A 26-year-old female is seen on the postpaum fouh day after delivering a 4.5 kg baby boy. She is concerned about her right foot, which has become numb and weak since delivering the baby. Walking has been difficult for her because her right foot tends to drop, and her toes drag. When asked about her labor course, she repos that she had an epidural with satisfactory pain relief but a difficult and prolonged pushing stage of labor (3 hours). She was put on the following bed during labor. She denies any back pain or problems with the other leg. On examination, she has decreased sensation on the top of the right foot and lateral side of the lower leg along with an inability to dorsiflex the right foot, resulting in a foot drop. Minimal peripheral edema is seen in both lower extremities. What is the most likely nerve that got compressed?
The image shows the Stirrup used while delivery which predisposes the female A- Common fibular nerve compression B- Deep peroneal nerve compression C- SURAL nerve D- Superficial peroneal nerve compression Compression of the common fibular nerve during labor is the most common postpaum nerve injury of the lower extremity. Compression of the common fibular nerve occurs from both the flexion of the knees and compression from stirrup on lateral aspect of knee. Because of the epidural anesthesia, the patient likely felt no pain from the prolonged compression. Injury to the common fibular nerve causes numbness, weakness to the lower leg and foot, and foot drop (inability to dorsiflex the foot). The majority of compression injuries after delivery are self-limiting and improve with suppoive care. Proper positioning of the patient requires a good understanding of anatomy to avoid periods of prolonged nerve compression.
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