High-Resolution Ultrasound Mapping of the Superficial Peroneal Nerve in the Distal Leg: An Anatomical Guide for Surgical Approaches

International Journal of Anatomy and Physiology | Vol. 15, No. 9, September 2026 | pp. 161–172

DOI: 10.46882/2026/IJAP/000181

Article Type: Original Research Article

Title: High-Resolution Ultrasound Mapping of the Superficial Peroneal Nerve in the Distal Leg: An Anatomical Guide for Surgical Approaches

Names of Authors: Min-Ji Kim¹, Dong-Hyun Seo²

Authors’ Affiliations: ¹Department of Anatomy, Yonsei University College of Medicine, Seoul, South Korea; ²Department of Orthopedic Surgery, Severance Hospital, Seoul, South Korea

Abstract:
Iatrogenic injury to the superficial peroneal nerve (SPN) frequently complicates lateral malleolar fixations, ankle arthroscopies, and compartment decompressions. This study utilized high-resolution ultrasound (HRUS) to precisely trace the exit point and branching patterns of the SPN relative to bony landmarks. One hundred healthy lower limbs from fifty volunteers (25 males, 25 females) were scanned using a 15-MHz linear transducer. The point where the SPN pierced the deep crural fascia was measured relative to the tip of the lateral malleolus. The nerve's bifurcation into the medial dorsal cutaneous nerve (MDCN) and intermediate dorsal cutaneous nerve (IDCN) was mapped. The SPN pierced the crural fascia at a mean distance of 7.4 ± 1.2 cm proximal to the lateral malleolus. In 84.0% of limbs, the nerve emerged in the anterior intermuscular septum (Type Type I), while in 16.0% it pierced the peroneus longus belly (Type II). Bifurcation into the MDCN and IDCN occurred subfascially in 28.0% of cases and extrafascially in 72.0%. The mean distance from the bifurcation to the lateral malleolus tip was 4.8 ± 0.9 cm. No significant correlation was noted between side or gender and nerve position (p > 0.05). These ultrasonic measurements offer reliable anatomical boundaries, allowing surgeons to non-invasively locate the SPN and mitigate nerve injury risk during distal leg procedures.

Keywords: Superficial Peroneal Nerve, High-Resolution Ultrasound, Anatomical Variations, Crural Fascia, Lateral Malleolus

Manuscript Timeline: Received: June 25, 2026; Revised: August 06, 2026; Accepted: August 23, 2026; Published: September 07, 2026

Citation: Kim M.J., & Seo D.H. (2026). High-Resolution Ultrasound Mapping of the Superficial Peroneal Nerve in the Distal Leg: An Anatomical Guide for Surgical Approaches. International Journal of Anatomy and Physiology, 15(9), 161–172. DOI: 10.46882/2026/IJAP/000181

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