Peroneal Nerve Decompression for Foot Drop in Gainesville and Atlanta

Treating Foot Drop From a Trapped Nerve

Suddenly catching your toes or tripping because your foot won’t lift can be frightening. When the peroneal nerve is trapped near the knee, peroneal nerve decompression can often correct the problem by freeing the nerve so strength and feeling can return.

What Is Peroneal Nerve Decompression?

The common peroneal nerve (also called the common fibular nerve) wraps around the outside of the knee, just below the bony bump at the top of the fibula. It controls the muscles that lift the foot and toes and provides feeling to the top of the foot and outer leg. Because it sits close to the surface, it is easily compressed, causing peroneal nerve injury, numbness and foot drop.

Peroneal nerve decompression is surgery to release the tight bands of tissue and muscle that are squeezing the nerve near the knee.

Who Needs Peroneal Nerve Decompression?

Foot drop or weakness lifting the foot and toes that isn’t improving
Numbness or tingling on the top of the foot and outer leg
Nerve testing showing compression of the peroneal nerve at the knee
Peroneal nerve compression after weight loss, leg crossing, prolonged squatting, a cast or brace, or a knee injury

Treatments to Try First

Remove the pressure: avoid crossing your legs, squatting or leaning on the outside of the knee
Ankle-foot orthosis (AFO): a brace that holds the foot up so you don’t trip
Physical therapy: to keep the ankle flexible and strengthen the leg
Time and monitoring: many pressure-related nerve injuries recover over a few months, with repeat nerve testing to track progress

When the nerve isn’t recovering, or symptoms keep returning, surgery can often correct the problem.

How Peroneal Nerve Decompression Is Done

Anesthesia: An outpatient procedure, usually under general anesthesia.
Incision: A small incision is made along the outside of the knee, below the fibular head.
Releasing the nerve: The bands of fascia and muscle over the nerve are opened to relieve pressure.
Closing: The incision is closed and a dressing is applied.

Watch Dr. Grunch explain peroneal neuropathy:

Video: Case Study 79, Peroneal Neuropathy, presented by Dr. Grunch on her Ladyspinedoc channel (YouTube)

And a case of “slimmer’s palsy,” peroneal nerve compression after weight loss:

Video: Case Study 238, Slimmer’s Palsy (Peroneal Neuropathy), explained by Dr. Grunch on her Ladyspinedoc channel (YouTube)

Benefits and Risks

Benefits

Relieves pressure so the nerve can recover
Can improve foot drop, numbness and pain
Usually a same-day outpatient surgery

Risks

Numbness near the incision
Infection or bleeding
Weakness that doesn’t fully recover, especially if the nerve was compressed for a long time
Risks related to anesthesia

Why Choose Dr. Betsy Grunch for Your Peroneal Nerve Decompression

Duke-trained: Dr. Grunch completed her neurosurgical residency at Duke University School of Medicine, one of the top neurosurgery programs in the country.
A nerve specialist: Neurosurgeons are trained in the entire nervous system, from the brain and spine to the nerves in the arms and legs. Dr. Grunch can tell whether your symptoms come from a pinched nerve in the neck or back or from a trapped nerve in the limb, so the right problem gets treated.
Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
A teacher at heart: As “Ladyspinedoc,” she is known for explaining nerve and spine conditions clearly. You’ll leave your visit understanding your diagnosis and every option in front of you.

What to Expect

Before surgery

You’ll meet with Dr. Grunch or one of her physician assistants to review your symptoms, exam and nerve testing, and to decide together whether peroneal nerve decompression is right for you. Our team will review your medications (including blood thinners you may need to pause) and walk you through the day of surgery. You’ll have nerve testing (EMG and nerve conduction studies), and sometimes an MRI of the lower back, to confirm the nerve is trapped at the knee.

Procedure day

Surgery usually takes about an hour, and you go home the same day. Keep using your brace if you have one.

Recovery timeline

First days: Walk with help as needed, and keep the leg raised to limit swelling.
Two weeks: Follow-up visit and removal of any stitches.
Four to six weeks: Most people return to normal daily activities.
Months: Nerves recover slowly. Strength in the foot can keep improving for many months, and physical therapy helps.

Watch Dr. Grunch’s post-op care instructions for a peroneal nerve release:

Video: Post-op Care Instructions for a Peroneal Nerve Release, from Dr. Grunch on her Ladyspinedoc channel (YouTube)

Caring for yourself at home

Your incision: Remove the dressing on day three and leave the stitches in place. You may shower starting day three. Gently clean the incision and pat it dry without scrubbing. Leave it open to air, and don’t use ointments or creams. A small amount of brownish-red drainage for a few days is normal.
No soaking: Don’t soak the incision in a bath, hot tub or pool for six weeks and until any scabs are gone.
Swelling: For the first few days, raise your leg above the level of your heart for about 30 minutes every two to three hours.
Activity: Walk every day, but avoid squatting, kneeling on the incision and heavy lifting for about four to six weeks. Protect the incision from bumping or rubbing on hard surfaces.
Medications: Take pain medication with food and avoid alcohol while taking it. Most people need it for up to two weeks. Take a daily stool softener and a laxative as needed. Don’t take blood thinners such as aspirin, warfarin, Xarelto or Plavix for five to seven days after surgery, until the office tells you to restart them.
Driving: You may drive once you’re no longer taking narcotic pain medication. Riding as a passenger is fine.
Smoking: Smoking slows healing. Our office can help if you’d like to quit.
Follow-up: Your visit is about two weeks after surgery, when any stitches are removed. If you can’t work during recovery, our office can complete employer paperwork.

Call the office at 470-293-9800 if you have a fever over 101°F, redness, warmth or significant drainage from the incision, new weakness or numbness that wasn’t there before surgery, calf pain or swelling, or constipation that medication doesn’t relieve. Call 911 for chest pain or shortness of breath.

Download your patient instructions

Your instructions depend on the type of surgery you have. Our team will give you written instructions before you go home, and you’ll find other patient sheets on our Patient Resources page.

Frequently Asked Questions

Will my foot drop get better?

Often, yes, especially when the nerve is released before it has been compressed for too long. Recovery can take several months.

What causes peroneal nerve compression?

Common causes include rapid weight loss, frequently crossing the legs, prolonged squatting or kneeling, a tight cast or brace, and injuries around the knee.

Do I still need my brace after surgery?

Keep wearing it until your foot strength returns enough that you no longer trip.

Could my foot drop be coming from my back?

Yes. A pinched L5 nerve root in the lower back can also cause foot drop, which is why your evaluation looks at both the spine and the knee.

When can I drive?

Once you’re off narcotic pain medication and can control the pedals safely, especially if the right leg was operated on.

Take the Next Step

If foot drop or numbness in your leg is affecting how you walk, you don’t have to live with it. Whether you need a diagnosis, a treatment plan or a second opinion, Dr. Grunch and the Southern Neurosurgery team are here to help you understand your options.

Call 470-293-9800 to schedule an appointment or contact us online.

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We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.

This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. If you have sudden weakness, numbness or loss of function, call 911 or go to the nearest emergency room.