| A "foot-drop" is a medical term
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| | Sciences Center recently collected a
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| which--thankfully--does not mean that the
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| | series of 318 patients with peroneal
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| foot suddenly disconnects from the leg.
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| | neuropathy who required surgery, while
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| Rather, it means that when the leg is
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| | Italian researchers collected another 69
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| lifted from the ground, the foot droops
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| | cases that included those who didn't need
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| downward at the ankle. The muscles that
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| | surgery. From these two tabulations of
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| are supposed to prop up the foot have
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| | cases a good picture emerges of the more
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| become so weakened that they cannot
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| | common causes of peroneal neuropathy.Many
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| overcome gravity's downward pull. When
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| | were due to physical traumas. Some of the
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| people with this problem try to walk,
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| | traumas were severe enough to break or
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| they have to either hike the leg higher
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| | dislocate bones, while others involved
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| to clear their drooping toes or else risk
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| | deep cuts in the soft tissues, and still
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| tripping over them.What is to blame for
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| | others involved just a stretch or bruise.
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| this inconvenient symptom? In truth,
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| | Another common cause was surgical
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| there are multiple possible causes, but
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| | operations. Some of the surgeries were to
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| one of the most common culprits is injury
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| | the nearby knee, but others were
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| to a nerve-bundle in the leg known as the
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| | performed on more distant structures,
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| peroneal nerve. To understand how this
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| | like the hip, the abdomen or even the
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| nerve-bundle can get in trouble, a quick
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| | chest.Many cases were due to excessive
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| review of the bones of the leg is
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| | external pressure being applied to the
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| helpful. There is just one bone, a big
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| | nerve. This occurred in different ways.
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| one, that connects the hip to the knee,
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| | For example, in prolonged leg-crossing
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| and that is the femur. There are two
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| | the knee of the bottom leg pushes
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| bones that connect the knee to the ankle.
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| | steadily against the peroneal nerve of
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| The tibia is the larger one and lies more
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| | the crossing leg. Peroneal neuropathies
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| to the inside, while the fibula is the
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| | seen in bedridden patients were
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| thinner one and lies more to the outside.
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| | presumably due to lying on the fibular
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| That's the extent of the bony anatomy we
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| | tunnel for too long without a shift in
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| need to know.The nerve-fibers
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| | position. Other patients had entrapment
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| constituting the peroneal nerve travel
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| | or pinching of the nerve within the
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| with the huge sciatic nerve that runs
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| | fibular tunnel unrelated to external
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| behind the femur from the buttock to the
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| | pressure.A surprisingly large group of
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| lower thigh. That's where the "common
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| | patients had peroneal neuropathy due to
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| peroneal nerve" splits out from the pack
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| | weight loss, also known as "slimmer's
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| and runs along the outside of the knee,
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| | paralysis." More than one factor might
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| tucking behind the head of the fibular
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| | have been at play in these cases,
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| bone (a knobby protrusion just beyond the
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| | including lack of nutrients, pressure on
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| knee) and then snaking around the neck of
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| | the nerve, or both.Researchers and
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| the fibula just below its head. The neck
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| | clinicians find that in some people an
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| of the fibula forms the floor of the
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| | apparently isolated peroneal neuropathy
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| fibular tunnel that the common peroneal
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| | is actually the leading edge of a more
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| nerve must pass through. Within this
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| | widespread polyneuropathy.
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| tunnel the common peroneal nerve is
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| | "Polyneuropathy" means that peripheral
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| particularly vulnerable to injury.Also
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| | nerves are impaired in a more diffuse
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| within this tunnel the common peroneal
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| | pattern--not just single nerves in single
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| nerve splits into two branches, the "deep
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| | places. So in some cases of apparent
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| peroneal nerve" (farther from the leg's
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| | peroneal neuropathy further
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| surface) and the "superficial peroneal
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| | investigations turn up polyneuropathy due
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| nerve" (closer to the leg's surface).
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| | to other causes, for example, diabetes,
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| Because the two branches have different
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| | excessive alcohol consumption or genetic
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| connections to muscles and skin, injury
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| | factors.How are cases evaluated? The
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| to one produces different impairments
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| | physician's evaluation starts with the
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| than are produced by injury to the
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| | time-honored methods of history-taking
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| other.The deep peroneal nerve is
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| | and physical examination. As part of the
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| responsible for cocking up the ankle and
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| | physical examination the doctor
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| toes, so injury to this branch produces
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| | inventories which muscles are weak (and
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| weakness or paralysis of the muscles
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| | which are not) and maps out areas of
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| responsible for these actions. There is
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| | numbness affecting the skin. Additional
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| just a tiny patch of skin, located
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| | testing with electromyography and nerve
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| between the big toe and the toe next to
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| | conduction studies, which check on
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| it, connected to the deep peroneal nerve,
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| | electrical functions of the muscles and
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| so damage to this branch produces
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| | nerves, often provides valuable
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| numbness limited to this small area.The
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| | information, including whether additional
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| superficial peroneal nerve, by contrast,
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| | nerves are affected and how bad the
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| is responsible for skin sensation on most
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| | impairments are.How about treatment?
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| of the outside of the calf and top of the
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| | Treatment varies according to what caused
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| foot, so these areas can become numb when
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| | the peroneal neuropathy in the first
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| the superficial peroneal nerve is
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| | place, but let's consider a typical case
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| injured. This branch is also responsible
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| | unrelated to severe trauma. Nonsurgical
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| for lifting the outside edge of the foot,
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| | approaches are usually tried first,
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| so this action is gone when the
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| | including avoidance of further pressure
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| superficial peroneal nerve is not
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| | on the peroneal nerve, improved nutrition
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| functioning properly.Impairments due to
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| | and supplementation of the diet with
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| injury of the common peroneal nerve (the
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| | vitamins. A simple brace applied to the
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| parent of the two branches) are the sum
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| | ankle improves walking. In many cases the
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| of the impairments associated with each
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| | nerve recovers without anything more
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| of the branches. So this means that the
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| | drastic being done. But if these
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| ankle and toes cannot cock upwards, the
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| | conservative treatments fail (and the
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| outside edge of the foot cannot lift, and
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| | peroneal neuropathy is not part of a more
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| there is numbness on the outside of the
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| | widespread polyneuropathy) then surgical
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| calf and top of the foot."Peroneal
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| | exploration of the fibular tunnel is
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| neuropathy" means impairment of the
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| | often indicated. If the nerve is pinched,
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| peroneal nerve. Peroneal neuropathies are
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| | then the surgeon frees up the nerve from
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| the most common neuropathies (of the kind
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| | whatever was pinching it.(C) 2005 by Gary
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| that affects just one nerve at a time) in
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| | CordingleyGary Cordingley, MD, PhD, is a
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| the lower extremities. Investigators at
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| | clinical neurologist, teacher and
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| the Louisiana State University Health
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| | researcher who works in Athens, Ohio.
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