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Formenti P, Sabbatini G, Brenna G, Galimberti A, Mattei L, Umbrello M, Iezzi M, Uldedaj E, Pezzi A, Gotti M. Foot drop in critically ill patients: a narrative review of an elusive complication with intricate implications for recovery and rehabilitation. Minerva Anestesiol 2024; 90:539-549. [PMID: 38551615 DOI: 10.23736/s0375-9393.24.17912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Foot drop is a condition characterized by the inability to lift the foot upwards towards the shin bone. This condition may affect a proportion of critically ill patients, impacting on their recovery after the acute phase of the illness. The occurrence of foot drop in critical care patients may result from various underlying causes, including neurological injuries, muscular dysfunction, nerve compression, or vascular compromise. Understanding the etiology and assessing the severity of foot drop in these patients is essential for implementing appropriate management strategies and ensuring better patient outcomes. In this comprehensive review, we explore the complexities of foot drop in critically ill patients. We search for the potential risk factors that contribute to its development during critical illness, the impact it has on patients' functional abilities, and the various diagnostic techniques adopted to evaluate its severity. Additionally, we discuss current treatment approaches, rehabilitation strategies, and preventive measures to mitigate the adverse effects of foot drop in the critical care setting. Furthermore, we explore the roles of critical care physical therapists, neurologists, and other healthcare professionals in the comprehensive care of patients with foot drop syndrome and in such highlighting the importance of a multidisciplinary approach.
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Affiliation(s)
- Paolo Formenti
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy -
| | - Giovanni Sabbatini
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Giovanni Brenna
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Andrea Galimberti
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Luca Mattei
- Department of Neurosurgery, C. Besta IRCCS National Neurologic Institute Foundation, Milan, Italy
| | - Michele Umbrello
- Department of Intensive Care, New Hospital of Legnano, Legnano, Milan, Italy
| | - Massimiliano Iezzi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ersil Uldedaj
- Unit of Anesthesia, Resuscitation and Intensive Therapy, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Angelo Pezzi
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Miriam Gotti
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
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Minghetti S, Riva A, Arienti G, Peruzzi C, Nacinovich R. Peroneal mononeuropathy and polyneuropathy in adolescents with Anorexia Nervosa: a case report and literature review. Eur J Clin Nutr 2024; 78:280-285. [PMID: 38228867 DOI: 10.1038/s41430-024-01402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024]
Abstract
Peroneal neuropathy and polyneuropathy are displayed with a variable percentage in subjects affected by eating disorders and in particular by anorexia nervosa. Actually, little is known on features of these complications during the paediatric age. We describe the case of a female adolescent with right peroneal palsy and subclinical polyneuropathy associated with anorexia nervosa (AN). We review previous research about peroneal mononeuropathy and polyneuropathy associated with AN, and we develop a diagnostic and therapeutic protocol to help clinicians recognize and treat these disorders.
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Affiliation(s)
- S Minghetti
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - A Riva
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - G Arienti
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Italy
| | - C Peruzzi
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - R Nacinovich
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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3
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Collis RW, Gee AJ, Dillon P, Warwick M. Slimmer's Palsy Following Weight Loss Associated With Metastatic Breast Cancer: A Case Report. Cureus 2024; 16:e52519. [PMID: 38371057 PMCID: PMC10874286 DOI: 10.7759/cureus.52519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Common peroneal neuropathy (CPN), also known as Slimmer's Palsy, is an isolated peripheral neuropathy typically associated with rapid weight loss resulting in loss of adipose tissue and subsequent nerve compression at the fibular head and is up to three times more common in individuals with malignancy. In this case report, we describe the diagnosis of CPN in a 54-year-old female with a 2.5-month history of atraumatic left foot drop and left ankle paresthesias, preceded by a 35-40 pound weight loss over the prior 3.5 month period in the setting of metastatic breast cancer.
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Affiliation(s)
- Reid W Collis
- Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, USA
| | - Alaric J Gee
- Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, USA
| | - Patrick Dillon
- Hematology and Oncology, University of Virginia, Charlottesville, USA
| | - Michael Warwick
- Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, USA
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Baharin J, Yusof Khan AHK, Abdul Rashid AM, Loh WC, Ibrahim A, Inche Mat LN, Wan Sulaiman WA, Hoo FK, Basri H. Slimmer’s palsy following an intermittent fasting diet. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Isolated common peroneal neuropathy (CPN) is the most common lower extremity mononeuropathy and the third most common mononeuropathy overall in adults. It often associated with multiple aetiologies, such as trauma, hereditary neuropathies and iatrogenic causes. We report a rare case of acute bilateral foot drop in a late adolescent female following a rapid weight loss attributable to intermittent fasting diet.
Case presentation
A 19-year-old female presented with worsening bilateral foot drop following a rapid intentional weight loss by intermittent fasting diet. She lost 20% of her baseline bodyweight within a period of 4 months. Systemic disease and metabolic screenings for neuropathy differentials were unremarkable. Electrophysiological studies revealed severe entrapment neuropathy involving bilateral common peroneal nerves (CPN). Her confounding risk factors for CPN injury include contact sport activities and habitual leg crossing during sitting. Following a dietary modification and physical therapy she achieved complete recovery of weakness and function on follow-up.
Conclusions
In a patient with bilateral PN rapid weight loss, prognosis is good and complete neurologic recovery can be attained through combination of cessation of extreme diet and physical therapy.
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Jaeger JA, Gohil A, Nebesio TD. Acute Peroneal Neuropathy and Foot Drop in Two Adolescent Female Athletes with New-Onset Diabetes. Curr Sports Med Rep 2022; 21:39-41. [PMID: 35120048 DOI: 10.1249/jsr.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Joel A Jaeger
- Division of Sports Medicine, Department of Orthopedics, Major Health Partners, Shelbyville, IN
| | - Anisha Gohil
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Todd D Nebesio
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
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Oosterbos C, Decramer T, Rummens S, Weyns F, Dubuisson A, Ceuppens J, Schuind S, Groen J, van Loon J, Rasulic L, Lemmens R, Theys T. Evidence in peroneal nerve entrapment: A scoping review. Eur J Neurol 2022; 29:665-679. [PMID: 34662481 DOI: 10.1111/ene.15145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Daily management of patients with foot drop due to peroneal nerve entrapment varies between a purely conservative treatment and early surgery, with no high-quality evidence to guide current practice. Electrodiagnostic (EDX) prognostic features and the value of imaging in establishing and supplementing the diagnosis have not been clearly established. METHODS We performed a literature search in the online databases MEDLINE, Embase, and the Cochrane Library. Of the 42 unique articles meeting the eligibility criteria, 10 discussed diagnostic performance of imaging, 11 reported EDX limits for abnormal values and/or the value of EDX in prognostication, and 26 focused on treatment outcome. RESULTS Studies report high sensitivity and specificity of both ultrasound (varying respectively from 47.1% to 91% and from 53% to 100%) and magnetic resonance imaging (MRI; varying respectively from 31% to 100% and from 73% to 100%). One comparative trial favoured ultrasound over MRI. Variable criteria for a conduction block (>20%-≥50) were reported. A motor conduction block and any baseline compound motor action potential response were identified as predictors of good outcome. Based predominantly on case series, the percentage of patients with good outcome ranged 0%-100% after conservative treatment and 40%-100% after neurolysis. No study compared both treatments. CONCLUSIONS Ultrasound and MRI have good accuracy, and introducing imaging in the standard diagnostic workup should be considered. Further research should focus on the role of EDX in prognostication. No recommendation on the optimal treatment strategy of peroneal nerve entrapment can be made, warranting future randomized controlled trials.
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Affiliation(s)
- Christophe Oosterbos
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Thomas Decramer
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Sofie Rummens
- Department of Physical Medicine and Rehabilitation, University Hospitals of Leuven, Leuven, Belgium
- Locomotor and Neurological Disorders, Catholic University of Leuven, Leuven, Belgium
| | - Frank Weyns
- Department of Neurosurgery, East Limburg Hospital, Genk, Belgium
- Neurosciences, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Annie Dubuisson
- Department of Neurosurgery, University Hospitals of Liège, Liège, Belgium
| | - Jeroen Ceuppens
- Department of Neurosurgery, Groeninge General Hospital, Kortrijk, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - Justus Groen
- Nerve Centre, University of Leiden, Leiden, the Netherlands
| | - Johannes van Loon
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Lukas Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, Catholic University of Leuven, Leuven, Belgium
- Centre for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals of Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
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Brand P, Cejas CP, Rivero AD. Childhood focal compressive mononeuropathies during the COVID-19 pandemic in Buenos Aires, Argentina. Muscle Nerve 2022; 65:590-593. [PMID: 35083751 PMCID: PMC9015344 DOI: 10.1002/mus.27507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
Introduction/Aims Focal peripheral neuropathies are infrequently seen in pediatric patients. The COVID‐19 pandemic has disrupted normal life for many people, including complete lockdowns and school closing for long periods of time in many countries, which prompted children to stay at home. Our aim is to assess whether there has been an increased incidence of focal compressive peripheral neuropathies in the pediatric population during COVID‐19–associated lockdown. Methods Clinical, electrophysiological, and imaging characteristics were reviewed for patients referred to the electrodiagnostic (EDx) laboratory with suspicion of a focal neuropathy. The incidence of focal compressive peripheral neuropathies seen during the period of March to September 2020 was compared with the same time period in 2019. Results An increased incidence of focal neuropathies was seen in 2020 (31%) compared with 2019 (6.8%). During 2020, 7 fibular (peroneal) mononeuropathies and 2 ulnar neuropathies were diagnosed. Most patients with focal neuropathies were underweight and acknowledged prolonged screen time periods. Electrophysiological findings consisted of mostly demyelinating lesions with an overall good clinical outcome. Discussion In this study we raise awareness about a possible increased incidence of focal compressive peripheral neuropathies in children during COVID‐19–associated lockdown, which may be prevented with changing positions during sedentary activities.
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Oh MW, Gu MS, Kong HH. Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery: A case report. World J Clin Cases 2021; 9:1909-1915. [PMID: 33748241 PMCID: PMC7953405 DOI: 10.12998/wjcc.v9.i8.1909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The causes of peroneal neuropathy are various, but are rarely due to weight loss. Bilateral peroneal neuropathy caused by weight loss after surgery has been reported only after bariatric surgery and there were no reports associated with other abdominal surgery. In this report, we describe a case of the bilateral peroneal neuropathy that occurred due to marked weight loss after biliary surgery.
CASE SUMMARY A 58-year-old male did not receive adequate nutritional support after biliary surgery, and showed a massive weight loss over a short period of time (body mass index; 24.1 kg/m2 to 20.5 kg/m2 for 24 d). Then, foot drop occurred on both sides. Physical examination, electromyography (EMG) and magnetic resonance imaging studies were conducted and he was diagnosed as bilateral common peroneal neuropathy around the fibular head level. The patient was treated electrical stimulation therapy on both lower legs along with exercise therapy, and received sufficient oral nutritional support. The patient gradually recovered to his original weight, and the power of the dorsiflexor of bilateral ankles improved after conservative treatment. In addition, the follow-up EMG showed signs of improvement.
CONCLUSION Any abdominal surgery that may have rapid and marked weight loss can lead to peroneal neuropathy as a complication.
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Affiliation(s)
- Min Woo Oh
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
| | - Min Su Gu
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
| | - Hyun Ho Kong
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
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9
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Reyhani A, Dortcan N. A Rare Etiology of Bilateral Foot Drop: Weight Loss. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Excessive weight loss especially when it occurs in a short period of time can lead to some neurological problems including peroneal nerve palsy. Foot drop is the most common presentation of peroneal neuropathies and they rarely occur bilaterally at the same time. Herein, we presented a 46-year-old male patient who developed bilateral foot drop after losing 25 kgs. in two months with an intensive weight reduction diet which was advised by a doctor as a therapeutic regimen. The electromyographic study confirmed the bilateral entrapment neuropathy of the peroneal nerves at the fibular necks and these findings could not be attributed to any other factor except the weight loss. After a balanced diet and a physiotherapy programme, he recovered completely. This case highlights an uncommon but a well documented etiology of peroneal neuropathies. Being aware of this complication and close follow-up are important for the prognosis of these patients.
Keywords: foot deformities, peroneal neuropathies, weight loss
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Affiliation(s)
- Aylin Reyhani
- Health Sciences University, Fatih Sultan Mehmet Education and Research Hospital
| | - Nimet Dortcan
- Health Sciences University, Fatih Sultan Mehmet Education and Research Hospital
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10
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Broekx S, Weyns F. External neurolysis as a treatment for foot drop secondary to weight loss: a retrospective analysis of 200 cases. Acta Neurochir (Wien) 2018; 160:1847-1856. [PMID: 29961126 DOI: 10.1007/s00701-018-3614-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peroneal nerve entrapment is the most common peripheral mononeuropathy of the lower limbs. Foot drop, a common presentation, leads to an impaired eversion and dorsiflexion of the foot. An intriguing observation is the occurrence of foot drop secondary to weight loss. METHODS A retrospective study of patients surgically treated for peroneal nerve entrapment was performed between January 1, 1995 and December 31, 2016, at the Department of Neurosurgery, Genk, Belgium. Out of a total of 421 patients, 200 patients with foot drop secondary to weight loss were included. For each subject, motor and sensory outcomes after external neurolysis were investigated. As a primary objective, we examined the postoperative outcomes of external neurolysis as a treatment for foot drop in patients with peroneal nerve entrapment at the fibular head secondary to weight loss. As a secondary objective, we analyzed the correlation between patient characteristics and the success rate of external neurolysis. RESULTS When defining success as a postoperative MRC score of 4 or 5, external neurolysis has a success rate of 85% in patients with foot drop secondary to weight loss. A significant difference (P = < 0.0001) between postoperative and preoperative MRC scores indicates that external neurolysis leads to significant improvement of motor function in patients with foot drop secondary to weight loss. A multiple logistic regression model showed that "preoperative MRC scores" and "duration of symptoms" were the only variables with an impact on postoperative MRC scores. Other variables such as "age," "gender," and "side of entrapment" had no significant impact on postoperative results. CONCLUSIONS Statistical analysis emphasizes the important role of external neurolysis in the treatment of peripheral peroneal nerve entrapment. Therefore, external neurolysis at the fibular head should be regarded as a very effective and safe procedure in patients with foot drop secondary to weight loss.
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Affiliation(s)
- Senne Broekx
- Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Frank Weyns
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
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11
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Bilateral peroneal neuropathy after bariatric surgery: A case report. Turk J Phys Med Rehabil 2017; 63:348-350. [PMID: 31453478 DOI: 10.5606/tftrd.2017.670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/25/2016] [Indexed: 12/31/2022] Open
Abstract
The popularity of bariatric surgery (BS) began to increase due to the dramatic rise in severe obesity in the past decades. Postoperative follow-up after BS is important to avoid possible medical complications. Therefore, medical complications after BS should be well-known and defined. Herein, we present a case of bilateral peroneal neuropathy (PN) developed after successful BS. The patient lost 40 kg during 16 weeks of follow-up. The foot drop developed after 18 weeks after surgery on the left side and than 24 weeks after surgery on the right side. Peroneal neuropathy-associated weight loss is usually unilateral. Bilateral PN with weight loss is uncommon. The rate of weight loss is an important risk factor for PN. This case report highlights the importance of optimal dietary after BS to control the weight loss rate and nutrient deficiency.
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Mizuno J, Takahashi T. Factors that increase external pressure to the fibular head region, but not medial region, during use of a knee-crutch/leg-holder system in the lithotomy position. Ther Clin Risk Manag 2015; 11:255-61. [PMID: 25733841 PMCID: PMC4337688 DOI: 10.2147/tcrm.s72511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Paralysis of the common peroneal nerve is one of the relatively common nerve injuries related to the lithotomy position with the use of a knee-crutch/leg-holder system. Several risk factors have been implicated in lithotomy position-related common peroneal nerve paralysis during operation. Materials and methods In the present study, 21 young healthy volunteers participated in the investigation of the causes of the paralysis of the common peroneal nerve in the lithotomy position using a knee-crutch/leg-holder; Knee Crutch. We assessed the external pressure applied to the fibular head and medial regions using the Big-Mat pressure-distribution measurement system. Relationships between the peak contact pressure and physical characteristics, such as sex, height, weight, body mass index (BMI), and fibular head circumference, were analyzed. Results The peak contact pressure to the fibular head region was greater for males than for females. For all subjects, significant positive correlations were observed between the peak contact pressure to the fibular head region and weight, BMI, or fibular head circumference. However, there was no significant difference between the peak contact pressure to the fibular head region and height for any subjects. Moreover, there was no sex-related difference in the peak contact pressure to the fibular medial region, and no significant differences between the peak contact pressure to the fibular medial region and height, weight, BMI, or fibular head circumference. Conclusion External pressure to the fibular head region is greater for males than for females using a knee-crutch/leg-holder system in the lithotomy position. In addition, the external pressure to the fibular head region, but not the fibular medial region, increases with increasing weight, BMI, and fibular head circumference. Therefore, these patient-related characteristics may contribute to the risk of developing lower-extremity neuropathy, leading to injury or ischemia of the common peroneal nerve.
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Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology and Pain Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Toru Takahashi
- Faculty of Health and Welfare Science, Okayama Prefectural University, Soja, Japan
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13
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Gujar B, Flores RH. Entrapment neuropathies and compartment syndromes. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gologan RE, Walter V, Röhl H. [Peripheral nerve lesions of the lower leg due to tibiofibular ganglion]. DER NERVENARZT 2014; 85:749-52. [PMID: 24441848 DOI: 10.1007/s00115-013-3966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cystic formations around the knee are a common object of orthopedic treatment. When associated with neurological or vascular deficits further diagnostic imaging is required. This case study demonstrates the appearance of an intramuscular ganglion causing drop foot, arising from the tibio-fibular joint.
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Affiliation(s)
- R E Gologan
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland,
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15
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Patel A, Singh R, Johnson B, Smith A. Compression neuropathy of the common peroneal nerve by the fabella. BMJ Case Rep 2013; 2013:bcr-2013-202154. [PMID: 24293541 DOI: 10.1136/bcr-2013-202154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The fabella is a normal anatomical variant and has been found in up to 30% of the general population. We present the case of a 67-year-old man with pain down the lateral aspect of the left lower limb of 18 months duration. A clinical examination revealed a palpable fabella and nerve conduction studies confirmed a common peroneal nerve neuropathy at its level. Dynamic ultrasound scan and MRI of the knee showed the fabella to be impinging on the common peroneal nerve. Operative excision of the fabella was performed with significant improvement at 3 months and full recovery at 1 year. A literature review has shown that the last reported case of a compression neuropathy of the common peroneal nerve was in 1976. Anatomical considerations need to be taken into account and operative treatment has been recommended due to the favourable outcome in this case.
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Affiliation(s)
- Amit Patel
- Department of Trauma and Orthopaedics, Robert Jones Agnes Hunt Orthopaedic Hospital, Shropshire, UK
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16
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Foot drop in an adolescent with muscle edema in the anterior compartment. Eur J Paediatr Neurol 2013; 17:419-20. [PMID: 23402740 DOI: 10.1016/j.ejpn.2013.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/12/2013] [Indexed: 11/24/2022]
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17
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Reife MD, Coulis CM. Peroneal neuropathy misdiagnosed as L5 radiculopathy: a case report. Chiropr Man Therap 2013; 21:12. [PMID: 23618508 PMCID: PMC3662609 DOI: 10.1186/2045-709x-21-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/18/2013] [Indexed: 01/05/2023] Open
Abstract
Objective The purpose of this case report is to describe a patient who presented with a case of peroneal neuropathy that was originally diagnosed and treated as a L5 radiculopathy. Clinical features A 53-year old female registered nurse presented to a private chiropractic practice with complaints of left lateral leg pain. Three months earlier she underwent elective left L5 decompression surgery without relief of symptoms. Intervention and outcome Lumbar spine MRI seven months prior to lumbar decompression surgery revealed left neural foraminal stenosis at L5-S1. The patient symptoms resolved after she stopped crossing her legs. Conclusion This report discusses a case of undiagnosed peroneal neuropathy that underwent lumbar decompression surgery for a L5 radiculopathy. This case study demonstrates the importance of a thorough clinical examination and decision making that ensures proper patient diagnosis and management.
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Affiliation(s)
- Michael D Reife
- Private Practice, 8 Independence Drive, Marlborough, CT 06447, USA.
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A rare cause of deep peroneal nerve palsy due to compression of synovial cyst - Case report. Int J Surg Case Rep 2013; 4:515-7. [PMID: 23567545 DOI: 10.1016/j.ijscr.2012.11.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/10/2012] [Accepted: 11/27/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Synovial cyst is a rare cause of compression neuropathy and its differential diagnosis can be misleading. PRESENTATION OF CASE This article presents clinical, radiological, and histological findings of deep peroneal nerve palsy due to compression of a synovial cyst in a 30-year-old patient admitted with sudden drop foot. DISCUSSION Focal nerve entrapment in lower extremity due to synovial cystis a rare entity. Differential diagnosis is important. Surgical excision is the main treatment method with high success rate. CONCLUSION Synovial cyst compression which can be treated easily with surgical excision should be considered in rapidly progressed drop foot.
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Abstract
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
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Affiliation(s)
- P Bouche
- Department of Clinical Neurophysiology Salpêtrière Hospital, Paris, France.
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Meylaerts L, Cardinaels E, Vandevenne J, Velghe B, Gelin G, Vanormelingen L, Weyns F. Peroneal neuropathy after weight loss: a high-resolution ultrasonographic characterization of the common peroneal nerve. Skeletal Radiol 2011; 40:1557-62. [PMID: 21534018 DOI: 10.1007/s00256-011-1177-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/07/2011] [Accepted: 04/10/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to use in vivo ultrasonographic imaging to analyze the common peroneal nerve in controls and patients who were diagnosed with peroneal neuropathy (PN) due to significant weight loss. We also looked for a relationship between weight loss (magnitude) and the occurrence of PN. MATERIALS AND METHODS Fifty controls and six patients who were diagnosed with PN after losing a significant amount of weight were examined by means of ultrasonography (US). On the US images, the structure and reflectivity of the nerve were analyzed. Correlations were made between the ultrasonographic measurements and the body mass index (BMI) of controls. In PN patients, these ultrasonographic parameters were compared between the normal and pathological legs. RESULTS BMI was positively correlated with the transverse cross-sectional area of the nerve and fibular tunnel in controls. In controls with a high BMI, the peroneal nerve appeared thicker and the US reflectivity of the nerve was higher. A lower US reflectivity was observed in the pathological legs of the six patients who developed PN after weight loss. CONCLUSION The transverse cross-sectional area and reflectivity of the peroneal nerve on the US images could be viable tools in the diagnosis of PN after weight loss.
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Affiliation(s)
- Liesbeth Meylaerts
- Department of Radiology, Ziekenhuis Oost-Limburg, Schiepsebos 6, 3600 Genk, Belgium.
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Greer-Bayramoglu RJ, Nimigan AS, Gan BS. Compression neuropathy of the peroneal nerve secondary to a ganglion cyst. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011; 16:181-3. [PMID: 19721802 DOI: 10.1177/229255030801600307] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Peripheral neuropathies caused by ganglion cysts are rare, particularly in the lower extremities. The case of a 45-year-old man with a two-month history of foot drop and swelling in the region of the right fibular head is presented. Physical examination and electromyogram studies verified a peroneal nerve palsy. Magnetic resonance imaging revealed a lobulated, multilocular, cystic-appearing mass extending around the fibular neck. Surgical decompression of the nerve with removal of the mass and careful articular branch ligation was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. The patient regained full function within four months of the decompression. Pertinent findings on physical examination are discussed, as well as electromyogram and magnetic resonance imaging results. If symptoms persist, early surgical decompression (between the third and fourth months) is recommended.
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Greer-Bayramoglu RJ, Nimigan AS, Gan BS. Compression neuropathy of the peroneal nerve secondary to a ganglion cyst. Plast Surg (Oakv) 2011. [PMID: 19721802 DOI: 10.4172/plastic-surgery.1000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Peripheral neuropathies caused by ganglion cysts are rare, particularly in the lower extremities. The case of a 45-year-old man with a two-month history of foot drop and swelling in the region of the right fibular head is presented. Physical examination and electromyogram studies verified a peroneal nerve palsy. Magnetic resonance imaging revealed a lobulated, multilocular, cystic-appearing mass extending around the fibular neck. Surgical decompression of the nerve with removal of the mass and careful articular branch ligation was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. The patient regained full function within four months of the decompression. Pertinent findings on physical examination are discussed, as well as electromyogram and magnetic resonance imaging results. If symptoms persist, early surgical decompression (between the third and fourth months) is recommended.
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De novo footdrop resulting from an isolated acute repetitive strain injury. Pediatr Emerg Care 2009; 25:102-4. [PMID: 19225378 DOI: 10.1097/pec.0b013e318196fac3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To report a case of a teenage boy (N.K.) who had a peroneal nerve palsy after an isolated repetitive stain injury from an episode of sustained repetitive kicking and to explore the emergency physician's approach to footdrop or absent dorsiflexion. METHODS Chart review. RESULTS N.K. presented to the emergency department (ED) with right footdrop, inability to dorsiflex. Results of investigations in the ED, including radiographs of his lumbar spine and knees and a magnetic resonance imaging scan of the lumbar spine, were all normal. Electromyography showed that the extensor digitorum brevis muscle was borderline prolonged at 4.1 m/s for 65 mm, whereas the distal latency of the tibial nerve to abductor hallucis muscle was prolonged at 4.8 milliseconds for 7 cm. There were increased insertional activity and 2+ fibrillation potentials in EDB, but motor units were normal, as was recruitment. There was no conduction velocity slowing across the fibular head segment of the peroneal nerve. N.K. did not need any further follow-up because his function was completely regained. CONCLUSIONS Repetitive strain injury, even in acute settings may predispose one to developing a peroneal neuropathy. As in the case of N.K., most cases resolve in weeks to months, and electromyography studies are important to help definitively decide what type of neuronal injury has been sustained.
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Weyns FJM, Beckers F, Vanormelingen L, Vandersteen M, Niville E. Foot drop as a complication of weight loss after bariatric surgery: is it preventable? Obes Surg 2008; 17:1209-12. [PMID: 18074496 DOI: 10.1007/s11695-007-9203-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although rare, the relationship between peroneal nerve palsy and weight loss has been well documented over the last decades. Of the 160 patients operated for persisting foot drop in our institution, weight loss was considered to be the major contributing factor for 78 patients (43.5%). METHODS We compared patients who developed a foot drop after bariatric surgery with a control group of patients who underwent bariatric surgery (gastric banding) but did not develop peroneal neuropathy. RESULTS 9 patients developed foot drop after bariatric surgery. The mean weight loss for these patients was 45 kg. Weight reduction took place during a mean period of 8.6 months. Our control group consists of 10 patients. The mean weight loss of these patients was 43.8 kg, and the weight reduction took place during a mean period of 21.7 months. CONCLUSION In contrast to earlier studies, we demonstrated that significant weight loss is correlated with a higher risk to develop foot drop and that the time period in which the weight loss is achieved is important. A rapid reduction of body weight is correlated with a higher risk to develop foot drop.
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Affiliation(s)
- Frank J M Weyns
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
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Bibliography. Current world literature. Neuro-muscular diseases: nerve. Curr Opin Neurol 2007; 20:600-4. [PMID: 17885452 DOI: 10.1097/wco.0b013e3282efeb3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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