Deep Peroneal Nerve

Fig. 14.10a-d. Anatomy of the peroneal nerve, a Schematic drawing of a lateral view of the knee illustrates the course of the common peroneal nerve (curved arrows) which branches from the sciatic nerve (black arrow) at the apex of the popliteal fossa and descends posterior to the biceps femoris muscle (Bf) and tendon (asterisk) to turn anteriorly around the fibular head. The nerve then continues down between the lateral side of the neck of the fibula and the peroneus longus muscle (PI). Here the peroneal nerve divides into its two terminal branches, the superficial peroneal nerve (white arrowhead) and the deep peroneal nerve (white arrow), md sends a recurrent articular branch (open arrowhead).b-d Transverse Tl-weighted MR images obtained at the levels indicated in a (horizontal bars) reveal the normal position of the common peroneal nerve (curved arrow) relative to the biceps tendon, the crural fascia (open arrowhead) fibular head (FH). Note the relationships of the main trunk and the superficial (white arrowhead) and deep (white arrow) peroneal nerves with the fibular and neck (FN). Black arrow, tibial nerve... 

The anterior ankle is traversed by the deep peroneal nerve and the anterior tibial artery. The deep peroneal nerve is the larger of the two terminal divisions of the common peroneal nerve. It enters the anterior ankle crossing the interosseous membrane together with the anterior tibial artery and veins, usually lateral to the extensor hallucis longus tendons (Fig. 16.9). The anterior tibial artery, the smaller of the terminal branches of the popliteal artery, ends at the ankle joint, midway between the malleoli where it becomes the dorsalis pedis artery. It contributes to the blood supply of the ankle. 

Fig. 16.9. Deep peroneal nerve. Anterior view of a gross dissection of the ankle shows the position of the deep peroneal nerve (arrows) relative to the tihialis anterior (ta), extensor hallucis longus (ehl) and extensor digitorum longus (edl) tendons as well as to the inferior extensor retinaculum (stars). LM, lateral malleolus. The insert at the left of the figure indicates the site of the anatomic specimen illustrated...

At the medial ankle, the tibial nerve, a continuation of the medial trunk of the sciatic nerve, passes deep to the flexor retinaculum in the space between the medial malleolus and the medial wall of the calcaneus (Fig. 16.10a). The retinaculum consists of a thin fascia and forms the roof of the tarsal tunnel (Fig. 16.10). In addition to the nerve, the tarsal tunnel encloses the tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons, the posterior tibial artery and two veins (Fig. 16.10a,b). Posteroinferior to the medial malleolus, the tibial nerve divides into the medial and lateral plantar nerves and the calcaneal nerve, which is responsible for the sensitive supply of the heel (Fig. 16.11). The plantar nerves supply the intrinsic foot muscles, except for the extensor digitorum brevis, which is innervated by the deep peroneal nerve. The posterior tibial artery accompanies the nerve deep to the flexor retinaculum and, inferior to the medial malleolus, it divides into medial and lateral plantar arteries (Fig. 16.11). 

Fig.l6.94a,b. Schwannoma of the deep peroneal nerve, a Longitudinal gray-scale and b transverse color Doppler 12-5 MHz US images over the anterior ankle reveal a well-defined oval hypoechoic mass (asterisk) between the extensor hallucis longus muscle (ehl) and distal tibia. Note the continuity of the mass with the deep peroneal nerve (open arrows) and the displacement of the anterior tibial artery (white arrow). No erosive signs to the underlying bone are observed... 

The dorsalis pedis artery is the direct continuation of the anterior tibial artery and represents the main vascular supply for the toes it begins midway between the lateral and medial malleolus and runs anteromedially between the tendons of the extensor hallucis longus and extensor digitorum longus to reach the first interosseous space. At the level of the tarsometatarsal joint, the dorsalis pedis artery gives off the first metatarsal artery and an arcuate artery which sends branches to the second, third, and fourth metatarsals. Lateral to the dorsalis pedis artery, the medial branch of the deep peroneal nerve is directed straight forward to reach the first intermetatarsal space. 

Fig. 17.12a,b. Dorsalis pedis artery, a Long-axis and b short-axis color Doppler 12-5 MHz US images reveal the dorsalis pedis artery (white arrows) as it passes over the tarsometatarsal joint (arrowhead) between the middle cuneiform (Cutij) and the second metatarsal (Met. During its course, the artery is accompanied by the deep peroneal nerve (black arrow). The photograph at the bottom right of the figure indicates probe positioning... 

Entrapment of the deep peroneal nerve at the dorsal aspect of the hindfoot and midfoot may occasionally be encountered in runners, soccer players, skiers, and dancers (Schon 1994 McCrory et al. 2002 Delfaut et al. 2003). The nerve can be compressed at several locations, including the point... 

The anterior recess of the tihiotalar joint is reached hy means of an anterior approach inserting the needle between the tihialis anterior and the extensor hallucis longus tendons in order to avoid damage to the anterior tihial artery and the deep peroneal nerve that run in a more lateral position. Because... 

Deep Peroneal Nerve, Common Peroneal Nerve, Sciatic Nerve, Dorsal Division Sacral Plexus, L5, SI. 

Figure 110. Course and distribution of the deep peroneal nerve. (From Haymaker, W., and Woodhall, B. Peripheral Nerve Injuries, 2nd ed. W. B. Saunders Co., 1953.)...

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