Ultrasound-guided Hydrodissection and Integrated Rehabilitation for Postsurgical Common Peroneal Nerve Entrapment

Postoperative common peroneal nerve (CPN) entrapment is a common iatrogenic cause of foot drop, and an established rehabilitation protocol is currently lacking. This article provides a step-by-step visual demonstration of an integrated approach, combining ultrasound-guided hydrodissection with structured task-oriented rehabilitation. The protocol includes: (1) real-time ultrasound identification of CPN entrapment; (2) in-plane, multi-quadrant hydrodissection using a 5% dextrose, lidocaine, and mecobalamin injectate; and (3) a phased rehabilitation program initiated 24 h post procedure, comprising neural gliding, therapeutic ultrasound, neuromuscular electrical stimulation, and five task-oriented training modules. In the representative case, the leg-foot angle during maximal dorsiflexion effort demonstrated a 38° reduction (from 142° to 104°), and gait analysis showed restoration of heel-strike, push-off, and swing-phase foot clearance. Post-intervention EMG revealed reinnervation potentials in the tibialis anterior, peroneus longus, and extensor hallucis longus. This visually formatted, stepwise protocol demonstrates the feasibility of combining percutaneous nerve decompression with task-specific rehabilitation, offering a replicable framework for managing refractory postoperative CPN entrapment.