Acute Foot Drop Due to Common Peroneal Neuropathy After Primary Total Knee Arthroplasty: A Case Report With Complete Recovery.

BACKGROUND

Common peroneal nerve palsy (CPNP) is an uncommon but potentially disabling complication of primary total knee arthroplasty (TKA). It typically presents with weakness of ankle and toe dorsiflexion, foot drop, a steppage gait and reduced or absent sensation over the dorsum of the foot. Delayed recognition or inadequate management may lead to atrophy of the anterior and lateral compartment muscles and persistent disability.

CASE PRESENTATION: We report a 72-year-old woman who developed an acute, complete CPNP with foot drop and dorsal foot sensory loss on the first day after primary right TKA. Management was nonoperative and centred on early limb repositioning, ankle-foot orthosis (AFO) support and a structured physiotherapy programme that included neuromuscular electrical (faradic) stimulation. Full neurological recovery was achieved 115 days after surgery, with normal muscle power and no residual sensory deficit.

CONCLUSION

Complete CPNP after TKA carries a less favourable prognosis than incomplete palsy, yet this patient regained full function within approximately 4 months of conservative care underscoring that, in the absence of a compressive lesion or progressive deficit, early nonoperative management with orthotic support and physiotherapy can achieve excellent recovery and that surgical exploration can reasonably be reserved for deterioration or failure to improve.