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Fashion victim: rhabdomyolysis and bilateral peroneal and tibial neuropathies as a result of squatting in ‘skinny jeans’
  1. Karmen Wai1,
  2. Philip Douglas Thompson2,
  3. Thomas Edmund Kimber2
  1. 1Neurology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. 2Neurology Unit, Royal Adelaide Hospital and Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Associate Professor, Thomas Edmund Kimber, Neurology Unit, Royal Adelaide Hospital and Department of Medicine, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia; thomas.kimber{at}health.sa.gov.au

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A 35-year-old woman presented with severe weakness of both ankles.

On the day prior to presentation, she had been helping a family member move house. This involved many hours of squatting while emptying cupboards. She had been wearing ‘skinny jeans’, and recalled that her jeans had felt increasingly tight and uncomfortable during the day. Later that evening, while walking home, she noticed bilateral foot drop and foot numbness, which caused her to trip and fall. She spent several hours lying on the ground before she was found.

On examination, her lower legs were markedly oedematous bilaterally, worse on the right side, and her jeans could only be removed by cutting them off. There was bilateral, severe global weakness of ankle and toe movements, somewhat more marked on the right. Muscle power at the hips and knees was normal, knee jerks were normal and ankle jerks were absent. Sensation was impaired over the lateral aspects of both lower legs, and the dorsum and sole of both feet. Peripheral pulses were normal. The feet were warm and well-perfused.

Investigations showed markedly elevated creatine kinase of 73 215 IU/L. Renal function was normal. CT scan of the lower legs showed marked oedema and hypoattenuation of the posterior calf muscles, worse on the right, consistent with myonecrosis (figure 1). Nerve conduction studies showed conduction block in both common peroneal nerves between the popliteal fossa and fibular head. Compound muscle action potential amplitudes of the tibial nerves were also diminished with stimulation in the popliteal fossa, compared with the ankle. Sural and superficial peroneal sensory action potentials (SAPs) were of normal amplitude bilaterally, but the right medial plantar SAP was absent and the left medial plantar SAP was markedly reduced in amplitude (0.8 µV).

Figure 1

Sagittal CT scan of the right leg (A) and axial CT scans of both lower legs (B) showing hypoattenuation and oedema of muscles of the posterior compartment of the calves, consistent with myonecrosis.

The patient was treated with intravenous hydration. The oedema and neurological function of her lower limbs improved significantly, such that at the time of discharge 4 days later she was able to walk unaided.

Common peroneal neuropathies can be caused by a range of factors, of which external compression at or near the fibular head is the most common.1 Recognised causes include prolonged squatting.2–4 Combined common peroneal and tibial neuropathies have not previously been described in association with squatting.

We postulate that, in the present case, the peroneal neuropathies were the result of compression between the biceps femoris tendon and fibular head as a result of squatting. The tibial neuropathies were likely caused by compression of the nerves in the posterior compartment of the calf by oedematous muscles that 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.

Previous reports of neuropathy from wearing tight jeans have been limited to lesions of the lateral cutaneous nerve of the thigh, likely caused by compression of the nerve at the inguinal ligament.5 The present case represents a new neurological complication of wearing tight jeans.

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Footnotes

  • Contributors KW, TEK made substantial contributions to the conception and design of the work, as well as the acquisition, analysis and interpretation of data. PDT made substantial contributions to the analysis and interpretation of data; revised the draft critically for important intellectual content. KW drafted the work. TEK, PDT: revised the draft critically for important intellectual content; approved the version published. KW, TEK, PDT approved the version published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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