Peroneal Entrapment?

[lcat]

I have had a chronic foot drop for the past fifteen months.  I under went back surgery about a week after the foot drop and it was found the L5 nerve root had been severely damaged.  I have had five EMG and nerve conduction studies in the past seven months. All show active denervation in the right tibilas anterior without active denervation in other peroneal muscles.  I have two doctor's drastically disagreeing.  One strongly feels that the peroneal nerve is impinged at the fibula head and needs immediate surgery because of the length of time the damage has been going on.  The other feels that this is not the case because only the tib anterior shows active denervation.  He feels something may have gone wrong during the back surgery or something else damaged the nerve. Can the nerve be impingent at the fibula head only effect the tib anterior?  Charcot Marie Tooth, ALS and Multifocal Motor Neuropathy have all been considered and ruled out at this point. Two rounds of extensive blood tests (all negative) have been performed and I have under gone a week of IVIg.

[lcat]

The foot drop started about a week prior to the back surgery.  It was found that I had lateral recess stenosis in addition to the herniated disc.  I had a flexible fusion device installed in addition to the disc decompression.

I have seen multiple doctors including a neurologist at a major teaching hospital.  I have had five EMGs performed by three different doctors.  There has not been an agreement on the diagnosis but everyone agrees the EMGs indicate that there is active nerve damage going on in addition to the nerve root damage in the spine.  ALS and motor neuron diseases were questioned because my pateller reflexes are brisk, but they feel this may just be normal for me.  They have extensivelly tested the musles in other limbs and the muscles in my neck to look for signs of systemic problems.  All are normal.  Every blood test run for other causes of neuropathy have also been normal.

As far as my foot drop goes, it is not complete.  However, I have little use of the peroneal muscles and need to wear a brace unless I am in the house due to high risk of ankle sprain and fracture.  The neurologists thinks there might be very slight improvement but another doctor who I have been seeing for two years thinks that the 60-90 minutes a day I am spending on PT and stim to the muscles is just keeping the secondary source of damage in check.  He feels at this point, I am fighting a battle I am never going to win.  My fear is if I stop doing the PT, I am going to lose more function.

I have had MRIs taken of the sciatic nerve and the peroneal nerve in the lower leg.  There are no obvious abnormalities, but I have been told that if the peroneal nerve is compressed by bands of fascia or something similar that would not show.  The sciatic nerve images were taken last week and the radiologist commented that although the field of study was not focused on the lower leg some of the images he saw were highly suggestive of peroneal nerve entrapment.  The neurologist said it could wait until I go back in November.

I also had an appointment about a week ago with my spine surgeon and a lower leg specialist in his office.  I am not in a major city, but this practice is pretty progressive.  The spine surgeon is one of a small percentage of surgeons in the country performing the flexible fusion surgery I had and actually developed the instrumentation and procedure for performing the surgery.  He travels around the country training other surgeons.  The lower leg specialist just relocated here after ten years as a surgeon in a major teaching hospital in New York City.  She has experience with both the peroneal nerve decompression surgery and the tendon transfer.  She is willing to try the decompression surgery to see if it will at least stop the on going damage.  If there is no recovery but the progression is stopped, she will consider a tendon transfer.  Prior to either surgery, the spine surgeon is recommending a new MRI of the spine to make sure nothing has changed before going through any surgeries.

At this point, I have some decisions to make.  I have finally reached the point where I like and trust all of the doctors I am working with, but I am being put in a position of having to decide whose diagnosis I trust more.  I am very worried about making the wrong decision or taking so much time on making a decision that it will be too late to stop the damage.  As I found out when they were considering ALS and I had to face possibly having a fatal disease, things could be much worse.  I am only in my thirties and would really like to get back to being more active and move on to other things in life.

Thanks for all of you input.

Laurie

[davisesq212]

I posted somewhere else responding to you about this but there is more info here.  You need to see more doctors preferably the top orthopedic surgeons you can find in your city, as long as it is a large city.  

I had a L5-S1 herniation with impingement with foot drop.  I had back surgery to help the herniation, impingement and hopefully the foot drop.  The herniation and impingement resolved but the foot drop did not.  I then had a nerve release in the knee based on an incorrect reading of an EMG.  The EMG showed peroneal nerve damage causing a neuropathy.  The knee was opened, no impingement was found in the knee and the foot drop obviously persisted.  

New EMGs were taken by another hospital not just of the waist up but of my legs as well.  It was found that the herniation caused the nerve damage and resultant foot drop.  The tendon transfer was performed in Jan 07 with a follow up in Nov 07.  If I had to guess, the damage form your foot drop is a result of the nerve damage from the herniation since the nerve was so severly damaged.  

Feel free to follow up with me here.

By the way, I am confused by your timeline.....did you have the foot drop before the back surgery?  Also, don't rush too quickly into anything. If the drop has been there 15 months, the damage is already done.  I had my back surgery 6 weeks after the disc herniated and the foot dropped and apparently it was not soon enough.  It probably needs to be done within days or maybe hours if the damage could be reversed.