Abstract
Peroneal nerve palsy is an infrequent but potential complication of childbirth. Bilateral peroneal palsy is particularly rare following delivery with few reported cases. A 38-year-old gravida 1, para 0 underwent a prolonged second stage of labor, was diagnosed with an arrest of descent, and subsequently underwent an uncomplicated primary cesarean section. The patient was diagnosed with bilateral peroneal neuropathy four days after delivery. By two months postpartum, her foot drop had improved by 85% and the remainder of her symptoms resolved. Awareness of the risks of a peroneal neuropathy as well as implementation of preventive measures is important for members of the delivery team. Regional anesthesia during labor is a risk factor for the development of a peroneal neuropathy.
Highlights
The most common lower extremity mononeuropathy is a peroneal nerve palsy [1]
The superficial location of the nerve at the fibular neck predisposes it to injury from compression or trauma at this site, given the typical hand positioning while pushing during labor
The common peroneal nerve travels between the fibula and the peroneal longus muscle, dividing into the superficial and deep branches (Figure 1) [8]
Summary
The most common lower extremity mononeuropathy is a peroneal nerve palsy [1]. In obstetrics, sciatic and femoral neuropathies are much more common and typically associated with an instrument-assisted delivery; peroneal nerve palsy is another less commonly encountered peripheral neuropathy [2,3,4]. The common peroneal nerve branches from the sciatic nerve at the level of the popliteal fossa, continues along the medial aspect of the biceps femoris muscle, and passes superficially over the lateral head of the gastrocnemius muscle. It courses laterally around the fibular head adjacent to the periosteum. The deep peroneal nerve primarily innervates the muscles of the foot and ankle responsible for eversion and dorsiflexion and provides sensory innervation to the first web space [1, 9]
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