Physiotherapy Management of Postoperative Peroneal Nerve Palsy in a Case of Hereditary Multiple Exostoses

Hereditary Multiple Exostoses (HME) is a non-frequent autosomal dominant disorder, described by nearness of exostoses. In symptomatic patient surgical intervention is required, most common surgery is wedge osteotomy. One of the complications of this surgery is peroneal nerve palsy. The intention of this case report is to explain the physiotherapy intervention strategies and report its effectiveness in symptomatic management of peroneal nerve palsy (axonotmesis) post-surgically in a 23-year- old male with HME. Patient had difficulty in moving his right ankle and shock like pain in his right lower limb post-operative. Patient was diagnosed to have right peroneal nerve injury. Patient was managed on the basis of clinical presentation with supervised and unsupervised physiotherapy for 10 weeks. Supervised physiotherapy intervention consisted of patient's education, neural mobilization, electrical stimulation, sensory reeducation (cognitive behavior therapy), exercise therapy and counseling for 45-60 min a day for 6 days a week for first 6 week later 5 days per week. The effectiveness of supervised physiotherapy was followed for 10 weeks and sensory and motor assessment was performed, along with an S-D curve was performed to measure the improvement. For the next 3 month follow up for the patient was taken. Physiotherapy management was found to be effective in case of peroneal neuropathy with increased patient satisfaction.