1615 - Multiple Etiologies of Foot Drop in a 37-Year Old Male: Peroneal Nerve Compression After Tibial Bracing and GLP-1 Agonist Associated “Slimmer’s Paralysis”

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

EM

Eliyah Malik, MS

Medical Student
Florida State University - College of Medicine
Newberry, Florida, United States

Co-Author(s)

BL

Bergen e. Lemack, BS

Medical Student
Texas College of Osteopathic Medicine
Fort Worth, Texas, United States
OS

Omar Selod, DO

Physician
PMR Fort Worth
Fort Worth, Texas, United States
SS

Sommer Selod, BS

medical student
Texas College of Osteopathic Medicine
Fort Worth, Texas, United States

Submitter(s)

EM

Eliyah Malik, MS

Florida State University - College of Medicine
Newberry, Florida, United States

Case Diagnosis: A 37-year old male with chronic back pain developed progressive left leg weakness, muscle atrophy, and foot drop months after sustaining a gastrocnemius tear treated with an ankle-to-knee brace and significant weight loss on a GLP-1 receptor agonist.

Case Description: The patient presented to the clinic with left-sided foot drop and atrophy of the gastrocnemius following a 6-week history of brace use for gastrocnemius tear, which he discontinued in February. He also reported an estimated 80-pound weight loss while taking semaglutide during the past year. Physical exam revealed ⅘ strength in the left dorsiflexor, difficulty with heel walking, and mild atrophy of the left tibialis anterior. MRI of the lumbar spine from several years prior revealed L5-S1 disc herniation with impingement of the S1 nerve root. Electrodiagnostic testing demonstrated focal peroneal nerve entrapment at the fibular head, consistent with compressive peroneal neuropathy. The combination of brace-related pressure and rapid weight loss likely contributed to the patient’s neuropathy, while disuse during bracing contributed to muscle atrophy.

Discussions: The etiology of foot drop is multifactorial, and careful evaluation is required to differentiate central from peripheral causes. Mechanical compression of the peroneal nerve at the fibular head is well-described after orthopedic interventions, such bracing1. In addition, peroneal neuropathy following rapid weight loss known colloquially as “slimmer’s paralysis” is an increasingly documented phenomenon2. Recent reports link use of GLP-1 agonists such as semaglutide with peroneal nerve entrapment and acute foot drop3. This case illustrates how overlapping risk factors can potentiate neuropathy, underscoring the value of electrodiagnostic testing to localize the lesion.

Conclusions: Foot drop requires a broad differential that includes both central and peripheral etiologies. This case highlights multiple concurrent risks for peroneal neuropathy: brace-related mechanical compression and GLP-1 associated weight loss. Electrodiagnostic studies are indispensable in establishing diagnosis and guiding management.