1611 - Squat Goals Gone Wrong: An Unusual Cause of Deep Fibular Neuropathy at the Knee

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SC

Stephen Chien, BA

Medical Student
Drexel University College of Medicine
Reading, Pennsylvania, United States

Co-Author(s)

JK

Jessica Kurtz, MD

SCIM Fellow
Carolinas Rehabilitation
Charlotte, North Carolina, United States
WB

William L. Bockenek, MD

Chief Medical Officer
Carolinas Rehabilitation/Atrium Health
Charlotte, North Carolina, United States

Submitter(s)

SC

Stephen J. Chien, BA

Drexel University College of Medicine
Reading, Pennsylvania, United States

Case Diagnosis: Right deep fibular (peroneal) neuropathy

Case Description: A 24-year-old male with known chronic mild bilateral heel cord tightness presented with six weeks of right ankle dorsiflexion weakness and paresthesias of the dorsal foot. Symptoms developed following weighted deep knee bends (hack squats) without additional trauma. Exam revealed a positive Tinel’s sign at the right fibular head with persistent decreased sensation over the 1st interdigital webspace, 3/5 ankle dorsiflexion, 4/5 great toe extension, and otherwise 5/5 strength (including right ankle evertors). MRI lumbar spine was unremarkable. Nerve conduction studies across the fibular head demonstrated reduced motor amplitude in the extensor digitorum brevis, and conduction velocity slowing. Electromyography showed abnormal spontaneous activity with early reinnervation in the tibialis anterior and extensor hallucis longus. These findings, in addition to a normal superficial fibular nerve study, supported an acute to subacute axonal and demyelinating isolated deep fibular neuropathy.

Discussions: With rising strength training participation, weightlifting-related neurologic injuries are increasingly reported, though upper extremity neuropathies remain more common than lower extremity neuropathies. Squatting can compress the common fibular nerve at the fibular head during knee flexion; however, isolated deep fibular nerve neuropathy is rare. This patient’s preserved superficial fibular nerve function localized the injury distal to the common fibular nerve bifurcation. Electrodiagnostics were key to rule out other peripheral neuropathies and L5 radiculopathy. Prolonged nerve compression can progress to axonal injury, which may delay recovery. Heel cord stretching exercises were recommended, and orthopedics and physical therapy referrals were considered for further management.

Conclusions: This case highlights an uncommon presentation of deep fibular neuropathy, which should be considered in weightlifters who frequently perform squats and present with isolated ankle dorsiflexion weakness. Education on proper workout techniques, and early diagnosis after a weightlifting-related injury, can help prevent long-term activity limitations and participation restrictions.