633 - Collapsing Under Pressure - From Compartment Syndrome to Foot Drop

Case Diagnosis: A 69-year-old female with right peroneal nerve neuropathy secondary to compartment syndrome.

Case Description: A 69-year-old woman presents with ongoing right foot pain and foot drop that originates from an injury sustained one year ago in which she jammed her foot against a metal rack, causing severe swelling. EMG indicated right peroneal neuropathy with denervation of the peroneus longus and anterior tibialis. On exam there's reduced sensation in the anterior shin and dorsum of the foot, significant motor weakness in ankle dorsiflexion, eversion, and inversion, with a mild steppage gait. The patient's symptoms are consistent with peroneal nerve neuropathy secondary to compartment syndrome. The patient's symptoms and gait abnormality warranted custom-fabricated ankle-foot orthosis to improve gait and reduce fall risk.

Discussions: Compartment syndrome is a serious medical condition characterized by increased pressure within a muscle compartment. It is caused by swelling or bleeding within the compartment, which can restrict blood flow and damage nerves and tissues resulting in neuropathy. Although this is a rare cause of peroneal nerve neuropathy, it should be considered in patients with a history of injury to the lower extremity. The management of such neuropathies often involves a combination of physical therapy, pharmacologic intervention, and orthotic devices. The use of a custom-fabricated ankle-foot orthosis is supported by evidence showing that it can enhance foot clearance, reducing the likelihood of tripping and falling—an especially important consideration for elderly patients with compromised balance and proprioception.

Conclusions: This case exhibits a unique etiology of peripheral nerve neuropathy secondary to compartment syndrome. It highlights the wide variety of etiologies and mechanisms that can play a role in neuromuscular conditions. This case also portrays how the application of a tailored orthotic device plays a pivotal role in enhancing mobility and quality of life.