Skip to main content

Advertisement

SpringerLink
Log in

External neurolysis as a treatment for foot drop secondary to weight loss: a retrospective analysis of 200 cases

  • Original Article - Peripheral Nerves
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Aagaard BD, Lazar DA, Lankerovich L, Andrus K, Hayes CE, Maravilla K, Kliot M (2003) High-resolution magnetic resonance imaging is a noninvasive method of observing injury and recovery in the peripheral nervous system. Neurosurgery 53:199–203 discussion 203-194

    Article  PubMed  Google Scholar 

  2. Agur AMRDA (2012) Grant’s atlas of anatomy, 13th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  3. Alam M, Choudhury IA, Bin Mamat A (2014) Mechanism and design analysis of articulated ankle foot orthoses for drop-foot. TheScientificWorldJournal 2014:867869. https://doi.org/10.1155/2014/867869

    Article  PubMed  PubMed Central  Google Scholar 

  4. Aprile I, Padua L, Padua R, D'Amico P, Meloni A, Caliandro P, Pauri F, Tonali P (2000) Peroneal mononeuropathy: predisposing factors, and clinical and neurophysiological relationships. Neurol Sci 21:367–371

  5. Baima J, Krivickas L (2008) Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med 1:147–153. https://doi.org/10.1007/s12178-008-9023-6

    Article  PubMed  PubMed Central  Google Scholar 

  6. Buschbacher RM PN (2006) Superficial peroneal sensory nerve. Manual of nerve conduction studies (2nd edition):p. 222–226

  7. Cruz-Martinez A, Bort S, Arpa J, Palau F (1997) Hereditary neuropathy with liability to pressure palsies (HNPP) revealed after weight loss. Eur Neurol 37:257–260

    Article  PubMed  CAS  Google Scholar 

  8. Daube JR, Rubin DI (2009) Needle electromyography. Muscle Nerve 39:244–270. https://doi.org/10.1002/mus.21180

    Article  PubMed  Google Scholar 

  9. De Labachelerie CACC, Pelissier J, Laffont I, Froger J (2013) A new approach to treatment of foot-drop syndrome with functional electrical stimulation in chronic stroke patients. Ann Phys Rehabil Med:56–e384. https://doi.org/10.1016/j.rehab.2013.07.987

  10. Denny-Brown D (1947) Neurological conditions resulting from prolonged and severe dietary restriction; case reports in prisoners-of-war, and general review. Medicine 26:41–113

    Article  PubMed  CAS  Google Scholar 

  11. Drake LRVA, Mitchell AWM (2014) Gray’s anatomy for students, 3d edn. Elsevier, Philadelphia

  12. Ducic I, Felder JM 3rd (2012) Minimally invasive peripheral nerve surgery: peroneal nerve neurolysis. Microsurgery 32:26–30. https://doi.org/10.1002/micr.20959

    Article  PubMed  Google Scholar 

  13. Fabre T, Piton C, Andre D, Lasseur E, Durandeau A (1998) Peroneal nerve entrapment. J Bone Joint Surg Am 80:47–53

    Article  PubMed  CAS  Google Scholar 

  14. Ghugare BW, Singh RK, Patond KR, Joshi MU (2013) Assessment of nerve conduction study to establish most common electrophysiological predictor of lumbosacral radiculopathy among radiologically diagnosed L5S1 neural foramina compression cases. Indian J Physiol Pharmacol 57(2):209–213

  15. Gloobe H, Chain D (1973) Fibular fibrous arch—anatomical considerations in fibular tunnel syndrome. Acta Anat 85:84–87

    Article  PubMed  CAS  Google Scholar 

  16. Grant GA, Britz GW, Goodkin R, Jarvik JG, Maravilla K, Kliot M (2002) The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve 25:314–331

    Article  PubMed  Google Scholar 

  17. Graus F, Ferrer I, Lamarca J (1983) Mixed carcinomatous neuropathy in patients with lung cancer and lymphoma. Acta Neurol Scand 68:40–48

    Article  PubMed  CAS  Google Scholar 

  18. Harrison MJ (1984) Peroneal neuropathy during weight reduction. J Neurol Neurosurg Psychiatry 47:1260

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Hirose CB, McGarvey WC (2004) Peripheral nerve entrapments. Foot Ankle Clin 9:255–269. https://doi.org/10.1016/j.fcl.2004.02.001

    Article  PubMed  Google Scholar 

  20. Ho B, Khan Z, Switaj PJ, Ochenjele G, Fuchs D, Dahl W, Cederna P, Kung TA, Kadakia AR (2014) Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration. J Orthop Surg Res 9:67. https://doi.org/10.1186/s13018-014-0067-6

    Article  PubMed  PubMed Central  Google Scholar 

  21. Humphreys DB, Novak CB, Mackinnon SE (2007) Patient outcome after common peroneal nerve decompression. J Neurosurg 107:314–318. https://doi.org/10.3171/jns-07/08/0314

    Article  PubMed  Google Scholar 

  22. Huynh W, Kiernan MC (2011) Nerve conduction studies. Aust Fam Physician 40:693–697

    PubMed  Google Scholar 

  23. Ja S (2013) The common fibular nerve. In: Ultrasound Evaluation of Focal Neuropathies: Correlation with Electrodiagnosis. Demos Medical, New York, pp 349–365

    Google Scholar 

  24. Kane NM, Oware A (2012) Nerve conduction and electromyography studies. J Neurol 259:1502–1508. https://doi.org/10.1007/s00415-012-6497-3

    Article  PubMed  CAS  Google Scholar 

  25. Kang PB, Preston DC, Raynor EM (2005) Involvement of superficial peroneal sensory nerve in common peroneal neuropathy. Muscle Nerve 31:725–729. https://doi.org/10.1002/mus.20329

    Article  PubMed  Google Scholar 

  26. Katirji B (1999) Peroneal neuropathy. Neurol Clin 17:567–591 vii

    Article  PubMed  CAS  Google Scholar 

  27. Katirji MB, Wilbourn AJ (1988) Common peroneal mononeuropathy: a clinical and electrophysiologic study of 116 lesions. Neurology 38:1723–1728

    Article  PubMed  CAS  Google Scholar 

  28. Kim JY, Ihn YK, Kim JS, Chun KA, Sung MS, Cho KH (2007) Non-traumatic peroneal nerve palsy: MRI findings. Clin Radiol 62:58–64. https://doi.org/10.1016/j.crad.2006.07.013

    Article  PubMed  CAS  Google Scholar 

  29. Koehler PJ, Buscher M, Rozeman CA, Leffers P, Twijnstra A (1997) Peroneal nerve neuropathy in cancer patients: a paraneoplastic syndrome? J Neurol 244:328–332

    Article  PubMed  CAS  Google Scholar 

  30. Krackow KA, Maar DC, Mont MA, Carroll C (1993) Surgical decompression for peroneal nerve palsy after total knee arthroplasty. Clin Orthop Relat Res (292):223–228. https://doi.org/10.1097/00003086-199307000-00028

  31. Kuks JBM (2012) Mononeuropathieën van het been: Leerboek Klinische Neurologie 17th edition

  32. Lee JH, Lee BN, An X, Chung RH, Kwon SO, Han SH (2011) Anatomic localization of motor entry point of superficial peroneal nerve to peroneus longus and brevis muscles. Clin Anat 24:232–236. https://doi.org/10.1002/ca.21076

    Article  PubMed  Google Scholar 

  33. Maalla R, Youssef M, Ben Lassoued N, Sebai MA, Essadam H (2013) Peroneal nerve entrapment at the fibular head: outcomes of neurolysis. Orthop Traumatol Surg Res 99:719–722. https://doi.org/10.1016/j.otsr.2013.05.004

    Article  PubMed  CAS  Google Scholar 

  34. Mackinnon S, Dellon A (1988) Surgery of the peripheral nerve 1st Edition. George Thieme Verlag, p 638

  35. Marciniak C (2013) Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am 24:121–137. https://doi.org/10.1016/j.pmr.2012.08.016

    Article  PubMed  Google Scholar 

  36. Masakado Y, Kawakami M, Suzuki K, Abe L, Ota T, Kimura A (2008) Clinical neurophysiology in the diagnosis of peroneal nerve palsy. The Keio journal of medicine 57:84–89

    Article  PubMed  Google Scholar 

  37. Mont MA, Dellon AL, Chen F, Hungerford MW, Krackow KA, Hungerford DS (1996) The operative treatment of peroneal nerve palsy. J Bone Joint Surg Am 78:863–869

    Article  PubMed  CAS  Google Scholar 

  38. Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, Bittner C, Fialka-Moser V (2008) Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 40:665–671. https://doi.org/10.2340/16501977-0235

    Article  PubMed  Google Scholar 

  39. Price BA, Miller G (1992) Internal neurolysis. J Foot Surg 31:250–259

    PubMed  CAS  Google Scholar 

  40. Ramanan M, Chandran KN (2011) Common peroneal nerve decompression. ANZ J Surg 81:707–712

    Article  PubMed  Google Scholar 

  41. Ramos-Levi AM, Matias-Guiu JA, Guerrero A, Sanchez-Pernaute A, Rubio MA (2013) Peroneal palsy after bariatric surgery; is nerve decompresion always necessary? Nutr Hosp 28:1330–1332. https://doi.org/10.3305/nh.2013.28.4.6495

    Article  PubMed  Google Scholar 

  42. RE H (1996) Peroneal nerve entrapment at the knee. Oper Tech Sports Med 4(1):46–53

    Article  Google Scholar 

  43. Rubin DI, Kimmel DW, Cascino TL (1998) Outcome of peroneal neuropathies in patients with systemic malignant disease. Cancer 83:1602–1606

    Article  PubMed  CAS  Google Scholar 

  44. Ryan W, Mahony N, Delaney M, O'Brien M, Murray P (2003) Relationship of the common peroneal nerve and its branches to the head and neck of the fibula. Clin Anat 16:501–505. https://doi.org/10.1002/ca.10155

    Article  PubMed  Google Scholar 

  45. Shahar E, Landau E, Genizi J (2007) Adolescence peroneal neuropathy associated with rapid marked weight reduction: case report and literature review. Eur J Paediatr Neurol 11:50–54. https://doi.org/10.1016/j.ejpn.2006.10.008

    Article  PubMed  Google Scholar 

  46. Sherman DG, Easton JD (1977) Dieting and peroneal nerve palsy. Jama 238:230–231

    Article  PubMed  CAS  Google Scholar 

  47. Russell S (2006) Examination of peripheral nerve injuries: an anatomical approach. Thieme Medical Publishers, New York, pp 6–30 36-32

    Google Scholar 

  48. Sommer C (2001) Pain in peripheral nerve diseases. Karger. https://doi.org/10.1159/isbn.978-3-318-00741-1

  49. Sorell DA, Hinterbuchner C, Green RF, Kalisky Z (1976) Traumatic common peroneal nerve palsy: a retrospective study. Arch Phys Med Rehabil 57:361–365

    PubMed  CAS  Google Scholar 

  50. Sotaniemi KA (1984) Slimmer’s paralysis—peroneal neuropathy during weight reduction. J Neurol Neurosurg Psychiatry 47:564–566

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Spinner RJ, Puffer RC, Skinner JA, Amrami KK (2011) The MRI appearance and importance of the “very” terminal branches of the recurrent articular branch in fibular intraneural ganglion cysts. Clin Anat 24:268–272. https://doi.org/10.1002/ca.21109

    Article  PubMed  Google Scholar 

  52. Streib E (1993) Weight loss and foot drop. J Iowa Med Soc 83:224–225

    CAS  Google Scholar 

  53. Thoma A, Fawcett S, Ginty M, Veltri K (2001) Decompression of the common peroneal nerve: experience with 20 consecutive cases. Plast Reconstr Surg 107:1183–1189

    Article  PubMed  CAS  Google Scholar 

  54. Van den Bergh FR, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL (2013) Peroneal nerve: normal anatomy and pathologic findings on routine MRI of the knee. Insights Imaging 4:287–299. https://doi.org/10.1007/s13244-013-0255-7

    Article  PubMed  PubMed Central  Google Scholar 

  55. Wadstrom C, Backman L, Persson HE, Reizenstein P (1991) The effect of excessive weight reduction on peripheral and central nervous functions. A study in obese patients treated by gastric banding. Eur J Surg 157:39–44

    PubMed  CAS  Google Scholar 

  56. Weyns F, Bringmans T, Vandevenne J, Daenekindt T, Van Goethem A, Wuyts J, Vanormelingen L, Vandersteen M (2012) Peripheral neuropathy caused by joint-related cysts: a review of 17 cases. Acta Neurochir 154:1741–1753. https://doi.org/10.1007/s00701-012-1444-8

    Article  PubMed  CAS  Google Scholar 

  57. Weyns FJ, Beckers F, Vanormelingen L, Vandersteen M, Niville E (2007) Foot drop as a complication of weight loss after bariatric surgery: is it preventable? Obes Surg 17:1209–1212

    Article  PubMed  Google Scholar 

  58. Wilkinson MC, Birch R (1995) Repair of the common peroneal nerve. J Bone Joint Surg Br 77:501–503

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We would like to thank the Department of Neurosurgery at Ziekenhuis Oost-Limburg for providing the required data.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Senne Broekx

  2. Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium

    Frank Weyns

  3. Department of Neurosurgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium

    Frank Weyns

Authors
  1. Senne Broekx
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frank Weyns
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frank Weyns.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Comments

An interesting article with results that are not surprising, namely that: Decompressing the common peroneal nerve following the development of a weight loss associated neuropathy has a high success rate; patients with a higher preoperative MRC score and shorter duration of symptoms did better following surgical decompression. The relatively large number of patients studied makes it a useful addition to the literature.

Michel Kliot

CA, USA

This article is part of the Topical Collection on Peripheral Nerves

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Broekx, S., Weyns, F. External neurolysis as a treatment for foot drop secondary to weight loss: a retrospective analysis of 200 cases. Acta Neurochir 160, 1847–1856 (2018). https://doi.org/10.1007/s00701-018-3614-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-018-3614-9

Keywords

Search

Navigation