Big Toe Weakness: Peroneal Nerve Palsy vs. L5 Nerve Root Compression

In this video called Big Toe Weakness: I show you one patient who had a traumatic peroneal nerve palsy and the other an L5 nerve root compression from a herniated disc. Two different diagnoses that look so much alike. I even give a little "pearl" about how to differentiate between the two.

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#PeronealNerve #OrthoEvalPal #PhysicalTherapy #Weakness

[ohiostatesmith]

I know this video is 4 years old now. However, the motor weakness is not the same. You have to test inversion to differentiate the two.


Tibialis posterior m. (inversion) is innervated by the tibial nerve. It will be preserved in a deep peroneal injury while L5 radiculopathy will not.

[DeeRaman]

Medical student- was super confused and this has solved it for me- many thanks!

[khalidhussein]

Great effort from you and many thanks to the patients, but why didn't you complete the whole examination. It is very rare to find those cases together, so it would be great if you ilustrate everything.

[shyamsingh-luwj]

What is the solution. Either surgery of physio therapy

[naeimdeshak]

The different is that one with the L5 radiculopathy should have also weakness of tabialis posterior (which also oregan from L5 root) and weakness of the hip abduction, but the one with peroneal neuropathy Will don't))

[vallee]

I seem to have this, can you tell me will it ever heal??? and are there any specific exercises I could do thanks.

[crokkadoodledoo]

please tell me that the L4-L5 nerve compression goes away. can be healed with therapy exercise and inflammation medicines

[ultimatebeast]

I used to be an athlete, however I fell from a horse, now I've L5-S1 and L4-L5 disc bulge, very painful especially while sitting and traveling, over the years my right leg has thinned considerably 1.5 cm at calf level as compared to the left leg also shortened by 1 cm, I'm in constant pain..., Foot finger near the right thumb remains fallen, my right foot has become 1 cm shorter, now same pain also has started being felt in left leg and foot, not many videos available

[nameisprivate]

Jesus. I’ve gone to 2 sports med doctors, 2 chiropractors, a neurospinal surgeon and they still haven’t considered or spoken that it could be this.
What if I get a spinal surgery I don’t need? 😐
They keep saying my MRI doesn’t match the level of pain I’m in. Bulges are 2-3, 3-4, 4-5, and 5-S1 with L4-L5 having “some” contact with a root nerve.
I woke up and couldn’t walk. I couldn’t bear weight in my left leg without sobbing. When I put my feet on the floor that morning I crumbled into the floor.
I’ve had these back bulges for 20yr. I see pain management so I called, went in for an epidural. Didn’t work.
My doc left town for the holidays so i saw him early December and wouldn’t see him again til early feb.
Well I was dying. I made appointments and kept going doctor to doctor begging…mindless…sobbing, unable to walk right. I cannot even recall half the people I saw or what they said because I couldn’t even focus. I was literally running on muscle memory.
Finally my doc gets back and did a transformial (spelling) injection to the nerve…..it took the pain away…..so does that eliminate the perineal nerve or could it still be that? Does it prove l4-l5 is problematic? Help?
My left calf is smaller than my right. My left butt check is same. When I sit with legs straight out I cannot get the last 3 toes of that left leg to come up without lifting them first and then pulling my ankle back. My daughter said the muscle on that side doesn’t feel as if it’s even working.
I asked if he would send me to physical Therapy. He said “not yet”. From what I see in all these videos you guys know better than the damn doctor is do and I feel I would be better diagnosed if I could just go on there.
The neurosurgeon used a reflex thingy to run down both legs over my clothing and asked if it “felt the same”…..and it did! He looked at me crazy when I said if he did it in my bare skin it wouldn’t feel the same or if he used more pressure it wouldn’t feel the same. Sigh. He didn’t repeat the test.

[toddperry]

Who can I go see to determine this. I have the same issues as the first gentleman with my big toe in my right leg

[daryaeudakiyapryma]

Many thanks for this great content ! I have a herniated disc in L4-L5 and after reading all the comments I have not found that people have a similar issue. In fact, I have a problem that my heel cannot raise all my foot up, just one side with the big toe, but totally I cannot raise my foot on the right heel. Do you know if it is spacticity ? I think it is L4 herniation that is pressing on peroneal nerve. Do you know what can be done because I can walk but I have pain in the hallus valgus a lot. Thank you.

[manjeetkundu]

Hello sir.
Weakness of plantar flexion due to S1 nerve compression, is it curable?

[MuhammadAsim-ocre]

Sir tendon transfer is going good in foot dropped
Pronealnerve Damage

[Solodolo]

Do the middle toes matter if you test resistance individually

[gopicheguri]

I have a through tabia surgery 50days back. Doctor have been advised to do exercise but I found that my big finger is not able to lift itself up even after forcing pressure on it. And also not able to move the foot upwards at the joint. But I noticed that when we do it by our hands there is no pain at all. Is there any solution and any specific exercise to do for it. I hope you reply. Thank you

[nylotus]

I just came from a podiatrist yesterday and they can't seem to figure this out and I have exactly this. I had a high ankle sprain and can feel shocks of pain from the peroneal nerve. Constant tingling in my toes, numbness in my foot, and my ability to keep my toes up are pretty much impossible. They now want me to go see a physiologist. Do you recommend I go see an orthopedist instead??

[kitafit]

I have anterior peroneal burning like shin splints it’s not shin splints deeper I have recently had a total hip replacement any stretches for this would be awesome 😎

[Janet-hswl]

I have this exact problem I. Right foot.

[ghostship]

*Hi Doc! I got tendon transfer surgery after facing drop foot due to achilles rupture operation. Now my ankle pretty good. %70-75 going up and pretty strong but toes are not that good. Especially the big toe. They can't go up more than straight positions (big toe is the worst). 3 years passed after the tendon transfer surgery but i'm still working out. Do you think am i able to get better toes lifting? Thanks for you valuable time!*

[nooks]

Hi there Paul. Is it possible for you to do a video on peroneal tendonitis? Thank you.