Clinical features: A 19-year old male elite skier on the junior national ski team presented with complaints of pain and muscle weakness in the lateral aspect of his left lower leg, ankle and foot that had occurred while ski racing. Tenderness on palpation was noted over the left anterior talo-fibular ligament and left peronei and gastrocnemius muscle bellies. Manual resisted muscle testing revealed weakness of the anterior tibialis, peroneus longus and brevis muscles. All other neurological testing and vascular testing was normal and the remainder of the examination was unremarkable.
Intervention and outcome: Initially diagnosed as an ankle sprain and muscle strain, the patient was treated for three days using pelvic and lower extremity chiropractic manipulation, interferential current, and cryotherapy. After three days, the patient reported improvement of Pot and ankle pain but reported foot drop present when wearing his ski boot. Peroneal nerve entrapment was diagnosed and the patient's treatment plan was modified to additionally include acupuncture and soft tissue mobilization. A modified Gilliat's test was used to monitor how much pressure was needed to induce muscle weakness at the ankle. After three days of care, the patient reported alleviation of the pain and weakness.
Conclusion: This case describes the management of peroneal nerve entrapment by conservative care including chiropractic manipulation of the lumbar spine, pelvis and lower extremity, interferential current, cryotherapy, acupuncture and trigger point therapy.