FOOT DROP FOLLOWING RIGHT LOWER EXTREMITY FASCIOTOMY

A 21-year-old male without significant medical history seen at clinic after recent hospitalization for a right lower extremity (RLE) gunshot wound to the upper thigh with pulsatile hemorrhage. Imaging showed arterial extravasation, and the patient underwent right groin exploration with orchiectomy, femoral vein ligation, and RLE four-compartment fasciotomy. At discharge, the patient could ambulate 150 feet supervised with a rolling walker and climb 22 stairs. Bed mobility and all transfers were independent, however, he had an RLE foot drop requiring a brace.

On initial examination, the patient had well healed surgical scars, edema from the right knee extending to the toes, with mild tenderness to palpation in the calf. Sensation was otherwise diminished in the L2-S2 dermatomes on the right compared to the left. He had significant right foot drop with 1/5 strength on plantarflexion and 3/5 on dorsiflexion, resulting in his gait lacking heel strike on the right. Electromyographic studies showed evidence of axonal neuropathy of the common peroneal nerve with muscle denervation.

Common peroneal nerve injury can occur with both traumatic and atraumatic causes. Standard-of-care is conservative, employing orthotics and physical therapy (PT). Our patient received ankle-foot orthotics and was prescribed twice weekly PT with gait training. He was also educated on home exercise therapy and continued strength-building exercises at a gym. While in certain cases surgical intervention has successfully treated peroneal nerve compression, our patient demonstrated remarkable improvement with conservative treatment.

Foot drop is a well-documented complication following lower extremity fasciotomy and traumatic compartment syndrome and can prolong post-surgical recovery for patients. Implementing a multidisciplinary approach including PT, bracing, and medical management can significantly improve patients' quality of life.