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Pediatric Rehabilitation

Neuroblastoma-associated sciatic neuropathy with CRPS and complex gait abnormality in a pediatric patient: A Case Report

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Case Report Theater
Has Audio

    Poster Presenter(s)

  • Martin Nguyen, DO (he/him/his)

    Resident
    University of Arkansas for Medical Sciences PM&R Program
    Little Rock, Arkansas

    • Co-Author(s)

  • Emory L. Reyes, DO

    Resident Physician
    University of Arkansas for Medical Sciences PM&R Program
    Pomona, California

  • AL

    Aimee M. Lambeth, DO

    Assistant Professor of Pediatric Rehabilitation Medicine
    Children's Mercy Kansas City
    Little Rock, Arkansas

Disclosure(s):
Martin Nguyen, DO: No financial relationships to disclose
Emory L. Reyes, DO: No financial relationships to disclose
Case Diagnosis: Neuroblastoma-associated sciatic neuropathy (primary diagnosis) with Complex regional pain syndrome (CRPS) type 2 (likely), neuropathic pain, and complex gait abnormalities

Case Description or Program Description: The patient was a 3-year-old female with an intra-abdominal neuroblastoma diagnosed at age 15 months who presented to the pediatric rehabilitation clinic for right leg pain and weakness in the setting of chronic tumor-related right sciatic neuropathy. The tumor was entangled in her right sciatic nerve, and after resection, she had right leg weakness and was non-ambulatory for several months. Her treatment included inpatient therapies, ankle-foot orthoses (AFOs), amitriptyline and gabapentin. When seen in our clinic, she had been weaned off these medications, and had completed serial casting. Her mother reported the casts placed her foot too far into eversion, and noted increasing ankle pain, swelling, and sensitivity. On exam, she had 0/5 strength in ankle dorsiflexion and eversion, with a tendency to walk on the right lateral foot and right genu valgum. She struggled to tolerate bracing, resulting in significant functional impairment.

Setting: Pediatric rehabilitation outpatient clinic

Assessment/Results: Her pain improved upon restarting and up-titration of gabapentin. She underwent a posterior tibialis tendon transfer and gastroc recession resulting in improved genu valgum and gait. We are re-casting her for daytime solid AFO and making a custom nighttime positioning boot.

Discussion (relevance): Neuroblastomas are the most common extra-cranial solid tumor of childhood. However, only 5–15% of neuroblastomas present with spinal cord or nerve root compression, and are less frequently seen on peripheral nerves. There are very few documented cases with sciatic neuropathy. Pediatric CRPS is also rare, which adds to the complexity of this case.

Conclusions: This is an interesting example of how sciatic neuropathy presents in a very young patient. It also highlights how important a multifaceted approach is to rehabilitating complex gait dysfunction.