Superficial Peroneal Nerve Entrapment in Female Collegiate Tennis Athlete: A Disablement Model Case Study

Abstract

A 19-year-old female, NCAA Division I collegiate tennis player presented with a burning and aching sensation halfway up the lateral portion of her right calf following an extensive period spent in a squatting position. This discomfort began distal to the fibular head, then ran along her lateral calf, reached into her ankle, and wrapped behind the lateral malleolus. Initially, the patient only noticed this discomfort during long durations of physical activity. However, she began to report symptoms with activities of daily living (ADLs) and following workouts. The patient first received a working diagnosis of a stress reaction along the mid shaft of the tibia and was restricted from activity to allow for rest and proper healing. Following the three-week rest period, the patient returned to activity but reported no improvement in symptoms. She returned for a follow-up appointment where an MRI was conducted and showed a posterior tibial stress reaction, which was treated with limited activity for an additional three weeks. Following the second rest period, the patient decided to visit another physician for an additional opinion. There, the physician performed a series of tests and imaging. The findings, along with the clinical presentation were consistent with superficial peroneal nerve (SPN) entrapment. Following this diagnosis, the patient was prescribed with a topical NSAID for pain relief, along with an individualized plan for management and return-to-activity. After a few weeks of consistent treatment, the athlete reported an improvement of symptoms and was able to return to full, pain-free activity. SPN entrapment is an interesting pathology due to its high rate of misdiagnosis and relatively uncommon nature. While SPN entrapment is not a frequently recognized condition, having the ability to observe signs, symptoms, risk factors, and etiologies is critical for accurate patient diagnosis and proper treatment to return to full, pain-free activity.