Acute Peroneal Neuropathy and Foot Drop in Two Adolescent Female Athletes with New-Onset Diabetes

Abstract

The common peroneal nerve is derived from the sciatic nerve. It travels superficially along the lateral aspect of the knee near the fibular head where it bifurcates into the superficial and deep peroneal nerves. These nerves also provide sensation to the lateral lower leg and dorsal foot. The superficial and deep peroneal nerves innervate the muscles of the lateral lower leg and anterior lower leg compartments, respectively. Loss of the soft tissue and subcutaneous fat pad that surrounds and cushions the peroneal nerve near the fibular head leaves it susceptible to injury (1). This can affect the common peroneal nerve or either of its two branches, the deep or superficial peroneal nerves (2). Damage to the nerve by stretching or compression may result in loss of sensation and motor function, resulting in foot drop (3). Acute peroneal neuropathy in the context of rapid weight loss (also known as “slimmer's paralysis”) has been reported in prisoners of war, extreme dieting, and after bariatric surgery (2,4). It also is more common in individuals who habitually cross their legs (2).

While seen less commonly than in adults, acute peroneal neuropathy also has been reported in children and adolescents (5). Etiologies in this age group include direct trauma, entrapment from bone tumors, compression from casting, and rapid weight loss (5,6). Causes of sudden and quick weight loss may be due to crash dieting and anorexia nervosa (6). There also are rare reports of slimmer's paralysis being caused by rapid weight loss from untreated type 1 diabetes (7,8). In this report, we present two active adolescent female athletes who presented with ankle pain or weakness that was ultimately due to acute peroneal nerve neuropathy associated with substantial and fast weight loss from undiagnosed type 1 diabetes.