Controversies in treatment strategies in patients with foot drop due to peroneal nerve entrapment: Results of a survey among specialists

INTRODUCTION: Peroneal nerve entrapment is a frequent cause of foot drop. Despite being frequent, no guidelines exist to recommend surgical or non-invasive treatment, leading to important variations in daily practice. RESEARCH QUESTION: To map variation in daily practice. MATERIALS AND METHODS: An online Qualtrics survey was distributed among neurosurgeons, neurologists, orthopaedic surgeons and physical medicine and rehabilitation physicians through various national and international scientific organizations, mapping current treatment strategies. Descriptive statistics and non-parametric tests were used to analyse data with SPSS. RESULTS: Responses from 181 out of 221 participants from 35 countries were analysed. A large majority of participants agreed that good evidence supporting any treatment strategy is lacking (77.9%) and that daily practice is mostly guided by own beliefs and experience (84.0%). Both non-invasive treatment and neurolysis are well established treatment strategies (supported by respectively 92.3% and 93.4% of physicians). Timing of neurolysis and duration of non-invasive treatment varied considerably. Duration of non-invasive treatment was significantly shorter in the group of surgeons compared to non-surgeons (p ​= ​0.033). Most physicians consider neurolysis a valid treatment option. However, significant more non-surgeons than surgeons were opposed to surgical treatment (p ​= ​0.001). DISCUSSION AND CONCLUSION: Important differences in attitudes were observed not only between, but also within specialisms, regardless of physician experience. This survey highlights important variations in daily practice for foot drop due to peroneal entrapment and emphasizes the need for future controlled studies.