth disease, peroneal muscle atrophy syndrome, cerebral tumors.
In especially serious cases, consultation with specialized specialists is required. For example, a traumatologist. Based on the results of the tests already obtained, the doctor may prescribe a radiography of the bones or knee joint.
Peroneal Neuropathy: ICD
To understand the essence of the diagnosis made by the doctor, you need to familiarize yourself with the special code system. They are recorded in the International Classification of Diseases (ICD). The system is built very simply. First comes the Latin letter designation, which defines a group of diseases. Then follows a numerical code indicating a specific ailment. Sometimes you can meet another character. It carries information about the type of disease.
Many patients are interested in what code (ICD) neuropathy of the peroneal nerve has. It should be noted that the described illness does not have such a designation. G57 category includes mononeuropathy of the lower extremities. If we delve into the study of pathologies belonging to this class, our disease will not meet there. However, it can be attributed to the code G57.8, which refers to other mononeuralgia of the lower limb.
Knowing what the International Classification of Diseases is, you can get any information on the issue of diagnosis. This applies to such a disease as neuropathy of the peroneal nerve. ICD-10 assigned him the code G57.8.
Principles of Therapy
The tactics of treatment of this pathology is determined by its cause. Sometimes it’s enough to replace the cast, which compresses the nerve. If uncomfortable shoes play the role of a provoking factor, new shoes can also be a solution to the problem.
Often patients go to the doctor with a whole "bunch" of concomitant diseases. Diabetes mellitus, oncology or renal failure - these disorders can cause ailment such as neuropathy of the peroneal nerve. Treatment in this case boils down to eliminating the primary disease. The remaining measures will be already indirect in nature.
Drug therapy
The main drugs that are used in the treatment of neuropathy are the following:
- Nonsteroidal anti-inflammatory drugs (Diclofenac, Nimesulide, Xefocam). They help reduce swelling and pain, remove the symptoms of inflammation. NSAIDs are most often prescribed for a diagnosis of axonal neuropathy of the peroneal nerve.
- Vitamins of group B.
- Antioxidants (Berlition, Thiogamma).
- Means for improving the conduction of impulses along the nerve (Prozerin, Neuromidin).
- Preparations for the restoration of blood circulation in the affected area (Caviton, Trental).
This list contains only a few medications. In each case, the choice of drugs depends on the clinical picture of the disease and the preceding ailments.
Physiotherapeutic procedures
Various physiotherapeutic measures have proven themselves in the treatment of neuropathy. Typically, patients are recommended the following procedures:
- magnetotherapy;
- electrical stimulation;
- massage;
- reflexology;
- Exercise therapy.
Particularly effective is massage for neuropathy of the peroneal nerve. But performing this procedure at home is unacceptable. Massage should be done by a qualified specialist. Otherwise, you can not only suspend the treatment process, but also harm your health.
The same recommendations are shown for exercise therapy. It is worth mentioning that the first lessons should be held under the supervision of an experienced trainer. Then you can repeat the exercises at home.
Surgical intervention
If conservative therapy has been shown to be ineffective for several weeks, the doctor will decide on the operation. Usually it is prescribed in case of traumatic damage to nerve fibers. Depending on the clinical picture and the general condition of the patient, decompression of the nerve, neurolysis or plasty is possible.
After surgery, a long recovery period is required. At this time, the patient should limit physical activity, exercise therapy. Every day it is necessary to examine the affected limb for cracks and wounds. If they are found, the foot should be completely relaxed. For this purpose, special crutches are used, and wounds are treated with antiseptic agents. The doctor gives the remaining recommendations individually.
Effects
What outcome awaits patients with a diagnosis of peroneal nerve neuropathy? The treatment of the disease largely determines the prognosis for recovery. If you start therapy in a timely manner and follow all the doctor's recommendations, you can hope for a positive result. The complicated course of the disease and delayed treatment exacerbate the situation. In this case, patients often lose their ability to work.
To summarize briefly
Peroneal neuropathy is a serious disease. It can be based on vascular disorders, intoxication and toxic lesions. However, injuries of various origins are still considered the main reason for the development of the pathological process.
Its main manifestations are associated with impaired motor activity of the limb, and therapeutic tactics are largely determined by factors that contributed to the development of the disease. The doctor may prescribe medication or physiotherapy. In rare cases, surgical intervention is required.