The deep peroneal nerve, a branch of the sciatic nerve complex originates from the spine and courses the top of the foot giving sensation to the first and second toe. The skin and underlying tissue on the top of the foot is very thin and is at risk of pressure related injury. Neuritis refers to inflammation of a nerve. Pressure exerted from the top portion or upper of the shoe can contribute to deep peroneal neuritis. Pain that is neurologic in origin can be quite severe and can be described as shooting, burning, radiating, knife-like or numbing in quality with pressure from the shoe.
Anytime there is a nerve “problem” it is important to make sure that there is no history of sciatica and low back because nerves that enter the foot can be at greater risk for altered function. Symptoms associated with deep peroneal neuritis tend to be relieved with removing the shoe pressure. People with a high arch or instep may have a greater risk of developing deep peroneal neuritis based on the volume of their foot. Shoes with strap buckle closure system or clogs with a closed upper are also suspect.

Treatment is primarily focused on reducing the pressure overlying the nerve. Lacing techniques can “bypass” the painful area on top of the foot to relieve pressure. The tongue of the shoe can also be padded in the form of “railroad tracks” to relieve the pressure of the upper portion of the shoe. A style change including the use of sandals can also help to relieve pressure and the painful symptoms associated with deep peroneal neuritis.