Dear John,
I suggest that you start by determining the level of the nerve
involvement. The most common cause for footdrop and reduced sensation
at the dorsum of the foot (particularly at the first web space)
following a surgical procedure is a compression neuropathy of the common
peroneal nerve. (Are the evertors also weak?). This usually happens at
the area of the fibular head because of the position of the completely
anesthesized and relaxed leg during the operation. EMG will confirm
this.
If this is the case, then the pathology would just be a neuropraxia or
an axonopathy (since you said there was significant sensory loss). My
experience with patients like this is that they have a very good
prognosis for recovery. Recovery usually occurs anytime between 3-6
months, some even show recovery earlier. I rarely get patients that
need a year to recover.
I hope your EMG will not reveal a higher level of nerve involvement and
that this is just a simple compression neuropathy. I hope your mother
will be walking soon. Fortunately a good ankle-foot orthosis will take
care of the footdrop problem during walking while the nerve is still
recovering. Just make sure no further pressure is placed at the fibular
head area, whether during sleep or with the orthosis.
Monette
Ramona Luisa Pablo Santos, MD, FPARM
Dept. of Physical and Rehabilitation Medicine
De La Salle University Medical Center
Cavite, Philippines
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