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Deep fibular nerve

The deep fibular nerve, also known as the deep peroneal nerve, is a major branch of the common fibular nerve that arises in the lower leg and provides essential motor innervation to the muscles responsible for foot dorsiflexion and sensory innervation to a specific region of the foot's skin.^[1] Originating from the sciatic nerve's posterior divisions (primarily L4-S1 nerve roots), it plays a critical role in lower limb mobility by supplying the anterior compartment muscles of the leg, including the tibialis anterior, extensor hallucis longus, extensor digitorum longus, and fibularis tertius.^[2] Additionally, it extends motor branches to intrinsic foot muscles such as the extensor digitorum brevis and extensor hallucis brevis, while its sensory component targets the skin between the first and second toes, as well as articular branches to the ankle, tarsal, and metatarsophalangeal joints.^[3] The nerve's course begins at the fibular neck, where the common fibular nerve bifurcates into deep and superficial branches; from there, it travels anteriorly through the leg, deep to the extensor digitorum longus and along the interosseous membrane, accompanying the anterior tibial artery toward the ankle.^[1] Near the ankle joint, it passes beneath the extensor retinaculum and divides into medial and lateral terminal branches: the medial branch accompanies the dorsalis pedis artery to innervate the first dorsal web space, while the lateral branch supplies the extensor muscles on the foot's dorsum.^[2] This pathway positions the deep fibular nerve within the anterior tarsal tunnel, making it susceptible to compression or trauma.^[3] Clinically, injury to the deep fibular nerve—often due to trauma at the fibular head, compression from tight footwear, or conditions like compartment syndrome—can result in foot drop, characterized by impaired dorsiflexion, weak toe extension, and sensory loss in the first web space, leading to gait abnormalities and potential falls.^[1] Diagnosis typically involves electromyography and nerve conduction studies, with management ranging from conservative observation to surgical decompression or tendon transfers in severe cases.^[3] Its vulnerability underscores its importance in orthopedic and neurological assessments of lower limb function.^[2]

Anatomy

Origin

The deep fibular nerve, also known as the deep peroneal nerve, arises as a terminal branch of the common fibular nerve at the fibular neck in the proximal third of the leg, positioned deep to the upper segment of the fibularis longus muscle and adjacent to the head of the fibula.^[4] This emergence occurs within the fibular tunnel, where the common fibular nerve bifurcates into its deep and superficial divisions, typically at a median distance of 2.8 cm (interquartile range: 2.1–3.8 cm) distal to the fibular head.^[5] The nerve's fascicles at this site are oriented medially, with motor axons positioned anteriorly and sensory axons posteriorly, reflecting its intraneural topography.^[5] From its origin, the deep fibular nerve travels obliquely anteriorly beneath the extensor digitorum longus muscle, piercing the anterior intermuscular septum to enter the anterior compartment of the leg.^[4] In this initial segment, it maintains close relations to the surrounding bony structures, coursing along the interosseous membrane near the proximal tibia and the posterior margin of the lateral tibial cortex.^[4] Early in its path, the nerve lies lateral to the anterior tibial artery and vein, which it accompanies as it descends in the upper third of the leg; the nerve initially lies lateral to the artery before crossing anteriorly to it and then returning to a lateral position.^[4] For surgical identification and procedures such as fasciotomy or tibial pin placement, the fibular head provides a critical landmark due to the nerve's superficial position at the neck and its vulnerability in the proximal zones adjacent to the tibia and fibula.^[4]

Course

The deep fibular nerve, arising as a branch of the common fibular nerve in the proximal leg, descends inferomedially through the anterior compartment of the leg in close association with the anterior tibial artery.^[4]^[6] It lies deep to the extensor digitorum longus muscle after passing obliquely forward beneath it and piercing the intermuscular septum to enter the anterior compartment.^[3]^[7] Throughout its course in the leg, the nerve runs along the anterior surface of the interosseous membrane, anterior to the tibia and adjacent to the fibula, maintaining a position lateral to the anterior tibial artery initially, before crossing anteriorly to it and then returning to a lateral position by the ankle joint.^[4]^[6] At the level of the ankle, the deep fibular nerve passes beneath the superior extensor retinaculum, located between the tendons of the extensor hallucis longus and extensor digitorum longus muscles, and continues under the inferior extensor retinaculum to transition into the foot.^[6]^[7] In the foot, it accompanies the dorsalis pedis artery (the continuation of the anterior tibial artery) and divides into lateral and medial terminal branches near the ankle joint, anterior to the talus and in relation to the tarsal bones.^[4]^[6] The nerve's path is enveloped by fascia in both the leg and foot, providing structural support along its trajectory.^[3] Anatomical variations in the deep fibular nerve's course may include the presence of an accessory deep fibular nerve in up to 28% of individuals, which can alter its positioning relative to the ankle joint and tarsal bones, potentially affecting its relations to surrounding vessels and fascia.^[4]

Branches

The deep fibular nerve, as it courses through the anterior compartment of the leg, provides multiple branches supplying the regional musculature and joints.^[4]

Muscular branches

In the leg, the deep fibular nerve issues muscular branches to the anterior compartment muscles, specifically innervating the tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius.^[6]^[3]^[4] Proximal to the ankle joint, the nerve divides into lateral and medial terminal branches.^[6]^[4] The lateral terminal branch continues into the foot, where it innervates the extensor digitorum brevis and extensor hallucis brevis muscles.^[6]^[3]^[4] The medial terminal branch travels along the dorsum of the foot, adjacent to the dorsalis pedis artery, to supply the first dorsal web space.^[4]^[3]

Articular branches

The deep fibular nerve gives rise to articular branches that supply the ankle (talocrural) joint directly, as well as contributions from its terminal branches to the talonavicular joint and metatarsophalangeal joints.^[4]^[3] Specifically, the lateral terminal branch provides innervation to the tarsal joints (including talonavicular) and the metatarsophalangeal joints of the second through fourth digits, along with a branch to the sinus tarsi.^[4] The medial terminal branch includes an interosseous branch to the first metatarsophalangeal joint.^[4]

Anatomical variations

Anatomical variations of the deep fibular nerve include an accessory deep fibular nerve arising from the superficial fibular nerve, which may provide innervation to the extensor digitorum brevis muscle either partially or exclusively; this variant occurs in up to 28% of individuals and shows autosomal dominant inheritance with incomplete penetrance.^[4]^[8] High division of the common fibular nerve, occurring proximal to the fibular neck, can alter the branching pattern and course of the deep fibular nerve.^[9]

Function

Motor innervation

The deep fibular nerve, a branch of the common fibular nerve, primarily supplies motor innervation to the muscles of the anterior compartment of the leg, enabling dorsiflexion of the ankle and extension of the toes. These muscles include the tibialis anterior, which performs dorsiflexion and inversion of the foot; the extensor hallucis longus, responsible for dorsiflexion of the ankle and extension of the great toe (hallux); the extensor digitorum longus, which extends the lateral four toes and assists in ankle dorsiflexion; and the peroneus tertius, aiding in dorsiflexion and eversion of the foot.^[4]^[10] In the foot, the lateral terminal branch of the deep fibular nerve innervates the intrinsic muscles extensor digitorum brevis, which extends the second through fourth toes at the metatarsophalangeal joints, and extensor hallucis brevis, which extends the hallux at the metatarsophalangeal joint.^[4]^[11] Additionally, the nerve provides articular branches that contribute to proprioception in the ankle, tarsal, and metatarsophalangeal joints of the foot, supporting coordinated motor responses.^[4] Within the lower limb's motor hierarchy, the deep fibular nerve facilitates reflex arcs, such as the tibialis anterior reflex (L4-S1 segments) and extensor hallucis longus reflex (L5 segment), which involve monosynaptic stretch reflexes for rapid adjustments in posture and gait.^[12]^[13]

Sensory innervation

The deep fibular nerve, also known as the deep peroneal nerve, contributes to sensory innervation primarily in the distal lower limb, with a focus on cutaneous and articular functions in the foot and ankle. Its sensory role is relatively limited compared to its motor responsibilities, but it provides essential afferent input for touch, pain, and joint position sense in specific regions. The nerve's terminal branches in the foot are key to this sensory distribution, emerging after it passes through the anterior tarsal tunnel beneath the extensor retinaculum.^[4] Cutaneous sensation is supplied via the medial terminal branch, which innervates the skin of the first dorsal web space between the great toe and the second toe. This branch divides into two dorsal digital nerves that provide sensory coverage to this interdigital area, enabling detection of tactile stimuli and temperature in this precise location. Unlike the broader dorsal foot coverage by the superficial fibular nerve, the deep fibular nerve's cutaneous contribution is uniquely confined to this web space, with minimal overlap elsewhere on the foot dorsum.^[4]^[3]^[14] Articular branches from the deep fibular nerve supply proprioceptive and nociceptive fibers to several joints in the ankle and foot, supporting joint stability and position awareness. An articular branch directly innervates the talocrural (ankle) joint, particularly its anterior capsule, while proprioceptive fibers extend to the surrounding ligaments for feedback during movement. Additionally, small articular branches reach the talonavicular joint as part of the talocalcaneonavicular complex and the cuneonavicular joint dorsally. The lateral terminal branch further contributes interosseous branches to the tarsal joints and metatarsophalangeal joints of the second to fourth toes, enhancing sensory integration in these areas. A separate branch may also innervate the sinus tarsi, a lateral cavity between the talus and calcaneus.^[4]^[15]^[16]^[17]

Clinical significance

Injuries

Injuries to the deep fibular nerve, also known as the deep peroneal nerve, represent a significant subset of lower extremity mononeuropathies. The prevalence of fibular (peroneal) neuropathy, in which the deep branch is commonly involved, is approximately 19 cases per 100,000 individuals, predominantly unilateral and more common in males.^[18] This nerve is particularly vulnerable due to its anatomical course around the fibular neck, where it is susceptible to trauma and compression.^[19] As the deep branch of the common fibular nerve, deep fibular injuries frequently occur in conjunction with common fibular nerve damage, though isolated deep fibular mononeuropathies can occur; overall, peroneal neuropathy is one of the most frequent mononeuropathies in the lower limb.^[11] Common causes of deep fibular nerve injuries include traumatic events such as knee dislocations, which affect up to 40% of cases, and fractures at the proximal fibula or tibia.^[19] Non-traumatic etiologies encompass compression from tight casts, prolonged squatting, or habitual leg crossing, as well as ischemic events and systemic conditions.^[20] Symptoms typically involve motor deficits such as foot drop due to impaired ankle dorsiflexion, weakness in great toe extension, and a characteristic steppage gait to compensate for the drop.^[19] Sensory manifestations include numbness or paresthesia in the first dorsal web space between the great and second toes.^[20] Diagnosis relies on clinical history and examination, supplemented by electromyography (EMG) and nerve conduction studies to confirm axonal loss or demyelination and localize the lesion.^[19] Magnetic resonance imaging (MRI) is valuable for assessing nerve continuity and identifying compressive masses or fractures.^[20] Prognosis varies by injury severity and timeliness of intervention; conservative management with ankle-foot orthoses, physical therapy, and bracing often suffices for mild cases, promoting recovery through neuroplasticity and strengthening.^[19] Severe or open injuries may require surgical decompression, neurolysis, or nerve repair within 72 hours, yielding functional recovery rates of up to 84% with end-to-end suturing and 75% with short grafts less than 6 cm.^[20]

Entrapment and compression

The deep fibular nerve, also known as the deep peroneal nerve, is susceptible to entrapment and compression primarily at the anterior tarsal tunnel, where it passes beneath the inferior extensor retinaculum at the ankle. This condition, termed anterior tarsal tunnel syndrome, results in compression of the nerve, leading to symptoms such as sharp pain, paresthesia, and numbness in the dorsal aspect of the foot, particularly the first web space between the great and second toes.^[21] Motor involvement may manifest as weakness in the extensor digitorum brevis muscle, potentially altering gait.^[22] Common causes include repetitive microtrauma from activities like running, acute ankle sprains, tight or ill-fitting footwear that exerts pressure over the dorsum of the foot, and space-occupying lesions such as ganglion cysts or osteophytes at the talonavicular or tarsometatarsal joints.^[21] Chronic ankle instability can exacerbate the entrapment by altering the retinacular tension.^[23] Diagnosis relies on clinical evaluation, including a positive Tinel's sign elicited by percussion over the entrapment site, which is reported in up to 100% of confirmed cases, along with provocation tests such as ankle plantar flexion to reproduce symptoms.^[21] Imaging modalities like ultrasound or MRI can identify compressive lesions, while nerve conduction studies may demonstrate slowed conduction across the affected segment, though electromyography is often normal due to the nerve's predominantly sensory distribution in this region.^[24] Diagnostic nerve blocks with local anesthetics can confirm the site by temporarily relieving symptoms.^[21] The deep fibular nerve is also vulnerable in anterior compartment syndrome, where elevated intracompartmental pressure in the anterior leg compartment compromises perfusion, leading to nerve ischemia, sensory deficits in the first dorsal web space, and potential motor weakness in foot dorsiflexion and toe extension. Initial treatment is conservative, emphasizing removal of offending factors such as modifying footwear, using orthotic inserts to reduce pressure, and administering nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections to alleviate inflammation.^[24] If symptoms persist after 3-6 months, surgical intervention involves decompression by releasing the inferior extensor retinaculum and excising any compressive masses, yielding good to excellent outcomes in 60-100% of cases.^[21] As of 2025, emerging regenerative approaches for refractory cases include neurotrophic agents like B vitamins to support axonal regeneration and mesenchymal stem cell therapies to promote nerve repair, particularly in cases with persistent deficits post-decompression.^[25] Nerve grafts or transfers, such as superficial peroneal nerve branches to the deep fibular nerve, are being explored in severe entrapments with significant axonal loss.^[26]

References

[1]
Anatomy, Bony Pelvis and Lower Limb: Calf Common Peroneal ...
Oct 17, 2022 · Structure and Function The common fibular nerve is ultimately responsible for innervating the muscles that compose the lower extremity's ...<|control11|><|separator|>
[2]
Deep fibular (peroneal) nerve: Origin, course, function - Kenhub
The muscular branches innervate the following muscles: tibialis anterior, extensor digitorum longus, extensor hallucis longus and fibularis tertius.
[3]
Deep Peroneal Nerve - Anatomy - Orthobullets
Oct 26, 2019 · Innervation ... none. Origin. CNS origin. is derived from the common peroneal (fibular) nerve, which is made of the dorsal branches of L4 and L5.
[4]
Anatomy, Bony Pelvis and Lower Limb: Calf Deep Peroneal Nerve ...
Aug 9, 2025 · Within the anterior (extensor) compartment of the leg, the deep fibular nerve supplies the tibialis anterior, extensor hallucis longus, extensor ...Introduction · Structure and Function · Muscles · Physiologic Variants
[5]
Intraneural Topography and Branching Patterns of the Common ...
Oct 17, 2024 · It then courses anteriorly along the fibular neck, where it terminates by dividing into the deep (DPN) and superficial peroneal nerves (SPN).
[6]
The Deep Fibular Nerve - Course - Motor - Sensory - TeachMeAnatomy
**Summary of Deep Fibular Nerve Course:**
[7]
Deep peroneal nerve | Radiology Reference Article | Radiopaedia.org
Jul 17, 2025 · The deep peroneal nerve, also known as deep fibular nerve, is one of two terminal branches of the common peroneal nerve.
[8]
The accessory deep peroneal nerve and anterior tarsal tunnel syndrome: case report - PubMed
### Summary of Anatomical Variations of the Deep Peroneal Nerve (Accessory Branches)
[9]
An anomalous variation in the division pattern of the common ... - NIH
Common peroneal nerve divides into superficial and deep peroneal nerve at the neck of fibula. An unusual finding in the dividing pattern of the common peroneal ...
[10]
Nerves of the Lower Limb | UAMS Department of Neuroscience
muscles of the anterior compartment of the leg (tibialis anterior m., extensor hallucis longus m., extensor digitorum longus m., fibularis tertius m.) and ...
[11]
[PDF] Fibular (Peroneal) Neuropathy
Just rostral or under the inferior extensor retinaculum, the deep fibular nerve branches into medial and lateral branches. The lateral branch of the deep ...
[12]
Reflex arcs | Deranged Physiology
Jul 3, 2021 · Reflex arcs consisiting of two neurons, i.e. with one synapse · Examples include the deep tendon reflexes: · Peripheral nerve (lower motor neuron) ...
[13]
https://www.ncbi.nlm.nih.gov/books/NBK541028/
[14]
Fibular (Peroneal) Neuropathy - Musculoskeletal Key
Apr 17, 2017 · Sensory loss may be found over the foot dorsum (superficial branch) and/or in the first web space (deep branch). However, sensory symptoms may ...Key Points · Common Fibular (peroneal)... · Causes
[15]
Ankle joint denervation. Part 1: Anatomy - The sensory innervation of ...
Aug 7, 2025 · The anterior aspect of the joint capsule receives innervation from articular branches from the saphenous, superficial, and deep fibular nerves; ...<|separator|>
[16]
Talocalcaneonavicular joint: Bones, ligaments, movements - Kenhub
The innervation of the inferomedial aspect of the talocalcaneonavicular joint is provided by the medial plantar nerve, while the dorsomedial, dorsal and lateral ...Missing: cuneonavicular | Show results with:cuneonavicular
[17]
Joints and ligaments of the foot: Anatomy | Kenhub
Innervation of the cuneonavicular joint is provided by the deep fibular (dorsally), medial and lateral plantar nerves (plantar surface). Muscles. Slight gliding ...Ankle Joint · Talocalcaneal Joint · Tarsometatarsal Joints
[18]
Foot Drop - StatPearls - NCBI Bookshelf
May 1, 2025 · The deep fibular nerve innervates the ankle and toe extensors and provides sensory innervation to a small area in the first web space ...
[19]
Peroneal Nerve Injury - StatPearls - NCBI Bookshelf
Feb 25, 2024 · The peroneal nerve, or the fibular nerve, is a significant nerve innervating the lower extremity. With fibers originating from the posterior ...
[20]
Evaluation and treatment of peroneal neuropathy - PMC
Peroneal nerve compromise results in the clinical complaint of weakness of the ankle dorsiflexors and evertors. This peripheral origin of foot drop has been ...
[21]
The Peripheral Nervous System in Amyotrophic Lateral Sclerosis
Axonal degeneration, loss of peripheral axons and destruction of nerve terminals are early events in the disease pathogenic cascade, anticipating MN ...
[22]
Anterior Tarsal Tunnel Syndrome - StatPearls - NCBI Bookshelf - NIH
May 23, 2023 · Most commonly, the deep peroneal nerve becomes entrapped beneath the inferior extensor retinaculum secondary to acute trauma or repetitive ...Continuing Education Activity · Introduction · Etiology · Evaluation
[23]
An Update on Peroneal Nerve Entrapment and Neuropathy - PMC
Deep Peroneal Nerve (DPN) Radiographic imaging is important for diagnosing DPN neuropathy specifically as the most common causes are secondary to nerve ...
[24]
Nerve entrapment syndromes of the lower limb: a pictorial review
Oct 2, 2023 · Entrapment of the deep peroneal nerve can occur as it passes through the anterior tarsal tunnel, known as anterior tarsal tunnel syndrome (Fig.
[25]
Overview of nerve entrapment syndromes in the foot and ankle - NIH
Mar 5, 2025 · Non-surgical management is the primary treatment for anterior tarsal tunnel syndrome, focusing on patient education, medications, local ...
[26]
Complete Recovery From Acute Peroneal Nerve Palsy With ... - NIH
Feb 3, 2025 · Neurotrophic agents such as B vitamins and vitamin C supplements can support nerve recovery and regeneration.
[27]
Superficial Peroneal Nerve Motor Branch Transfer to the Deep ... - NIH
May 9, 2025 · This study explored a new surgical approach by transferring a superficial peroneal nerve (SPN) branch to DPN. Cadaveric analysis, manual histomorphometry, and ...