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Abstract

Objective: To determine the clinical and ultrasound features of medial branch lesion of the deep fibular nerve and the improvement in symptoms after conservative treatment.
Patients and methods: Patients with sensory symptoms suggestive of deep fibular nerve lesion and at least a trigger zone radiating along the course of the nerve at physical examination were included in the study if the lesion was confirmed by electroneuromyography. Each foot underwent hypoesthesia testing of the first intermetatarsal webspace using light touch with finger and a monofilament; profile weight-bearing x-rays, as well as ultrasonography.
Results: Seventy-eight feet displaying a medial branch lesion of the deep fibular nerve in electroneuromyography were included in the study. Fifty-nine (76%) of these 78 feet had hypoesthesia of the first dorsal intermetatarsal webspace and 34 (44%) a pes cavus foot. Ultrasonography revealed at least one nerve impingement in 40 of these feet (51%). Conservative treatment was effective in 68 feet (87%), including 31/40 feet (78%) with nerve impingement. Ten feet out 78 (13%) had surgical nerve release.
Discussion: The association of trigger point on the nerve pathway and hypoesthesia of the first dorsal intermetatarsal webspace allowed diagnosis of medial branch lesion of the deep fibular nerve in three-quarters of all cases. Imaging should be performed to seek direct impingement on the nerve. However, impingement is often absent and the lesion of the nerve can be caused in this case by extrinsic compression at the foot as well as stretching of the nerve. Remarkably, we showed here that feet with medial branch lesion of the deep fibular nerve most often respond to conservative care, even in the cases of nerve impingement.
Conclusion: These results should encourage physicians in charge of patients experiencing pain of the dorsum of the foot to carefully seek clinical features of the medial branch lesion of the deep fibular nerve.

Keywords: Foot; Medial branch of the deep fibular nerve; Anterior tarsal tunnel syndrome