The aim of this study was to identify the trends and gaps in literature regarding peroneal nerve dysfunction in children with clubfoot.
This scoping review included all the available articles on peroneal nerve dysfunction in children with clubfoot from 2000 to 2024. All the articles were identified using Google Scholar, Medline, Pubmed, and Embase. Data was extracted manually because there was a small number of studies available.
Total 7 studies were retrieved for this scoping review. Out of which 5 studies were relevant to the research question. Out of these 5 studies, 4 studies were retrospective and 1 was a case report with literature review. In all studies, children were treated with the Ponseti method except in one study in which the treatment method was not mentioned. Total 32 children with clubfoot who had peroneal nerve dysfunction (40 feet) had been reported in all included studies. The average age of peroneal nerve dysfunction identification was 12.5 months (0.5 to 24 months). Total 16 (50%) children were diagnosed at early stage and before the start of treatment for CTEV and remaining half 16(50%) children were diagnosed in a later age when foot drop gait was observed. Average number of casts was 5 (1 to 11 casts). None of the study reported serial casting pressure as a cause of nerve damage. The average age of follow up was 6 years (1 to 9 year). Average active dorsiflexion was 10 degree. Drop toe sign, loss of toe movements, below knee atrophy, Leg length discrepancy with a short foot (in unilateral case), and dimpling of skin over metatarsal has been reported as a sign of peroneal nerve dysfunction in clubfoot. NCS/ EMG were used for diagnosis and usually MRI did not help in diagnosis. Tibilias anterior tendon transfer, posteromedial and posterolateral release, metatarsal osteotomy for metatarsal adductus), supramalleolar tibial derotation osteotomy for internal tibial torsion, Achilles tendon lengthening, tibial posterior tendon transfers are commonly performed procedures. After successful treatment of clubfoot deformity by the Ponseti method, the child who have peroneal nerve dysfunction will have lost active Dorsiflexion and need an Ankle foot orthosis for day time and foot abduction brace for night.
Peroneal nerve dysfunction can also be observed in idiopathic clubfoot but it’s a very rare occurrence. A thorough initial neurological examination of children with idiopathic clubfoot should be carried out to rule out peroneal nerve dysfunctions at an early stage and before the start of Ponseti management. late diagnosis may raise the parent’s concern regarding the cause of peroneal nerve dysfunction.
This scoping review will help researchers in future research for peroneal nerve dysfunction in children with clubfoot. It will also improve the practice of clinicians in identifying peroneal nerve dysfunction before the start of treatment for clubfoot.
Peroneal nerve
Ponseti
