A 47-year-old man presented with difficulty walking and weakness in his right foot for the past 3 months. He had been in a road traffic accident 4 months prior which resulted in a fracture of both leg bones on his right side, treated with a plaster cast. After cast removal, he noticed inability to lift his right foot and it dragged on the ground when walking. Examination revealed weakness and paralysis of muscles supplied by the common peroneal nerve on the right side, with loss of sensation on the lateral leg and top of the foot. The diagnosis is a common peroneal nerve injury at the level of the fibula neck due to trauma from the accident 4 months ago.

1. Common peroneal nerve injury
Ashish Tripathi
Gen Surg PGT,
RTIICS

2. History
• 47 years old gentleman
• Resident of Asansol
• Self employed shop-keeper
• Chief complaints:
• Difficulty in walking and weakness of right
foot for 3 months.

3. History of present illness
• This gentleman sustained blunt trauma to
right leg 4 months back when he met a road
traffic accident. He was treated with
application of plaster cast for fracture of both
bones of upper right leg. After removal of cast
he noticed that he was unable to lift his foot
upward at ankle joint due to weakness of right
foot. His right foot drags on ground while brisk
walking. He could not feel upper part of foot
adjoining toes.

4. History
• No h/o of blisters of skin, swelling of leg or acute
pain/ throbbing sensation after application of
plaster cast.
• No h/o other major trauma / surgery to right
lower limb / spine.
• No h/o Leprosy, Diabetes, other major medical /
surgical illnesses.
• Personal History: History of social drinking. No
history of smoking and tobacco chewing.
• Family History
• Drug History
• Allergy History

5. General Examination
• Patient was explained about the examination
and required exposure. Examination was
performed in adequate light.
• Conscious/oriented/co-operative
• Average Built, normal nutrition with BMI of 25
kg/m2.
• Walks with high stepping gait.
• No pallor, edema, clubbing, lymphadenopathy.
• Pulse: 80/min, BP: 120/76 mm Hg, Temp. – N,
RR: 16/min

6. Local Examination
• Patient examined in lying down, standing and sitting
position as well as in walking position.
• Left lower limb appears normal.
• Right lower limb
• Attitude: Hip joint is slightly flexed, abducted and externally
rotated. Knee joint is in flexion and external rotation.
• Ankle plantar flexed and inverted with clawing of toes.
(Foot drop deformity)
• Prominent fibular groove.
• Scar of previous injury on anetro-lateral aspect of upper
part of leg.
• Muscle wasting of right leg.
• Skin over dorsum of foot : Less hairy, dry and shiny.
• Nails: brittle and ridged

7. Local Examination: Palpation
• Motor:
– Tones & Power of all muscles supplied by common
peroneal nerve are decreased:
– Toe extension 0
– Toe flexion 4+
– Ankle eversion 1
– Ankle inversion 4+
– Ankle dorsiflexion 0
– Plantar flexion 5
• Leg circumference: Rt = 26 cm, Lt=29.5cm.

8. Local examination
• Sensory: loss of sensation of lateral side of
right leg and dorsum of foot.
– Fine/crude touch: lost
– Pain : lost
– Joint sense and vibration sense: intact
• Reflexes:
– Plantar, ankle, knee – normal
• Tinel’s Sign: tingling sensation present over
previous injury site below knee joint.

9. Systemic Examination
• CNS
• CVS
• Respiratory
• GIT

10. Summary
• 47 yr old male gentleman, shop-keeper from Asansol presented
with chief complaints of difficulty in walking, weakness of right
foot and loss of sensation over dorsum of foot for last 3 months.
• He met a road traffic accident 4 months back and suffered right
leg injury (fracture of both the bones of leg) for which plaster
cast was applied. After removal of cast, he developed right foot
weakness, walking difficulty and loss of sensation over dorsum of
foot.
• On examination, his right foot was planter flexed and inverted
with clawing of toes (foot drop deformity). There is healed scars
over anterolateral aspect of upper leg. There is muscle wasting
of right leg as well as loss of hairs, skin lustre & subcutaneous fat
over dorsum of right foot. There is paralysis of tibialis anterior
along with loss of sensation over lateral surface of leg and
dorsum of foot. He walks with high stepping gait. Examination of
other peripheral nerves of lower limb are normal.

11. Provisional diagnosis
• This is a case of right foot drop due to
common peroneal nerve Injury at level of neck
of fibula due to trauma of 4 months duration.

12. Thank You