Foot drop in head and neck cancer

ObjectiveCommon peroneal nerve (CPN) paresis or paralysis presents with weakness of the toe extensors as well as of the ankle dorsiflexors and evertors, causing foot drop and hypesthesia or paresthesia in the CPN distribution. Previous studies have shown associations with weight loss and leg crossing. Although CPN neuropathy has been described in cancer patients, it has not been described in head and neck cancer (HNC) patients specifically. Our objective was to describe a series of patients who developed CPN neuropathy during the course of their disease.Materials and methodsA retrospective review of the charts of patients with HNC and CPN neuropathy who were seen at our institution between 1995 and 2004 was performed.ResultsFour HNC patients with CPN neuropathy were identified. All had significant weight loss. One patient became symptomatic before treatment, 2 patients became symptomatic during treatment, and 1 patient developed foot drop 4 years after treatment when his free jejunal flap developed a stricture. Two patients had electrodiagnostic study findings that revealed conduction block at the fibular head and denervation of peroneal innervated muscles. Imaging studies revealed no evidence of metastatic disease in the lumbosacral region. All 4 patients improved after weight gain.ConclusionsCommon peroneal nerve neuropathy may be seen in HNC patients. The CPN may be susceptible in weight loss because of the associated loss of subcutaneous tissue, which cushions the nerve from the fibular head. Consideration should be given to prevention, appropriate neurologic consultation, and patient counseling.