Injuries of peripheral nerves of the leg, foot and ankle: an often unrecognized consequence of ankle sprains

Gary C. Hunt

The Foot

Volume 13, Issue 1 March 2003, Pages 14-18

Gary Hunt provides an excellent review of peripheral nerve injuries as a consequence of ankle sprains in the latest issue of The Foot. The peripheral nerves of the lower limb may be damaged through compartment syndrome, bruising around the nerve, or nerve traction as a consequence of the ankle sprain trauma. The resulting symptoms include decreased proprioceptive ability, weakness of the pre-tibial nerves, sensory deficits and Tinel's sign (pain on gentle tapping of the lateral malleolus). All of these can complicate the rehabilitation process.

In the ankle the peripheral nerves which may be damaged are the Sural nerve, the Superficial Peroneal nerve, the Deep Peroneal nerve and the Tibial nerve. The Sural nerve provides cutaneous sensation and articular supply to the posterior, lateral, and anterior ankle joint. The Superficial Peroneal nerve provides sensory supply to the lateral and anterior aspects of the leg and dorsal foot and a motor supply to the Peroneal muscles. The Deep Peroneal nerve provides sensory and articular supply to the anterior aspect of the leg and foot, as well as a motor supply to Tibialis anterior muscle and the toe extensors. The Tibial nerve provides cutaneous and articular branches to the medial side of the ankle and foot, where it then divides into medial and lateral plantar branches in the talocalcaneal tunnel, and progresses into the foot to provide medial and lateral plantar sensation, respectively. The Tibial nerve provides a motor supply to the calf muscles and Tibialis Posterior and the Medial and Lateral Plantar nerves supply the intrinsic muscles of the foot. The author states that injury to any of these structures may be overlooked because of more obvious ligamentous injuries following an ankle sprain.

There is little evidence presented relating to the effective management of peripheral nerve injuries. The author concludes by stating that clinicians require a good knowledge of nerve pathophysiology and healing. Clinicians should also be mindful of the effect of nerve injury on proprioceptive mechanisms and its role in impaired ankle stability.

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