Delayed sciatic nerve branch injury following a gluteal stab wound presenting as intrinsic foot muscle denervation: A case report

Penetrating injuries to the gluteal region may result in occult peripheral nerve damage. Delayed presentation and nonspecific symptoms can lead to missed or late diagnosis, increasing the risk of irreversible muscle denervation and functional impairment. A 40-year-old previously healthy man presented with progressive left foot paresthesia and gait disturbance six months after sustaining a stab wound to the left buttock. Initial emergency management focused on hemorrhage control and wound closure, while early neurologic symptoms were overlooked. MRI of the left foot demonstrated diffuse edema and signal alteration within the intrinsic foot muscles, consistent with denervation injury. Retrospective clinical correlation revealed a penetrating gluteal injury, implicating a sciatic nerve branch injury as the underlying cause. This case emphasizes the importance of considering peripheral nerve injury in patients with penetrating trauma along the anatomic course of major nerve bundles. Early neurologic evaluation, appropriate imaging, and a multidisciplinary approach are essential to prevent delayed diagnosis and irreversible muscle atrophy.