The dorsal digital nerves of the foot arise primarily from the superficial fibular (peroneal) nerve, which divides into medial and intermediate dorsal cutaneous branches that supply most of the dorsal toes. The great toe medial side and the second toe lateral side are supplied by the deep fibular nerve. The fifth toe lateral aspect and the fourth web space are supplied by the sural nerve. These nerves supply the dorsal skin and nail beds of the toes.
Dorsal digital nerve injury most commonly follows hallux valgus surgery, where the medial dorsal cutaneous nerve of the great toe is at risk from incision placement and retraction. Numbness or painful neuroma on the dorsomedial great toe is a frequent patient complaint after bunion correction. The deep fibular nerve branch to the first web space can be compressed in the anterior tarsal tunnel, producing numbness of the first web space (anterior tarsal tunnel syndrome). Digital ring blocks for toe surgery must account for the dorsal and plantar digital nerve supply.
The medial dorsal cutaneous nerve branch to the great toe is inadvertently cut or stretched during medial longitudinal incisions for hallux valgus correction, producing permanent dorsomedial toe numbness and occasionally a painful neuroma at the scar.
Compression of the deep fibular nerve at the ankle retinaculum or on the dorsal foot from tight footwear produces numbness and tingling in the first web space, diagnosed by Tinel sign over the nerve on the dorsal foot and confirmed by nerve conduction studies.
