1. Fashion victim: Rhabdomyolysis and bilateral peroneal and tibial neuropathies as a result of squatting in skinny jeans

• Published in: Clinical neurophysiology Vol. 127; no. 3; p. e10
• Main Authors: Wai, Karmen, Thompson, Philip Douglas, Kimber, Thomas Edmund
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.03.2016
• Subjects: Neurology
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2015.11.021

A 35 year old woman presented with bilateral foot drop and numbness following repetitive squatting while wearing “skinny” jeans. Her examination demonstrated bilateral, severe, global weakness of ankle and toe movements, somewhat more marked on the right, absent ankle jerks and impaired sensation over the lateral aspects of both lower legs and the dorsum and soles of both feet. Her lower limbs were markedly oedematous and the jeans had to be cut off for removal. Investigations showed a creatine kinase level of 73215 IU/L with normal renal function. CT scan of the lower limbs demonstrated myonecrosis in the posterior calf muscles. Nerve conduction studies showed bilateral conduction block between the popliteal fossa and fibular head of the common peroneal nerves. Compound muscle action potential amplitudes of the tibial nerves were also diminished with stimulation in the popliteal fossa, compared with the ankle. The sural and superficial peroneal sensory responses were normal but the right medial plantar SAP was absent and the left medial plantar SAP was markedly reduced in amplitude. With conservative therapy, the patient’s oedema and neurological function improved and she was discharged after regaining independence with her mobility four days later. We postulate that the patient’s peroneal neuropathies were the result of compression between the biceps femoris tendon and fibular head as a result of squatting while the tibial neuropathies were likely caused by compression of the nerves in the posterior compartment of the calf by oedematous muscles which had undergone ischaemic myonecrosis as a result of squatting. The wearing of “skinny” jeans had likely potentiated the tibial neuropathies by causing a compartment syndrome as the lower legs swelled.