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Background Acute peroneal palsy is frequently caused by compression, trauma and surgery. Risk factors are weight loss, sitting with crossed legs, wrong positioning during surgery and diabetes mellitus. Focal demyelination is more frequent than axonal damage which in turn is related with an inferior prognosis. Rarely, acquired peroneal palsy is caused by intraneural ganglia. Methods We here report of three patients with untypical peroneal palsy caused by intraneural ganglia which were detected by nerve sonography (15 MHz Linear array transducer, GE Healthcare LOGIQ E9 Ultrasound). Results and conclusions A careful clinical history as well as a profound clinical and electrophysiological examination is required to disclose unusual findings. These are common in non-typical peroneal palsy. In this situation high resolution nerve sonography is a fast and sensitive method to detect intraneural ganglia. In contrast to the much more frequent “loco typico” lesion intraneural ganglia can be treated by microscopic nerve surgery as part of primary treatment strategy. Hence, detection of intraneural ganglia is meaningful for prognosis and guides therapy.