Recovery of Longstanding Painful Drop Foot Following Common Peroneal Nerve Neurolysis: A Case Series.

Abstract

A drop foot is characterized by the inability to lift the foot. If caused by common peroneal nerve (CPN) compression and conservative treatment is unsuccessful, a neurolysis may be considered. Studies suggest that a short period of time between start of symptoms and neurolysis is related to success. Aim of the present study is to report on 3 patients who underwent CPN neurolysis up to 72 months after the onset of a drop foot. The first patient was a 22-year-old female who sustained a painless left-sided drop foot after prolonged kneeling that was treated with a brace. One year later she developed severe anterolateral neuropathic lower leg pain not responding to medication. CPN neurolysis 14 months after the event resulted in complete pain relief and normal foot function that persists after two years of follow up. The second patient was a 58-year-old female with a 6-year history of chronic left-sided neuropathic lower leg pain and drop foot due to CPN damage following multiple knee surgeries. Three months after surgical CPN decompression, she reported pain relief and partial foot drop recovery. However, the painful drop foot recurred 5 months later, likely due to ongoing knee instability. Two years later, her situation is unchanged. The third patient was a 65-year-old male with spontaneous right-sided drop foot and severe neuropathic lower leg pain that had developed following intense walking for body weight reduction. As conservative treatment was unsuccessful, he chose to undergo CPN decompression 8 months later. Foot function recovered with total pain relief within the first 3 months postoperatively. Ten years later, he is still without symptoms. These cases illustrate that surgical decompression for drop foot may reduce symptoms, even in chronic cases. Neurolysis should be considered in selected cases, particularly if the drop foot is associated with unacceptable neuropathic pain.