Working Diagnosis:
Common peroneal nerve neuropraxia

Treatment:
The patient was referred to physical therapy for electrical stimulation of his common peroneal nerve, electrical muscle stimulation (estim), gait and strength training.
He was advised to continue to use the foot splint and to use a covering at the knee to protect the common peroneal nerve over the fibular head.

Outcome:
At 3 month follow-up appointment, patient had 50% return of strength. Patient was subsequently lost to follow up.

Author's Comments:
The common peroneal nerve neuropraxia was likely secondary to his excessive crossing of the legs resulting in compression at the fibular head. He has no previous history of easily compressible nerves which makes the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) less likely, although still possible. The resultant injury to the peroneal nerve can be secondary to compression (such as in this case), trauma, neurologic conditions, compartment syndrome or iatrogenic causes. The etiology of the nerve injury will determine the best course of action. As this patients nerve injury was likely secondary to excessive nerve compression, no further intervention was pursued and conservative management was continued.

Editor's Comments:
Patients may present with a “slapping gait”, foot drop, decreased sensation to the dorsal foot and the lateral aspect of the lower leg, weakness and muscle wasting.
An EMG, Nerve conduction tests and MRI may be beneficial.

References:
Baima J, Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med 2008; 1:147.
Poage C, Roth C, Scott B. Peroneal Nerve Palsy: Evaluation and Management. J Am Acad Orthop Surg 2016; 24:1.

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