The common fibular nerve is the most commonly injured major nerve in the lower limb. Its exposed position around the fibular neck makes it vulnerable to direct compression, traction from knee dislocation, and fibular head fracture. Complete CPN palsy produces foot drop (inability to dorsiflex or evert the foot) and requires ankle foot orthosis. Fibular neck compression from plaster cast, leg crossing, and lateral decubitus positioning are the most common causes.
| Origin | Sciatic nerve bifurcation at the popliteal fossa |
|---|---|
| Course | Descends lateral in the popliteal fossa along the biceps femoris tendon, winds around the fibular neck in the fibular tunnel, divides into deep and superficial peroneal nerves |
| Motor |
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| Sensory |
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CPN palsy must be distinguished from L4-L5 root compression: CPN spares hip abduction (superior gluteal), hamstrings (sciatic), and adductors (obturator), all intact in CPN palsy but variably affected in high sciatic or root lesions. EMG and nerve conduction studies localise the lesion to the fibular head level by showing peroneal slowing at this point. Most compressive palsies recover within 3-6 months.
Foot drop from fibular neck compression managed with ankle foot orthosis and nerve recovery monitoring, EMG at 3 months guides prognosis.
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