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2015 ; 2
(4
): 140-142
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Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent
Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report
#MMPMID28663985
Kim K
; Isu T
; Kokubo R
; Morimoto D
; Kobayashi S
; Morita A
NMC Case Rep J
2015[Oct]; 2
(4
): 140-142
PMID28663985
show ga
The diagnosis of peroneal nerve (PN) entrapment neuropathy (PNEN) is based on
clinical symptoms and nerve conduction studies. However, these studies do not
always detect PNEN. Our 64-year-old patient suffered persistent left L5 numbness
after two lumbar surgeries. Two years before admission to our institute his left
leg pain gradually reappeared. When walking, his numbness in the left lower thigh
to the dorsum of the foot increased. Electrophysiological testing revealed no
conduction block on the PN. To identify the origin of his intermittent symptoms
we performed loading of repetitive ankle plantar flexion in the at-rest posture
to avoid the lumbar factor. We used this provocation test to check for PNEN
because it occurs at a site where the PN passes the soleus- and the peroneus
longus muscle (SM, PLM). The symptoms appeared reproducibly within 10 s of
loading. PN neurolysis under local anesthesia showed that the PN was strongly
compressed by the SM and PLM. This procedure eased his symptoms and he was able
to walk without elicitation of numbness and pain upon repetitive ankle plantar
flexion. In our case, repetitive plantar flexion elicited the symptoms and this
provocation test may be useful to identify PN dynamic entrapment neuropathy as
the origin of intermittent claudication.