Superficial branch of the peroneal nerve. Symptoms of damage to the peroneal nerve

Peroneal nerve neuropathy often occurs in children and adults. To make a diagnosis, examinations are also needed.

The common peroneal nerve (n. peroneus communis, L4-L5, S1-S2) is the second terminal branch sciatic nerve, before disintegrating into terminal branches, the external cutaneous nerve departs from the common peroneal nerve, innervating the lateral and posterior surface of the leg, and also forming an anastomosis with the medial cutaneous nerve of the leg, which gives rise to the sural nerve (described above). Next, the common peroneal nerve approaches the neck of the head of the fibula, where it splits into its terminal branches, forming the superficial, deep and recurrent nerves.

Portrait of a young girl enjoying a healthy skin treatment at a spa resort.

The superficial peroneal nerve innervates the long and short peroneus muscles (elevate and abduct the outer edge of the foot). At the level of the middle third of the leg, the superficial branch exits under the skin, forming the medial dorsal cutaneous nerve (innervates the inner edge of the foot, 1st toe and 2nd interdigital space) and the intermediate dorsal cutaneous nerve (innervates the lower third of the leg, dorsum of the foot and 3rd and 4th interdigital spaces).

The deep peroneal nerve innervates the extensor digitorum longus (extends digits 2-5 and the foot at the ankle joint, simultaneously pronates and abducts the foot), the tibialis anterior muscle (extends the foot at the ankle joint, adducts and elevates the inner edge of the foot), extensor hallucis longus (extends thumb foot and takes part in the extension of the foot at the ankle joint). On the foot, the deep peroneal nerve innervates the short extensor of the digitorum (extends 2-5 fingers), the short extensor of the 1st toe (extends 1 toe and abducts it outward) and 1 interdigital space.

When the common peroneal nerve is damaged, the extension of the foot in the ankle joint and pronation of its outer edge are impaired, and a “horse foot” is formed - manifested by persistent plantar flexion of the foot. A steppage or “cock gait” appears, in which the patient, so that the back of the foot does not touch the floor, raises his legs high; when lowering the lower limb, the surface first touches the fingers, and then the entire foot. There is atrophy of the muscles of the anterior outer surface of the leg, in the same area there is a sensitivity disorder, on the foot there is hypoesthesia on the dorsal surface, which includes 1 interdigital space.

Treatment of peroneal nerve neuropathy should be comprehensive and include the use of medicines, physiotherapy, massage, exercise therapy, electrical and magnetic stimulation, reflexology, water treatments.

Peroneal nerve neuropathy is a disease that develops as a result of damage or compression of the peroneal nerve. There are several reasons for this condition. Symptoms are associated with a violation of the conduction of impulses along the nerve to the innervated muscles and areas of the skin, primarily weakness of the muscles that extend the foot and its toes, as well as impaired sensitivity along the outer surface of the lower leg, the dorsum of the foot and its toes. Treatment of this pathology can be conservative and surgical. From this article you can learn about what causes peroneal nerve neuropathy, how it manifests itself and how it is treated.

To understand where the disease comes from and what symptoms characterize it, you should familiarize yourself with some information about the anatomy of the peroneal nerve.

A small anatomical educational program

The peroneal nerve is part of the sacral plexus. The nerve fibers go as part of the sciatic nerve and are separated from it into a separate common peroneal nerve at the level of or slightly above the popliteal fossa. Here, the common trunk of the peroneal nerve is directed to the outer side of the popliteal fossa, spiraling around the head of the fibula. In this place it lies superficially, covered only by fascia and skin, which creates the preconditions for compression of the nerve from the outside. The peroneal nerve then splits into superficial and deep branches. Somewhat higher than the division of the nerve, another branch departs - the external cutaneous nerve of the leg, which in the region of the lower third of the leg connects with the branch of the tibial nerve, forming the sural nerve. The sural nerve innervates the posterolateral part of the lower third of the leg, the heel, and the outer edge of the foot.

The superficial and deep branches of the peroneal nerve are so named due to their course relative to the thickness of the lower leg muscles. The superficial peroneal nerve provides innervation to the muscles that provide elevation of the outer edge of the foot, as if rotating the foot, and also forms the sensitivity of the dorsum of the foot. The deep peroneal nerve innervates the muscles that extend the foot and toes, and provides sensations of touch and pain in the first interdigital space. Compression of one or another branch, accordingly, is accompanied by impaired abduction of the foot outward, the inability to straighten the toes and foot, and impaired sensitivity in various departments feet. According to the course of the nerve fibers, the places of its division and the origin of the external cutaneous nerve of the leg, the symptoms of compression or damage will be slightly different. Sometimes knowledge of the innervation of individual muscles and skin areas by the peroneal nerve helps to determine the level of nerve compression before use. additional methods research.

Causes of peroneal nerve neuropathy

The occurrence of peroneal nerve neuropathy can be associated with various situations. It can be:

• injuries (especially often this reason is relevant for injuries of the upper outer part of the leg, where the nerve lies superficially and next to the fibula. A fracture of the fibula in this area can provoke damage to the nerve from bone fragments. And even a plaster cast applied for this reason can cause peroneal nerve neuropathy. Fracture is not the only traumatic cause; falls, blows to this area can also cause peroneal nerve neuropathy).
• compression of the peroneal nerve along any part of its course. These are the so-called tunnel syndromes - upper and lower. Upper syndrome develops when the common peroneal nerve is compressed as part of the neurovascular bundle with intense approach of the biceps femoris muscle to the head of the fibula. Typically, this situation develops in people of certain professions who are forced long time maintain a certain position (for example, harvesters of vegetables, berries, parquet and pipe layers - a “squatting” position) or make repeated movements that compress neurovascular bundle in this area (seamstresses, fashion models). Compression can be caused by the “leg-to-leg” position, favored by many. Lower carpal tunnel syndrome develops when the deep peroneal nerve is compressed on the back ankle joint under the ligament or on the back of the foot in the area of ​​the base of the first metatarsal bone. Compression in this area is possible when wearing uncomfortable (tight) shoes and when applying plaster cast;
• disturbances in the blood supply to the peroneal nerve (nerve ischemia, as if a “stroke” of the nerve);
• Not correct position legs (legs) during a long operation or a serious condition of the patient, accompanied by immobility. In this case, the nerve is compressed at its most superficial location;
• getting into the nerve fibers when performing an intramuscular injection in the gluteal region (where the peroneal nerve is integral part sciatic nerve);
• severe infections accompanied by damage to many nerves, including the peroneal one;
• toxic lesions peripheral nerves(eg, severe renal failure, severe diabetes, drug and alcohol use);
• oncological diseases with metastasis and compression of the nerve by tumor nodes.

Of course, the first two groups of reasons are the most common. The rest cause neuropathy of the peroneal nerve very rarely, but they cannot be discounted.

Symptoms

Clinical signs of peroneal nerve neuropathy depend on the location of its lesion (along the route) and the severity of its occurrence.

Thus, with an acute injury (for example, a fracture of the fibula with displacement of fragments and damage to nerve fibers), all symptoms arise simultaneously, although the first days may not come to the fore due to pain and immobility of the limb. If the peroneal nerve is gradually injured (when squatting, wearing uncomfortable shoes, and other similar situations), symptoms will appear gradually, over some time.

All symptoms of peroneal nerve neuropathy can be divided into motor and sensory. Their combination depends on the level of the lesion (for which the anatomical information was presented above). Let's consider the signs of neuropathy of the peroneal nerve depending on the level of damage:

• with high compression of the nerve (as part of the fibers of the sciatic nerve, in the region of the popliteal fossa, that is, before the nerve divides into superficial and deep branches), the following occur:

1. disturbances in the sensitivity of the anterolateral surface of the leg, the dorsum of the foot. This may be the lack of sensation of touch, the inability to distinguish between painful irritation and just touch, heat and cold;
2. painful sensations along the lateral surface of the lower leg and foot, worsening when squatting;
3. violation of the extension of the foot and its toes, up to complete absence similar movements;
4. weakness or inability to abduct the outer edge of the foot (lift it);
5. inability to stand on your heels and walk like them;
6. when walking, the patient is forced to raise his leg high so as not to catch his toes; when lowering the foot, first the toes fall to the surface, and then the entire sole; when walking, the leg bends excessively at the knee and hip joints. This gait is called “cock” (“horse”, peroneal, steppage) by analogy with the gait of the bird and animal of the same name;
7. the foot takes on the appearance of a “horse”: it hangs down and seems to be turned inward with the toes bent;
8. with some experience of neuropathy of the peroneal nerve, muscle loss (atrophy) develops along the anterolateral surface of the leg (assessed in comparison with a healthy limb);

• when the external cutaneous nerve of the leg is compressed, exceptionally sensitive changes (decreased sensitivity) occur along the outer surface of the leg. This may not be very noticeable, because the external cutaneous nerve of the leg connects to a branch of the tibial nerve (the fibers of the latter take on the role of innervation);
• Damage to the superficial peroneal nerve has the following symptoms:

1. pain with a hint of burning in the lower part of the lateral surface of the leg, on the back of the foot and the first four toes;
2. decreased sensitivity in these same areas;
3. weakness in abduction and elevation of the outer edge of the foot;

• damage to the deep branch of the peroneal nerve is accompanied by:

1. weakness of extension of the foot and its toes;
2. slight drop of the foot;
3. impaired sensitivity on the back of the foot between the first and second toes;
4. with a long-term existence of the process - atrophy of the small muscles of the dorsum of the foot, which becomes noticeable in comparison with a healthy foot (the bones protrude more clearly, the interdigital spaces sink).

It turns out that the level of damage to the peroneal nerve clearly determines certain symptoms. In some cases, there may be a selective violation of the extension of the foot and its toes, in others there may be elevation of its outer edge, and sometimes only sensory disorders.

Treatment

Treatment of peroneal nerve neuropathy is largely determined by the cause of its occurrence. Sometimes replacing the cast that is compressing the nerve becomes the main treatment option. If the cause is uncomfortable shoes, then changing them also contributes to recovery. If the reason is existing concomitant pathology(diabetes mellitus, cancer), then in this case it is necessary to treat, first of all, the underlying disease, and other measures to restore the peroneal nerve will be indirect (albeit mandatory).

The main medications used to treat peroneal nerve neuropathy are:

• non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen, Xefocam, Nimesulide and others). They help reduce pain syndrome, relieve swelling in the nerve area, remove signs of inflammation;
• B vitamins (Milgamma, Neurorubin, Combilipen and others);
• means for improving nerve conduction (Neuromidin, Galantamine, Proserin and others);
• drugs to improve blood supply to the peroneal nerve (Trental, Cavinton, Pentoxifylline and others);
• antioxidants (Berlition, Espa-Lipon, Tiogamma and others).

Active and successful in complex treatment Physiotherapy methods are used: magnetic therapy, amplipulse, ultrasound, electrophoresis with medicinal substances, electrical stimulation. Recovery is facilitated by massage and acupuncture (all procedures are selected individually, taking into account the contraindications that the patient has). Complexes of physical therapy are recommended.

To correct the “rooster” gait, special orthoses are used that fix the foot in the correct position, preventing it from drooping.

If conservative treatment does not give effect, then they resort to surgical intervention. Most often this has to be done in case of traumatic damage to the fibers of the peroneal nerve, especially with a complete break. When nerve regeneration does not occur, conservative methods turn out to be powerless. In such cases, the anatomical integrity of the nerve is restored.
The sooner the surgery is performed, the better the prognosis for recovery and restoration of peroneal nerve function.

Surgical treatment becomes a salvation for the patient even in cases of significant compression of the peroneal nerve. In this case, the structures that are compressing the peroneal nerve are cut or removed. This helps restore the passage of nerve impulses. And then using the above conservative methods"bring" the nerve to full recovery.

Thus, peroneal nerve neuropathy is a disease peripheral system, which can arise from various reasons. The main symptoms are associated with impaired sensitivity in the lower leg and foot, as well as with weakness of extension of the foot and its toes. Treatment tactics largely depend on the cause of peroneal nerve neuropathy and are determined individually. For one patient, conservative methods are sufficient; for another, both conservative and surgical intervention.

Educational film “Neuropathy of peripheral nerves. Clinic, features of diagnosis and treatment” (from 23:53):

A test for the presence of pathology can be carried out by standing on your heels: if you can easily stand on them, there is no reason for concern, otherwise you should learn more about SUI. Note that the terms neuropathy, neuropathy, neuritis are different names for the same pathology.

Anatomical certificate

Neuropathy is a disease characterized by nerve damage that is non-inflammatory in nature. The disease is caused by degenerative processes, injuries or compression in the lower extremities. In addition to SUI, there is tibial nerve neuropathy. Depending on the damage to motor or sensory fibers, they are also divided into motor and sensory neuropathy.

Peroneal nerve neuropathy leads in prevalence among the listed pathologies.

Let's consider the anatomy of the peroneal nerve - the main part of the sacral plexus, the fibers of which are part of the sciatic nerve, departing from it at the level of the lower third of the femoral part of the leg. The popliteal fossa is where these elements separate into the common peroneal nerve. It bends around the head of the fibula along a spiral trajectory. This part of the nerve's "path" runs along the surface. Therefore, it is only protected skin, and therefore is under the influence of external negative factors that influence him.

Then the peroneal nerve divides, resulting in its superficial and deep branches. The “area of ​​responsibility” of the first includes the innervation of muscle structures, rotation of the foot and sensitivity of its dorsal part.

The deep peroneal nerve serves to extend the fingers, thanks to which we are able to feel pain and touch. Compression of any of the branches disrupts the sensitivity of the foot and its toes; a person cannot straighten their phalanges. The task of the sural nerve is to innervate the posterolateral part of the lower third of the leg, the heel and the outer edge of the foot.

ICD-10 code

The term “ICD-10” is an abbreviation for the International Classification of Diseases, which was subjected to its tenth revision in 2010. The document contains codes used to designate all diseases known to modern medical science. Neuropathy in it is represented by damage to various nerves of a non-inflammatory nature. In ICD-10, SUI is classified as class 6 - diseases nervous system, and specifically to mononeuropathy, its code is G57.8.

Causes and varieties

The disease owes its occurrence and development to many reasons:

• various injuries: a fracture can lead to a pinched nerve;
• falls and blows;
• metabolic disorders;
• compression of the MN along its entire length;
• various infections against which SUI may develop;
• severe general diseases, for example, osteoarthritis, when inflamed joints compress the nerve, which leads to the development of neuropathy;
• malignant neoplasms of any localization that can compress the nerve trunks;
• incorrect position of the legs when a person is immobilized due to serious illness or prolonged surgery;
• toxic nerve damage caused by renal failure, severe forms of diabetes, alcoholism, drug addiction;
• lifestyle: representatives of certain professions - farmers, agricultural workers, floor and pipe layers, etc. - spend a lot of time in a half-bent state and risk getting compression (squeezing) of the nerve;
• disorders of the blood supply to the MN.

Neuropathy can develop if a person wears uncomfortable shoes and often sits with one leg crossed over the other.

Lesions of the peroneal nerve are primary and secondary.

1. The primary type is characterized by inflammatory reaction, which occurs regardless of other pathological processes occurring in the body. The condition occurs in people who regularly load one leg, for example, when performing certain sports exercises.
2. Secondary type lesions are complications of pre-existing diseases in a person. Most often, the peroneal nerve is affected as a result of compression caused by a number of pathologies: fractures and dislocations of the ankle joint, tenosynovitis, post-traumatic arthrosis, inflammation joint capsule, deforming osteoarthritis, etc. The secondary type includes neuropathy and MN neuralgia.

Symptoms and signs

For clinical picture the disease is characteristic varying degrees loss of sensation in the affected limb. Signs and symptoms of neuropathy appear:

• dysfunction of the limb - inability to normal flexion and extension of the fingers;
• slight concavity of the leg inward;
• inability to stand on your heels or walk on them;
• swelling;
• loss of sensitivity in parts of the legs - foot, calf, thigh, area between the thumb and index finger;
• pain that gets worse when a person tries to sit down;
• weakness in one or both legs;
• burning sensation in different parts of the foot - it could be the toes or calf muscles;
• a feeling of changing heat to cold in the lower body;
• atrophy of the muscles of the affected limb on late stages illnesses, etc.

A characteristic symptom of SUI is a change in gait caused by the “dangling” of the leg, the inability to stand on it, and strong bending of the knees while walking.

Diagnostics

Identification of any disease, including neuropathy of the peroneal nerve, is the prerogative of a neurologist or traumatologist, if the development of the disease is provoked by a fracture. During the examination, the patient's injured leg is examined, then its sensation and functionality are tested to identify the area where the nerve is affected.

The diagnosis is confirmed and clarified through a number of examinations:

• ultrasonography;
• electromyography – to determine muscle activity;
• electroneurography - to check the speed of nerve impulses;
• radiography, which is carried out if there are appropriate indications;
• therapeutic and diagnostic blockade of trigenic points with the introduction of appropriate medications to identify affected areas of nerves;
• computer and magnetic resonance imaging - these precise, highly informative techniques reveal pathological changes in controversial cases.

Treatment

Treatment of neuropathy of the peroneal nerve is carried out by conservative and surgical methods.

Greater efficiency is demonstrated by the use of a complex of methods: this required condition to obtain a pronounced effect. We are talking about medication, physiotherapy and surgical techniques treatment. It is important to follow doctors' recommendations.

Medicines

Drug therapy involves the patient taking:

• nonsteroidal anti-inflammatory drugs: Diclofenac, Nimesulide, Xefocam, designed to reduce swelling, inflammation and pain. In most cases, they are prescribed for axonal neuropathy (axonopathy) of the peroneal nerve;
• B vitamins;
• antioxidants represented by the drugs Berlition, Tiogamma;
• medications designed to improve the conduction of impulses along the nerve: Proserin, Neuromidin;
• therapeutic agents that restore blood circulation in the affected area: Kaviton, Trental.

Prohibited permanent use painkillers, which with prolonged use will worsen the situation!

Physiotherapeutic procedures

Physiotherapy procedures that demonstrate high effectiveness in the treatment of neuropathy:

• massage, incl. Chinese dot;
• magnetic therapy;
• electrical stimulation;
• reflexology;
• Exercise therapy. The first classes should be conducted with the participation of an experienced trainer, after which the patient will be able to do therapeutic exercises independently at home;
• electrophoresis;
• heat therapy.

Massage for peroneal nerve neuropathy is the prerogative of a specialist, and therefore it is prohibited to do it yourself!

Surgical intervention

If conservative methods do not give the expected results, they resort to surgery. The operation is prescribed for traumatic rupture of the nerve fiber. Possible:

After surgery, a person needs a long recovery. During this period it is limited physical activity, including performing physical therapy exercises.

A daily examination of the operated limb is carried out to identify wounds and cracks, if detected, the leg is provided with rest - the patient moves with special crutches. If there are wounds, they are treated using antiseptic agents.

Folk remedies

The necessary assistance in the treatment of neuropathy of the peroneal nerve is provided by traditional medicine, which has a significant number of recipes.

1. Blue and green clay have properties that are useful in treating the disease. Roll the raw materials into small balls and dry them in the sun, store them in a jar with a closed lid. Before use, dilute a portion of clay using water at room temperature until you obtain a porridge-like consistency. Apply several layers to the cloth and place on the skin over the damaged nerve. Wait until the clay is completely dry. After use, the bandage should be buried in the ground - this is what healers advise. For each procedure, use a new clay ball.
2. Unlike the first recipe, the second involves preparing a substance for oral administration: after removing the seeds, ripe dates are ground using a meat grinder, the resulting mass is consumed 2-3 teaspoons three times a day after meals. If desired, dates are diluted with milk. The course of treatment lasts approximately 30 days.
3. Compresses using goat milk, with which gauze is moistened and then applied for a couple of minutes to the area of ​​skin over the affected nerve. The procedure is performed several times during the day until recovery.
4. Garlic will also help in the treatment of SUI. Grind 4 cloves with a rolling pin, add water and bring to a boil. After removing the decoction from the heat, inhale the steam through each nostril for 5-10 minutes.
5. Wash your face using natural apple cider vinegar, being careful not to get it in your eyes.
6. Pour 6 leaves of bay leaves with a glass of boiling water, then cook over low heat for 10 minutes. Apply the resulting decoction to your nose 3 times a day until the condition improves.
7. Pour the product obtained by thoroughly mixing 2 and 3 tablespoons of turpentine and water, respectively, over a piece of bread and apply it to the affected area of ​​the leg for 7 minutes. Do this before bed to immediately warm your foot and go to bed. The frequency of procedures is once every two days until complete recovery. The effectiveness of the recipe is that turpentine is an excellent warming agent.
8. At night, tie the peel of peeled lemons, pre-greased with olive oil, to the foot of the affected leg.

Recipes traditional medicine- one of the parts of the complex of measures, and therefore should not be neglected traditional treatment NMN.

Consequences and prevention

SUI is a serious disease that requires timely adequate treatment, otherwise a person will face a bleak future. Possible variant development of events - disability with partial loss of ability to work, since often a complication of SUI is paresis, manifested by a decrease in the strength of the limbs. However, if a person goes through all stages of treatment, the situation improves significantly.

Small tibial nerve neuropathy occurs due to various reasons, so it's better to prevent it.

1. People actively involved in sports should regularly see a doctor for timely detection of pathology, incl. tunnel syndrome, also called compression-ischemic neuropathy. They call it compression because when nerve trunks pass through a narrow tunnel, they are compressed, and ischemic - due to a disruption in the nutrition of the nerves.
2. You need to train in special comfortable shoes.
3. Reducing weight to reduce stress on the legs and feet to prevent deformation.
4. Women who prefer high heels should give their feet a break by taking them off during the day and taking time to therapeutic exercises to normalize blood circulation in the extremities.

An attentive and caring attitude towards your health is the key to ensuring that neuropathy of the peroneal nerve will bypass you.

How does peroneal nerve neuropathy manifest?

The nervous system is one of the main complexes in the human body. It includes the head and spinal cord, branches. Thanks to the latter, a rapid exchange of impulses occurs throughout the body. Failures of one section have almost no effect on the entire system, but may cause deterioration in the performance of some sections. Peroneal nerve neuropathy is a disease that is not caused by an inflammatory process.

The tibial nerve is also damaged and requires effective treatment. The disease appears due to degenerative processes, trauma or compression. The peroneal nerve is considered one of the main ones in the entire system, so its pinching leads to illness. Typically the legs are affected. The disease is divided into the following types:

• peroneal nerve neuropathy;
• tibial nerve neuropathy;
• sensory pathology.

All types of diseases are of interest to doctors from a scientific point of view. They are included in the “Neuralgia” section. The peroneal nerve is important, which should be discussed in more detail.

Features of the disease

The disease is also called “peroneal nerve neuropathy.” The disease is characterized as foot drop syndrome. All this puts stress on the lower leg and other parts of the limbs. Since the peroneal nerve includes thick fibers with a myelin sheath, it is the one that is affected by metabolic disorders.

Based on statistics, pathology manifests itself in 60% of people who are in traumatology, and only in 30% is it associated with nerve damage. Doctor studying anatomical features illness, since this allows us to determine the cause of the pathology. And when there is no timely help, paralysis of the limbs may occur.

Anatomical features

The peroneal nerve is part of the sciatic nerve, and it is located at the bottom of the thigh. It consists of many fibers. In the area of ​​the popliteal fossa, all its parts are attached to the peroneal nerve. It is covered only by skin, and therefore different external influences unfavorable for him.

Then it is divided into 2 parts: superficial and deep. The first serves to innervate muscular system, rotation of the foot, its sensitivity. And the deep nerve is necessary for the extension of the fingers, as well as the sensitivity of this part of the body.

Infringement of any part of it leads to deterioration of sensitivity different parts feet, legs, which makes it impossible to straighten the phalanges.

Therefore, peroneal nerve neuropathy may have various symptoms, it all depends on the area of ​​damage. Often knowledge anatomical structure allows you to determine the level of pathology before visiting a doctor. If professional help is not provided on time, there is a risk of developing a tumor called neuroma.

Why does the disease occur?

The appearance of pathology is associated with various factors. The main ones include:

• compression of the nerve area, which occurs due to pressure on the structures of the vascular bundle;
• uncomfortable positions in which a person remains for a long period;
• compression in the area of ​​its transition to the foot;
• deterioration of blood supply to the limb;
• infections;
• injuries;
• oncology;
• toxic pathologies;
• systemic diseases.

Due to these same factors, the tibial nerve is damaged. The causes of the pathology are varied, but in any case treatment and recovery are necessary. It will prevent the nerve from being pinched further.

Symptoms

Peroneal nerve neuropathy includes various signs depending on the pathology, location of the painful area. All symptoms are main and accompanying. The first group includes deterioration in the sensitivity of the painful limb. And the second signs are different in different situations, but usually manifest themselves:

• swelling of the legs;
• the appearance of discomfort;
• spasms and cramps;
• pain when moving.

For example, common trunk disease is characterized by difficulty flexing the foot, causing it to become droopy. When moving, a person bends his leg at the knee so that the foot does not damage the floor. He places his foot first on his toes, and then gradually on his entire foot. Motor damage is observed along with sensory damage. Patients often experience pain on the outer part of the lower leg, which becomes worse with squatting. Muscle atrophy gradually appears, and peroneal nerve paresis may occur.

If the deep branch is damaged, the foot drop is not very noticeable. But in this situation there are also various violations. If the disease is not treated, there will be a complication in the form of small muscle atrophy. With peroneal nerve neuropathy, symptoms may manifest as decreased sensitivity and pain. Upon examination, a person reveals weakness in pronation of the foot.

Diagnostic features

For peroneal nerve neuropathy, treatment depends on the diagnosis performed. Timely identification of pathology and treatment of the main ailment are necessary for quality therapy. First of all, a patient history is required. During this procedure, the doctor gets acquainted with the disease chart and conducts a survey on symptoms, complaints, and well-being. This will determine if there is tibial nerve neuropathy.

Then the specialist uses instrumental examination methods. The procedures will determine whether there is neuritis of the peroneal nerve. Special tests will help determine muscle strength, and skin sensitivity analysis is carried out with a needle. The use of electromyography and electroneurography is also necessary. Using these procedures, it will be possible to determine the extent of the damage.

An effective method of examination is ultrasound, in which the doctor examines painful areas. It is important to evaluate for additional disorders that have similar symptoms and causes. For this purpose they are appointed additional procedures. With them, neuritis of the tibial nerve is determined.

After completing all the diagnostic work, the doctor prescribes necessary funds. It could be like healing procedures, and drugs. Completing the entire course of treatment gives excellent results.

Therapy rules

Treatment principles are based on determining the cause. In some cases, you just need to change the plaster cast that is causing the nerve compression. If this is due to uncomfortable shoes, then you need to replace them with new, comfortable ones. In case of paralysis, electrical stimulation of the peroneal nerve is necessary.

Often people go to the doctor with a large number of ailments. Neuropathy of the tibial nerve or peroneal nerve can appear due to diabetes mellitus, oncology, and renal failure. Therefore, it is important to eliminate the disease that caused the disease. The remaining procedures will act as additional ones.

Drug therapy

Drug treatment is often prescribed. The main medications used to treat neuropathy are anti-inflammatory drugs. When choosing a product, the specialist takes into account the results of the examination. Doctors prescribe Diclofenac, Nimesulide, Xefocam. They are needed to reduce swelling and pain, eliminate the symptoms of the disease.

B vitamins and antioxidants are also needed, for example, Berlition, Thiogamma. Drugs for restoring the passage of impulses along the nerve: Proserin, Neuromidin. To improve blood circulation, Caviton and Trental are used. You should not self-medicate; all medications should be prescribed by a doctor.

Physiotherapy

If the sural nerve or other part of the limb is affected, physical therapy is used. The following procedures are used:

• magnetic therapy;
• electrical stimulation;
• massage;
• reflexology;
• Exercise therapy for peroneal nerve paresis.

Often activities are carried out in combination, which gives excellent results. An effective procedure is a therapeutic massage. You should not carry it out at home; you need to contact a specialist. Otherwise, you can not only slow down treatment, but also worsen the condition. The same applies to exercise therapy. The first procedures should be carried out under the supervision of a specialist, and then they can be performed at home.

Surgical methods

When traditional methods do not help, the doctor performs surgery. It is usually required for trauma to the nervous system. Nerve decompression, neurolysis, and plastic surgery are often necessary.

Once the operation is completed, rehabilitation is needed. At this time, the patient can perform gymnastics in limited quantities. It is important to constantly inspect the painful area so that cracks or wounds do not appear there. If they appear, then antiseptic medications are used for treatment. Special crutches are also used. The doctor provides other recommendations individually.

Consequences

With peroneal nerve damage, treatment affects recovery. If the therapy is carried out in a timely manner, as well as the doctor’s instructions, then positive dynamics in the condition will be observed. Complicated course of the disease and late measures lead to deterioration in working ability.

The disease is one of the most complex. It may be related to vascular disorders, intoxication, toxic effects. But important reason pathologies are injuries. It manifests itself in complexity motor activity, A therapeutic measures are performed depending on the factors that led to the disease. The doctor prescribes procedures individually.

Nervus fibularis communis recovers quite quickly

Common peroneal nerve, Latin name of which Nervus fibularis communis is the nerve of the sacral plexus. It is formed as a continuation of the sciatic nerve, the field of division of the latter in the area of ​​the popliteal fossa.

Where is the peroneal nerve located?

The peroneal nerve from the proximal apex in the popliteal fossa takes direction to its lateral side. It is located directly under the medial border of the biceps femoris muscle, between the lateral head of the calf muscle and it. The nerve spirals around the fibula in the area of ​​its head, being covered here only by skin and fascia.

In this part, articular non-permanent branches depart from the trunk of the peroneal nerve, going to the lateral parts of the capsule in the knee joint. Distally, the peroneal nerve passes through the thickness of the initial segment of the peroneus longus muscle, where it divides into its two terminal branches - the superficial and the deep.

Thus, the common peroneal nerve branches into:

• lateral cutaneous nerve;
• fibular connective;
• superficial peroneal nerve;
• deep peroneal nerve.

The lateral cutaneous nerve on the calf, which has the Latin name Nervus cutaneus surae lateralis: it originates in the popliteal fossae, after which it goes to the lateral heads of the calf muscles, piercing the fascia of the legs in these places, branches in the skin of the lateral surfaces of the legs, reaching the lateral ankles.

The peroneal connecting nerve, which in Latin is called Ramus communicans fibularis, can begin from the trunk of the common peroneal nerve, sometimes from the lateral cutaneous nerve, then, following the gastrocnemius muscle, is located in the space between it and the crural fascia, perforating the latter, then branching into the skin , unites with the medial cutaneous crural nerve.

The superficial peroneal nerve, whose Latin name is Nervus fibularis superficialis, passing between the heads of the long peroneal muscles, follows down at some distance. Moving to the medial surface in the area of ​​the peroneus brevis muscle, this branch of the nerve pierces the fascia in the lower third of the leg, branching into its terminal components:

The function of the branches of the superficial peroneal nerve is to innervate the long and short peroneal muscles;

The deep peroneal nerve, called in Latin Nervus fibularis profundus, pierces the thickness of the initial sections of the long peroneal muscles, the anterior intermuscular septa of the legs and long extensor fingers, then lies on the anterior surface of the interosseous membranes, located on the lateral sides of the tibial anterior vessels.

The deep peroneal nerve has the following functions:

• it innervates the muscles that extend the foot and toes;
• provides a sensation of touch or pain in the first space between the fingers.

Peroneal nerve - symptoms of damage

Since the lesser tibial nerve in some places passes superficially, covered only by skin and fascia, the likelihood that compression or damage to the peroneal nerve may occur is quite high.

Such damage is accompanied by the following symptoms:

• inability to abduct the foot outward;
• inability to straighten the foot and toes;
• disturbance of sensitivity in different departments feet.

Accordingly, as the nerve fibers are irrigated, depending on the location of the compression and the degree of damage, the symptoms will differ slightly. And only at least a superficial knowledge of the characteristics of the peroneal nerve, its innervation of individual muscles or areas of the skin will help a person determine that there is compression of the peroneal nerve even before contacting a doctor for an examination.

Peroneal nerve neuropathy

In the clinic of such a disease as neuropathy, neuropathy of the peroneal nerve is a fairly common pathology. Damage to the peroneal nerve, both as neuropathy, and as a consequence of injury, and as compression-ischemic syndrome, is in first place according to statistics.

Peroneal nerve neuropathy can occur due to the following reasons:

• injuries - most often this reason is relevant during injuries of the upper outer part of the leg, where the nerve passes superficially next to the bone: a bone fracture in this area can lead to damage to the nerve by bone fragments, moreover, neuropathy of the peroneal nerve can even appear from effects of a plaster cast;
• when the tibial nerve is compressed at any part of its passage - experts call this phenomenon tunnel syndrome - upper and lower: usually upper tunnel syndrome develops in people who have certain professions and are forced to maintain certain positions for quite a long time, for example, in vegetable and berry harvesters , in parquet layers from the “squatting” position, while inferior tunnel neuropathy develops from compression of the deep peroneal nerve on back side ankle joint, directly under the ligament;
• disturbances in the blood supply to the peroneal nerve - with ischemia of the nerve, as if there was a “stroke” of the nerve;
• incorrect position of the leg during a long operation or as a result of a serious condition of the patient, which is accompanied by immobility: in this case, the nerve is compressed at the location closest to the surface;
• severe infections that enter the nerve fibers as a result of intramuscular injection in the buttock area, in the place where the peroneal nerve is still a component of the sciatic nerve;
• severe infections that are accompanied by damage to numerous nerves, including the peroneal nerve;
• toxic damage, for example, as a result of severe renal failure or severe diabetes mellitus, from drug or alcohol use;
• cancer with metastasis and compression of the nerve by tumor nodes.

Naturally, the first two causes are actually much more common, however, the remaining causes of peroneal nerve neuropathy, although very rare, nevertheless provoke this pathology, so you shouldn’t discount them.

Signs of neuropathy

The clinical symptoms of peroneal nerve neuropathy primarily depend on the location of the lesion along the route and, of course, on how deep the lesion is.

For example, with a sudden injury, for example, with a fracture of the fibula with subsequent displacement of its fragments, from which the nerve fibers are damaged, all symptoms of neuropathy occur simultaneously, although in the first days the patient may not pay attention to them due to severe pain and immobility of the affected limb .

Whereas gradual damage to the peroneal nerve, for example, while squatting, wearing uncomfortable shoes and other situations, the symptoms gradually arise over a certain long period of time.

Experts divided all the symptoms into:

Their combinations depend on the level of damage. Depending on the degree of damage, Nervus fibularis communis neuropathy has different symptoms. For example,

• With high compression the following damage occurs:
• the sensitivity of the anterolateral shin or dorsum of the foot is impaired - there may be a lack of any sensation from touch, the inability to distinguish between painful stimuli and simple touches, warmth from cold;
• pain on the lateral surfaces of the lower leg and foot, aggravated by squatting;
• the process of straightening the foot or its toes is disrupted, up to the complete impossibility of making such movements;
• weakness or complete inability to abduct the outer edge of the foot or lift it;
• inability to stand on your heels and walk on them;
• forced raising of the leg when walking: the patient has to do this so as not to catch the fingers, in addition, when lowering the foot, first the toes fall to the surface of the floor and only then the sole, and the leg bends too much at the hip and knee joints when walking (this gait is called “cock’s gait”) ", "horse", as well as peroneal or steppage;
• the foot takes on a “horse” appearance: it hangs down and seems to be turned inward, and the toes are bent;
• if neuropathy is not treated for a long time, then weight loss or atrophy of the lower leg muscles along the anterolateral surface may develop;
• compression of the external cutaneous tibial nerve leads exclusively to sensory changes - a decrease in sensitivity on the outer surface, and this pathology may not be very noticeable, since the external cutaneous tibial nerve is connected to a branch of the tibial nerve, the fibers of which seem to take on the role of innervation.

Damage to the superficial peroneal nerve is characterized by the following symptoms:

• pain with a hint of burning on the lower part of the lateral surface of the leg, on the back of the foot and on the first four toes;
• decreased sensitivity in these same areas;
• weakness in abduction or elevation of the outer part of the foot.

Damage to the deep branch of the peroneal nerve is accompanied by the following symptoms:

• slight drop of the foot;
• weakness when extending the foot and fingers;
• impaired sensitivity on the dorsum of the foot in the area between the first and second toes;
• with a long process, neuropathy can lead to atrophy of the small muscles of the dorsum of the foot: this becomes noticeable only when comparing the diseased and healthy foot, when the bones of the first protrude more clearly, and the interdigital spaces noticeably sink.

Thus, neuropathy Nervus fibularis communis, depending on the degree of damage, is clearly defined by certain symptoms. In some cases, there is a selective violation of the process of straightening the foot or toes, in others - raising the outer edge of the foot, and sometimes neuropathy leads only to sensory disorders.

Treatment of peroneal nerve neuropathy

Treatment of neuropathy of a given nerve is largely determined by the cause from which it arises. Sometimes even a banal replacement of a plaster cast that is compressing the lesser tibial nerve can be a treatment. If the cause is uncomfortable shoes, then changing them also contributes to recovery. If the reason lies in the patient’s concomitant pathology, for example, diabetes mellitus, cancer, then in this case it is necessary to first treat the underlying disease, and the remaining measures will go towards restoring the peroneal nerve and will, although mandatory, be indirect .

Basic medications, with the help of which specialists treat neuropathy of the peroneal nerve, are the following:

• non-steroidal anti-inflammatory drugs, such as Diclofenac, Ibuprofen, Xefocam, Nimesulide and others - they are used for any neuralgia, including when the tertiary nerve is inflamed: they help reduce pain, relieve swelling and eliminate inflammation;
• B vitamins, such as Milgamma, Neurorubin, as well as Combilipen, etc.;
• drugs that improve nerve conduction - we are talking about Neuromidin, Galantamine, Prozerin and others;
• medications necessary to improve blood supply to Nervus fibularis communis are Trental, Cavinton, as well as Pentoxifylline and others;
• antioxidants - Espa-Lipon, Berlition, Tiogamma, etc.

Recovery

Complex treatment is expected not only drug therapy, but also physiotherapeutic treatment. The latter includes following methods physiotherapy:

• ultrasound;
• amplipulse;
• electrophoresis with medicinal substances;
• magnetic therapy;
• electrical stimulation.

Recovery is promoted not only drug treatment and physiotherapy, but also massage and acupuncture. In any case, the lesser tibial nerve is treated individually, with the selection of medications and taking into account the contraindications that the patient has.

Physical therapy complexes recommended by the attending physician can also restore the tibial nerve. To correct a “cock” gait, experts recommend using special orthoses that fix the foot in the correct position to prevent it from drooping.

When conservative treatment does not bring the desired effect, doctors may resort to surgery. Most often, surgery has to be done during a traumatic injury, when the fibers of the Nervus fibularis communis are damaged, especially with prolonged damage.

When nerve regeneration does not occur, treatment with conservative methods is useless. In such cases, it is necessary to restore the anatomical integrity of the Nervus fibularis communis. The faster surgical intervention is performed, the more effective the treatment will be and the better the prognosis for restoring the functions of the Nervus fibularis communis impaired by pathology.

In some relatively mild cases of damage, treatment with folk remedies is also possible.

The mixed nerve is one of the two main branches of the sciatic nerve and arises mainly from fibers of the LIV, LV and SI roots.

Motor fibers innervate mainly the extensors of the foot (m. tibialis anterior), extensors of the fingers (mm. extensores digitorum) and muscles that turn the foot outward (mm. peronei).

Sensitive nerve fibers innervate the skin of the outer surface of the leg (n. cutaneus surae lateralis) and the dorsum of the foot and fingers (cutaneous branches from n. peroneus superficialis and n. peroneus profundus), as shown in Fig. 96.

If the peritoneal nerve is damaged, extension (dorsial flexion) of the foot and fingers, as well as outward rotation of the foot, is impossible. The Achilles reflex (n. tibialis) is preserved.

Sensory disorders occur on the outer surface of the lower leg and the dorsum of the foot (see Fig. 96).

Articular-muscular sensation in the toes is not impaired (due to the preservation of sensitivity from the n. tibialis). Pain is usually mild or absent; the same applies to trophic disorders.

When the peroneal nerve is damaged, the foot hangs down, is slightly turned inward, the toes are slightly bent (pes equinovarus - Fig. 97). There is noticeable wasting of the muscles on the anterior outer surface of the lower leg. The patient’s gait becomes very typical (“peroneal”, “cock-like”, stoppage): the patient, in order not to touch the floor with the toe of the dangling foot, raises his leg high and first steps with the toe, then with the outer edge of the foot and, finally, with the sole.

Rice. 97. “Dangling” foot with damage to the peroneal nerve.

Rice. 98. Pes calcaneus with damage to the tibial nerve.

To determine movement disorders that occur when the peroneal nerve is damaged, in addition to the indicated gait, there are the following basic tests.

1. Extension (dorsal flexion) and outward rotation of the foot, as well as extension of the toes, are impossible.

2. It is impossible to stand and walk on your heels.

N. Tibialis (tibial nerve)

The mixed nerve is the other main branch of n. ischiadici and arises from fibers from LIV to SIII roots. Functionally, it is largely an antagonist of the peroneal nerve.

Its motor fibers innervate the flexors of the foot (m. triceps surae, i.e. m. soleus and two heads of the so-called gastrocnemii), flexors of the fingers (mm. flexores digitorum) and muscles that rotate the foot medially (mainly m. tibialis posterior).

Sensitive nerve fibers innervate the posterior surface of the leg (n. cutaneus surae medialis), the sole and plantar surface of the fingers with entry to the dorsal surface of the terminal phalanges (rr. cutanei from nn. plantares lateralis and medialis) and the outer edge of the foot (n. suralis, composed of anastomoses of the fibers of the peroneal and tibial nerves), as shown in Fig. 96.

Damage to the tibial nerve causes paralysis of the muscles that flex the foot and toes (plantar flexion) and rotate the foot medially. The Achilles reflex is lost.

Sensory disorders occur in the areas indicated in Fig. 96, i.e. on the back surface of the lower leg, the sole and plantar surfaces of the fingers, on the back of their terminal phalanges. Articular-muscular sensation in the toes while n. function is preserved. peronei does not suffer (it is disrupted only when both nerves are jointly affected, i.e., the peroneal and tibial or the main trunk of the sciatic nerve).

Muscle atrophy is usually significant and concerns the posterior group of muscles of the leg (m. triceps surae) and the sole (deep arch of the foot, retraction of the intermetatarsal spaces).

The foot is in an extension position; the protruding heel, deepened arch and “clawed” position of the toes determine the name pes calcaneus (Fig. 98).

Gait is difficult, but less than with a “dangling” peroneal foot: in this case, the patient stands on the heel due to the existing extension of the foot.

Tests to determine movement disorders in lesions of n. tibialis are: 1) the inability to flex (plantar flexion) the foot and toes and turn the foot inwards and 2) the inability to walk on the toes.

Pain when affected n. tibialis (and its fibers in the trunk. ischiadici) arise, as a rule, and are often extremely intense. Injuries to the tibial nerve and its bundles in the trunk of the sciatic nerve can cause causalgic syndrome. Vasomotor-secretory-trophic disorders are also usually significant. In this regard, there is a certain similarity between the tibial nerve and the median nerve, which is why, regarding causalgia and trophic disorders when it is damaged, one can refer to what was said above. the general symptomatology section of this chapter and in the description of lesions of the median nerve.

Peroneal nerve neuritis is a disease that is an inflammatory process that occurs due to mechanical, chemical or endogenous damage to nerve fibers.

Anatomy of the peroneal nerve

The peroneal nerve originates from the sacral plexus. Nerve fibers are part of the sciatic nerve, at the level knee joint The nerve bundle is divided into two: the tibial and peroneal nerves, which connect in the lower third of the leg into the sural nerve.

The peroneal nerve consists of several trunks and innervates the extensor muscles, the muscles that allow external rotation of the foot, and the muscles of the toes.

Causes

Due to the peculiarities of the anatomical structure, the peroneal nerve has increased vulnerability and suffers from injuries lower limbs more often than the tibial one: the nerve trunk runs almost along the surface of the bone and is practically not covered by muscle bundles.

Neuritis of the peroneal nerve can be caused by injury, hypothermia, or prolonged exposure of the limb in an awkward position. In addition, inflammation can be triggered by:

• Acute infectious diseases of microbial and viral nature: herpes, influenza, sore throat, typhoid fever.
• Chronic infections, including sexually transmitted ones: for example, syphilis or tuberculosis leads to nerve damage.
• Spinal diseases accompanied by degenerative changes or leading to narrowing of the spinal canal.
• Complications after nerve trunk injuries.
• Lower tunnel syndrome.
• Violation blood supply nerve: ischemia, thrombophlebitis, damage to arteries or veins.
• Long-term diseases leading to disorders metabolic processes: sugar diabetes both types, hepatitis of infectious and non-infectious origin, gout, osteoporosis.
• Toxic damage to nerves by alcohol, drugs, arsenic or salts of heavy metals.
• Hitting the barrel ischial nerve when performing an intramuscular injection into the buttock.
• Incorrect position legs in cases where the patient is forced to remain motionless for a long time.

Often, damage to the peroneal nerve occurs in professional athletes who receive excessive physical activity on their feet and often get injured.

Symptoms

The severity of symptoms depends on the localization of the pathological process; symptoms are divided into two groups: impaired mobility and changes in the sensitivity of the limb. The following symptoms will indicate deep compression of the nerve:

• Loss of pain, touch and temperature sensitivity surfaces of the foot from the side and front, as well as from the back of the foot, in the area of ​​​​the toes. The disorders affect the first, second and part of the third finger.
• Pain in the area of ​​the lateral surface of the leg and foot, it intensifies with movement and flexion of the limb.
• Difficulties with extension toes, up to complete limitation of mobility.
• Weakness or the inability to raise the outer edge of the foot, it is impossible to abduct the leg at the outer side of the shin.
• Inability to stand on heels or walk on them.
• "Cock" gait: the leg is excessively bent at the knee and hip joint, the foot first rests on the toes, and only then on the heel, forced lameness occurs, and the ability to move normally is lost.
• The foot that sags and turns inward, fingers are bent, return the limb to its anatomical normal position and the patient cannot straighten his fingers.
• Atphrophia leg muscles, their mass decreases compared to a healthy limb, and trophic ulcers can form.
• Change colors skin in the affected area: on the lateral surface of the leg and the back of the foot, the skin turns pale, acquiring a purple or bluish color as the neuritis develops, and sometimes darkening of areas of the skin is observed.

With superficial nerve damage, the symptoms are somewhat different:

• Arises discomfort, a burning sensation and pain on the back of the foot and fingers, as well as in the lower part of the leg, the sensitivity of these areas changes slightly.
• Observed weakness when moving the foot and toes, difficulty in extending movements of the toes, the first and second toes are especially affected.
• Foot sags slightly, the fingers do not bend.
• Atrophic the phenomena affect the lower leg only slightly; in this case, the small muscles of the foot and toes are mostly affected by degenerative changes.
• When comparing the affected leg with the healthy one, it becomes noticeable sinking interdigital spaces, especially between the first and second fingers.

If the motor branch of the nerve is not affected, only sensory symptoms will be observed, without changes in the structure of the muscle fibers.

Diagnostics

The diagnosis is established by a neurologist based on a clinical examination:

• Held survey- an anamnesis of life and illness is collected to determine when the symptoms first appeared. Based on the nature of the complaints, the cause can be determined: post-traumatic neuritis usually develops soon after injury, all symptoms in this case arise abruptly within a few days. If the cause of neuritis was chronic illness, symptoms will increase gradually.
• Performed diagnostic examination: a comparison is made of the healthy and diseased leg, the degree of muscle atrophy and the condition of the affected limb are calculated. The specialist pays attention to the position of the foot, toes, skin color and the condition of the spaces between the toes.
• The patient will be required to perform some exercises which will help the specialist understand which part of the nerve is captured: the patient is asked to abduct the foot, straighten the toes, raise the toe and stand on the heel. The extent of nerve damage can be judged by the range of movements performed.
• To determine sensitivity disorders, skin tests are performed. tests: they do dermatography of different areas of the skin, piercing the surface with a medical needle. To determine temperature sensitivity, a warm and cold water test is used.
• If neuritis was provoked by injury, it is prescribed X-ray study.
• It is used to determine the condition of muscles and nerve bundles. electromyography.

Once the diagnosis is made, treatment must begin immediately.

Drug treatment

Treatment of neuritis is aimed at eliminating the cause of the disease, and depending on it, will vary.

Inflammation of an infectious nature can be treated with antibiotics and antiviral agents. Preference is given to drugs wide range actions, sulfonamides are used as auxiliary agents.

If during the examination it was revealed serious illness, therapy is aimed at eliminating or correcting it: diabetics are prescribed insulin and similar drugs; if cancer is detected, they resort to chemotherapy or radio wave irradiation; specialized drugs are used to treat tuberculosis.

If the inflammation is caused by an incorrect position of the limb, for example, due to a too tight bandage or incorrect application of the plaster, the cause is eliminated. In some cases, changing the plaster brace is enough to eliminate the symptoms.

Before starting the course, you must familiarize yourself with all possible contraindications and side effects drugs, carefully follow the dosage and regimen of taking medications. The duration of the course depends on the patient’s condition and is determined by the attending physician.

In order to alleviate the patient's condition, symptomatic treatment is used:

• Anti-inflammatory non-steroidal drugs. Used both in the form of tablets and in the form of ointments and creams, they effectively relieve inflammation, relieve pain and swelling. The choice of form depends on the severity of the disorder: if inflammation is accompanied by pain and cannot be relieved by other means, a series of injections is performed. The dose of the drug is gradually reduced, then the patient is transferred to tablet forms, and then to local agents.
• Drugs that improve blood supply. Prescribed in order to saturate the cells with oxygen and glucose and prevent atrophic phenomena, a number of Actovegin and Solcoseryl, which effectively affect the cells of nerves and blood vessels, prevent atrophic phenomena, and contribute to the speedy restoration of nutrition of neurons and muscle fiber cells.
• Antioxidants- remove free radicals and inflammatory products from cells, help nerve cells fight hypoxia.
• Vitamins Group B- to improve nerve conduction and prevent complications of neuropathy.

The combination of drugs is prescribed by a specialist; self-medication is strictly contraindicated.

Procedures

In order for the therapy to be effective, a combination of various procedures is used:

• Physiotherapeutic exposure using amplimulse, magnetic therapy - procedures help relieve symptoms of inflammation, improve the condition of tissues and nerve fibers.
• To maintain muscle condition - stimulation dynamic currents - this prevents atrophy and maintains skeletal muscles in working condition.
• Electrophoresis. Used to transport medications directly to the treatment site. The combination of drugs depends on the cause of the disease and is selected by the attending physician.
• Recovery sensitivity and limb mobility - acupuncture and massage - a combination of various methods gives positive results and helps to quickly restore the functions of the limb after the acute phase of inflammation has passed.
• Orthopedic structures to restore the foot anatomically correct position, wearing an orthosis also helps to correct the gait.
• Treatment is recommended for rehabilitation physical training, a set of exercises is selected individually for the patient, attention is focused on returning muscles to mobility and restoring all movements in full.

Surgical intervention is resorted to if conservative treatment is ineffective.

Surgery

The operation is applied if:

1. Violated integrity nerve bundles over a significant area. If there is significant nerve injury, medications will not work, nor will any other conservative methods. The operation in this case is aimed at restoring the nerve.
2. If the nerve has been compressed, surgery may save limb patient. The surgeon cuts or removes the formations that led to the onset of neuropathy.

During the rehabilitation period, therapy is aimed at restoring the conduction of impulses and restoring limb mobility to the maximum extent possible.

Possible complications

Without treatment, the disease is protracted and can lead to a wide range of complications:

• Pain of a chronic nature, worsening the patient’s quality of life.
• Restricted leg mobility, “rooster” gait - will lead to impairment posture, lameness and, ultimately, the inability to move independently.
• Dabetic gangrene which threatens fatal or amputation of a limb.
• Trophic ulcers, muscle atrophy - in this case it will be problematic to restore mobility.

Infectious neuritis without treatment is dangerous for the development of polyneuropathy, as well as septic damage to the body.

In order to prevent complications, it is necessary to consult a doctor immediately after the first violations are noticed.