OUTLINE

DEFINITION
EPIDEMIOLOGY
AETIOLOGY
ANATOMY
HISTORY
PHYSICAL EXAMINATION
INVESTIGATION
MANAGEMENT
 DEFINITION
INABILITY TO LIFT THE FRONT PART OF FOOT
DUE
PARALYSIS OF ANTERIOR MUSCLE OF
FRONT LEG

INABILTY TO DORSIFLEX AT ANKLE AND

TOES
EPIDEMIOLOGY
ALL AGE GROUPS ARE AFFECTED EQUALLY
ABOUT 90% OF PERONEAL LESIONS ARE UNILATERAL, AND THEY CAN AFFECT THE RIGHT OR THE LEFT SIDE
WITH EQUAL FREQUENCY.
A FOOT DROP OF PARTICULAR CONCERN TO ORTHOPEDIC SURGEONS IS THE PERONEAL NERVE PALSY
SEEN AFTER TOTAL KNEE ARTHROPLASTY (TKA; 0.3-4% OF CASES) OR PROXIMAL TIBIAL OSTEOTOMY (3-
13% OF CASES)
PATIENTS WITH PREEXISTING SPINAL STENOSIS ARE BELIEVED TO BE AT INCREASED RISK FOR FOOT
DROP AFTER HIP ARTHROPLASTY BECAUSE OF THIS PROXIMAL COMPROMISE
AETIOLOGY
CENTRAL
STROKE
SPINE
PERIPHERAL
SCIATIC NERVE INJURY
COMMON PERONEAL NERVE INJURY
OTHERS
ANATOMY
 THE SCIATIC NERVE LEAVES THE PELVIC CAVITY AT THE GREATER SCIATIC FORAMEN
IT BIFURCATES TO FORM THE PERONEAL AND TIBIAL NERVES
THE PERONEAL NERVE CROSSES LATERALLY TO CURVE OVER THE POSTERIOR RIM OF THE FIBULAR NECK
TO THE ANTERIOR COMPARTMENT OF THE LOWER LEG, DIVIDING INTO SUPERFICIAL AND DEEP BRANCHES.
THE SUPERFICIAL BRANCH TRAVELS BETWEEN THE TWO HEADS OF THE PERONEI AND CONTINUES DOWN
THE LOWER LEG TO LIE BETWEEN THE PERONEAL TENDON AND THE LATERAL EDGE OF THE
GASTROCNEMIUS. IT THEN BRANCHES TO THE ANKLE ANTEROLATERALLY TO SUPPLY SENSATION TO THE
DORSUM OF THE FOOT
THE DEEP BRANCH DIVIDES JUST AFTER ROUNDING THE FIBULAR NECK. ITS INITIAL BRANCH SUPPLIES
THE TIBIALIS ANTERIOR, AND THE REMAINING BRANCHES SUPPLY THE EXTENSOR DIGITORUM LONGUS,
THE EXTENSOR HALLUCIS LONGUS, AND A SMALL SENSORY PATCH AT THE FIRST DORSAL WEB SPACE
HISTORY
TRAUMA/SURGERY
U/L DISEASE SUCH STROKE, DM, TB
SYMPTOMS
DIFFICULTY IN LIFTING THE FOOT
DRAGGING THE FOOT ON THE FLOOR
SLAPPING THE FOOT DOWN WITH EACH STEP
RAISING THE THIGH WHEN WALKING
PAIN, WEAKNESS OR NUMBNESS IN THE FOOT

NEUROLOGICAL SYMPTOMS
CONSTITUTIONAL SYMPTOMS
PHYSICAL EXAMINATION

LOOK
FEEL
MOVE
LOOK
FEEL
MOVE
INVESTIGATION

BLOOD
FBS
ESR
CRP
URINE
 IMAGING
PLAIN FILM
U/S
MRI
ELECTROMYELOGRAM
TREATMENT

DEPEND ON THE UNDERLYING CAUSES

SPECIFIC TREATMENT