Sciatic neuropathy

Clinical manifestations
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By Thy Nguyen MD and Kazim Sheikh MD

Sciatic neuropathy presents, usually acutely, with foot weakness, pain, and sensory loss (Yuen et al 1994). Foot pain and dysesthesia are common and major symptoms in most patients. Not infrequently, signs of reflex sympathetic dystrophy (allodynia with skin, nail, and bone dystrophic changes) become dominant and disabling. The foot weakness is commonly manifested as a foot-drop, which results in a diagnostic challenge as sciatic neuropathy may imitate a peroneal neuropathy at the fibular head. In severe sciatic neuropathy, weakness of hamstrings (knee flexion) and gastrocnemius (plantar flexion) are also present. The ankle jerk is usually depressed or absent. Sensory loss and dysesthesia of the sole and dorsum of the foot and lateral leg are common.