Origin and course
The superficial fibular nerve is formed by the division of the common fibular nerve (n. fibularis communis). This division occurs within the superior musculo-fibular canal, 6–7 cm distal to the apex of the fibular head.
Further course of the nerve:
- Emerges from the cleft between the heads of the fibularis longus muscle.
- Descends within the lateral muscular compartment of the leg, running between the muscles of the lateral group along the anterior intermuscular septum (septum intermusculare anterius cruris).
- In the lower third of the leg, the nerve pierces the crural fascia (fascia cruris).
- It then proceeds to the foot, running superficially in the loose subcutaneous tissue, deep to the superficial veins.
Motor innervation
The nerve contains motor fibers (spinal segments L4–S1 / L5–S1) that innervate the lateral muscle group of the leg. These muscles are responsible for dorsiflexion and eversion (pronation) of the foot:
- Fibularis longus muscle (m. peroneus longus) — originates from the head and upper part of the lateral surface of the fibula and the crural fascia. Its tendon passes posterior to the lateral malleolus to the sole. The muscle plantarflexes and everts the foot, depresses its medial border, and supports the transverse arch. It is supplied by the fibular and anterior tibial arteries (aa. peronea et tibialis anterior).
- Fibularis brevis muscle (m. peroneus brevis) — originates from the lower 2/3 of the lateral surface of the fibula and attaches to the base of the fifth metatarsal bone. Performs flexion (plantarflexion) and eversion of the foot, elevating its lateral border. It is supplied by the fibular and anterior tibial arteries (aa. peronea, tibialis anterior).
Sensory innervation and branches
After becoming subcutaneous, the superficial fibular nerve provides sensory innervation to the skin of the anterolateral leg and the major part of the skin on the dorsum of the foot.
On the dorsum of the foot, it gives off the following cutaneous branches:
- Medial dorsal cutaneous nerve (n. cutaneus dorsalis medialis) — innervates the medial half of the foot and the great toe (hallux).
- Intermediate dorsal cutaneous nerve (n. cutaneus dorsalis intermedius) — innervates the adjacent surfaces of the second–third (II–III) and third–fourth (III–IV) toes.
The terminal branches of the nerve are the dorsal digital nerves of the foot (nn. digitales dorsales pedis), which innervate the dorsal surface of the toes.
Note: The nerve does not innervate the first interdigital cleft, nor the lateral and medial margins of the foot.
Clinical significance
In fibular mononeuropathy (not related to direct trauma or traction), characteristic sensory disturbances develop: loss of sensation on the lateral surface of the leg and the dorsum of the foot.
To confirm the diagnosis and detect axonal or demyelinating abnormalities, nerve conduction studies / electromyography (EMG) testing motor and sensory fibers is recommended (strength of recommendation: C). The diagnostic criterion for a lesion of the superficial branch is a decrease or complete absence of sensory responses when testing the n. peroneus superficialis compared to the healthy side.
Class and exam questions
Does the superficial fibular nerve innervate the first interdigital cleft?
No, the skin of the first interdigital cleft on the dorsum of the foot is innervated by the deep fibular nerve (n. fibularis profundus).
Where does the superficial fibular nerve become subcutaneous?
The nerve pierces the crural fascia (fascia cruris) and enters the subcutaneous tissue in the lower third of the leg.
Which nerves innervate the margins of the foot not covered by the superficial fibular nerve?
The medial margin of the foot is innervated by branches of the saphenous nerve (n. saphenus), while the lateral margin and the fifth toe are supplied by branches of the sural nerve (n. suralis).
What else to study on this topic
- Common fibular nerve (n. fibularis communis)
- Deep fibular nerve (n. fibularis profundus)
- Lateral muscle group of the leg
- Topography of vessels and nerves of the dorsum of the foot
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