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Review
. 2025 May 24;17(11):1782.
doi: 10.3390/nu17111782.

Common Peroneal Nerve Paralysis Following Rapid Weight Loss-A Case Report and Literature Review

Laura-Elena Cucu  1   2 , Gabriela Popescu  2   3 , Alexandra Maștaleru  2   3 , Emilian Bogdan Ignat  2   4 , Cristina Grosu  2   4 , Lenuța Bîrsanu  1   2 , Maria Magdalena Leon  2   3
Affiliations
Review

Common Peroneal Nerve Paralysis Following Rapid Weight Loss-A Case Report and Literature Review

Laura-Elena Cucu et al. Nutrients. .

Abstract

Common peroneal nerve neuropathy at the fibular head secondary to weight loss is known as slimmer's paralysis. Although this pathology has long been documented in medical literature, it has gained more clinical significance in recent years due to the global rise in obesity and the increasing pursuit of rapid weight loss methods. While case reports exist in the current literature, there are limited data regarding its optimal management. This study summarizes all reported cases of common peroneal nerve paralysis after weight loss and reports one additional case, exploring disease mechanisms as well as diagnostic and therapeutic strategies. A literature review was conducted on the platforms PubMed, Google Scholar, and EMBASE. A total of 380 patients were included. Laterality of neuropathy was specified in 297 (78.16%) patients: 285 (95.96%) with unilateral neuropathy and 12 (4.04%) with bilateral neuropathy. A total of 19 (5.00%) patients had sudden onset, and in 145 (38.16%) of cases, the Tinel's sign was positive. Additionally, 373 (98.16%) patients underwent nerve conduction studies, demonstrating the fibular head as the site of injury. MRI or ultrasound imaging of the knee is indicated to exclude compressive etiology. A total of 302 (79.47%) cases were treated surgically and 42 (11.58%) conservatively, predominantly with favorable outcomes, regardless of the therapeutic approach chosen. Although the predominance of surgically treated cases in the literature limits definitive treatment recommendations, conservative management appears appropriate when an extended recovery time is acceptable, while surgical decompression is indicated in cases showing no improvement after 3 months.

Keywords: bariatric surgery; foot drop; peroneal neuropathy; rehabilitation therapy; slimmer’s palsy; weight loss.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
MRI of lumbar spine—sagittal T2 TSE. Disc protrusions at L4-L5 and L5-S1 levels (indicated by arrows).
Figure 2
Figure 2
Nerve conduction study. (A). Right leg—conduction block of peroneal nerve at fibular head. (B). Left leg—reduced motor potential amplitude of peroneal nerve (suggesting axonal loss), with conduction block at fibular head.
Figure 3
Figure 3
The ultrasound of the common peroneal nerve at the fibular head level. (A). Right and (B). left. The nerve structure is hypoechoic with a slightly enlarged cross-sectional area. The nerve is indicated by arrows, the surface is outlined by highlighted areas, and the dashed lines demonstrate the plane for the cross-sectional area assessment.
Figure 4
Figure 4
Graphical representation of process of evaluation and inclusion of articles in review.
Figure 5
Figure 5
Proposed causes of peroneal nerve paralysis after rapid weight loss.
Figure 6
Figure 6
Approaches to treatment of peroneal nerve paralysis following rapid weight loss.
See this image and copyright information in PMC

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