• Young-Keun Lee and Ji Woong Ho.
• Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea.
• Medicine (Baltimore). 2023 Nov 10; 102 (45): e36059e36059.

RationaleOsteochondroma is one of the most common primary benign bone tumors. In most cases, this disease is asymptomatic. However, it may become symptomatic owing to nerve and vascular compression when it affects the knee joint. Isolated tibial nerve palsy caused by proximal fibular osteochondroma is rare.Patients ConcernsA 60-year-old male, was treated for degenerative arthritis of the right knee, referred to the right great toe flexion limitation that occurred 3 weeks prior.DiagnosesMagnetic resonance imaging revealed compression of the tibial nerve and surrounding muscles due to an osseous lesion in the fibular head. A nerve conduction test confirmed tibial neuropathy in the right lower leg.InterventionsExploratory surgery was performed to decompress the tibial nerve and remove the bony lesion histopathologically diagnosed as an osteochondroma.OutcomesFifty-five months postoperatively, toe flexion recovered to normal. No recurrence of osteochondroma was observed.LessonsAs in our case, if a bony lesion is diagnosed on radiographs with neurological symptoms, early decompression surgery is necessary. Moreover, since it can be misdiagnosed as a simple bony spur, magnetic resonance imaging and tissue biopsy are also indicated.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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