Peroneal neuropathy from Ankle-Foot orthoses

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Abstract

Mononeuropathies are uncommon in childhood but can be a cause of significant disability. A considerable proportion of pediatric peroneal palsies arise as iatrogenic complications of casting, footboards, and intraoperative positioning. This article provides a description of a patient who developed bilateral peroneal palsies after cardiac transplantation. Factors predisposing this patient to neuropathy included hemophilia and prolonged immobilization, with focal involvement of the peroneal nerves being likely related to the use of ankle-foot orthoses. Peroneal nerve palsies are a significant, but potentially avoidable, iatrogenic complication of lower-extremity orthoses.

Introduction

Mononeuropathies are uncommon in childhood but can cause significant disability. Peroneal neuropathy most frequently occurs at the level of the fibular head as a result of focal compression, resulting in foot drop and variable sensory loss. A significant proportion of pediatric peroneal palsies arise as iatrogenic complications of casting, footboards, and intraoperative positioning. This article presents an adolescent with hemophilia and cardiomyopathy who developed bilateral peroneal palsies after cardiac transplantation. Factors predisposing this patient to neuropathy included prolonged immobilization, altered consciousness, and coagulopathy, with focal involvement of the peroneal nerves being likely related to the use of ankle-foot orthoses.

Section snippets

Case history

A 13-year-old male with mild hemophilia A (factor VIII activity of 5%) presented with increasing fatigability and exercise intolerance. Echocardiography revealed a severely dilated cardiomyopathy, which subsequently remained idiopathic in spite of an extensive evaluation. He was evaluated for cardiac transplantation. Since his myocardial dysfunction was so severe as to predispose him to formation of intracardiac thrombi, he was given factor VIII supplementation and anticoagulated with heparin.

Discussion

Peroneal neuropathies present with foot drop resulting from weakness of ankle and foot dorsiflexion. Pain is rare, but numbness of the lower lateral aspect of the leg and dorsum of the foot is common [1].

Peroneal neuropathies are uncommon in childhood, although they may represent as many as 18% of pediatric mononeuropathies [2]. Most occur at the level of the fibular head [2], where the common peroneal nerve winds around the fibular neck and passes between the fibula and peroneus longus,

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