Complete Recovery From Acute Peroneal Nerve Palsy With Neurapraxia After Prolonged Cross-Legged Sitting: Successful Conservative Management of a Foot Drop and a Brief Review of the Literature

TL;DR

A man recovered fully from foot drop caused by prolonged cross-legged sitting through conservative treatment, including orthoses and supplements.

Contribution

Demonstrates successful non-surgical recovery from posture-induced peroneal nerve palsy with neurapraxia.

Findings

Conservative management with an ankle-foot orthosis and neurotrophic supplements led to complete recovery of foot drop.

Acute peroneal nerve palsy can result from prolonged cross-legged sitting without typical nerve compression symptoms.

Early recognition and individualized treatment are crucial for optimal outcomes in positional nerve compression syndromes.

Abstract

Peroneal nerve palsy is the most common entrapment neuropathy of the lower extremity, often presenting with foot drop and sensory deficits. While trauma and space-occupying lesions are well-documented causes, prolonged static postures, such as cross-legged sitting, can lead to neurapraxia, a mere myelin injury, and a reversible conduction block caused by nerve compression. This case report aims to present the clinical course and successful conservative management of peroneal nerve palsy with foot drop in a 26-year-old male following prolonged cross-legged sitting, highlighting the unusual symptom presentation where typical nerve compression signs such as tingling, neuropathic pain, heaviness, or numbness were absent until the patient stood up. It also emphasizes the rare posture-related etiology, complete recovery without surgical intervention, and reviews similar rare cases to enhance clinical recognition of positional nerve compression syndromes.

A 26-year-old male developed acute foot drop and numbness in the right foot after sitting cross-legged on a hard surface for 2-3 hours without changing position. Physical examination revealed 0/5 strength in ankle dorsiflexion, hypoesthesia in the first web space, and steppage gait, with no history of trauma or prior symptoms. Radiographs excluded structural abnormalities. Conservative management, including an ankle-foot orthosis (AFO) and daily supplementation with neurotrophic agents (B vitamins, vitamin C, vitamin D3, zinc, and magnesium), was initiated. At the two-week follow-up, dorsiflexion strength improved to 3/5. By the one-month follow-up, the patient achieved complete recovery, with full restoration of muscle strength as 5/5, sensory function, and resolution of neuropathy. Acute peroneal nerve palsy with neurapraxia can result from prolonged cross-legged sitting due to compression at the fibular head. Conservative management, including neurotrophic supplementation and the use of an AFO, can achieve complete recovery without the need for surgical intervention. Early recognition, detailed patient history, and individualized treatment plans are essential for optimal outcomes. Surgical decompression should be considered judiciously in resistant cases based on the severity and progression of symptoms.

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