Send to

Choose Destination
NMC Case Rep J. 2015 Sep 11;2(4):140-142. doi: 10.2176/nmccrj.2014-0430. eCollection 2015 Oct.

Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report.

Author information

Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba.
Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido.
Department of Neurosurgery, Nippon Medical School, Tokyo.


The diagnosis of peroneal nerve (PN) entrapment neuropathy (PNEN) is based on clinical symptoms and nerve conduction studies. However, these studies do not always detect PNEN. Our 64-year-old patient suffered persistent left L5 numbness after two lumbar surgeries. Two years before admission to our institute his left leg pain gradually reappeared. When walking, his numbness in the left lower thigh to the dorsum of the foot increased. Electrophysiological testing revealed no conduction block on the PN. To identify the origin of his intermittent symptoms we performed loading of repetitive ankle plantar flexion in the at-rest posture to avoid the lumbar factor. We used this provocation test to check for PNEN because it occurs at a site where the PN passes the soleus- and the peroneus longus muscle (SM, PLM). The symptoms appeared reproducibly within 10 s of loading. PN neurolysis under local anesthesia showed that the PN was strongly compressed by the SM and PLM. This procedure eased his symptoms and he was able to walk without elicitation of numbness and pain upon repetitive ankle plantar flexion. In our case, repetitive plantar flexion elicited the symptoms and this provocation test may be useful to identify PN dynamic entrapment neuropathy as the origin of intermittent claudication.


diagnosis; entrapment neuropathy; neurolysis; peroneal nerve; provocation test

Conflict of interest statement

Conflicts of Interest Disclosure The authors have no conflicts of interest (COI) or financial disclosures. All authors are members of the Japan Neurosurgical Society (JNS) and all have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center