Weight Drop - Foot Drop: A Case Series of Peroneal Nerve Palsy from Leg Crossing after Tirzepatide-mediated Weight Loss

Introduction: Common peroneal nerve palsy, termed “Slimmer’s Palsy,” is a recognized complication of rapid weight loss. This case report describes two patients who developed foot drop following tirzepatide-induced weight loss precipitated by habitual leg crossing. Case Presentations: Peroneal neuropathy secondary to compression from habitual leg crossing developed in two male patients during tirzepatide therapy for wight loss. Patient 1 was a 55-year-old with severe hidradenitis suppurativa (HS) on multiple immunosuppressive medications who started on tirzepatide and lost 50 pounds over five months. Patient 2 was a 71-year-old with insulin resistance who lost 30 pounds over three months on tirzepatide. Both patients developed foot drop over 24-72 hours. Treatment was behavioral modification to avoid leg crossing, supplemented by physical therapy, and, in patient 1, ankle bracing. Foot drop signs resolved over three to four months. Conclusion: Clinicians prescribing tirzepatide should counsel patients about peroneal nerve palsy risk during rapid weight loss. Patients should avoid prolonged leg crossing. Early recognition enables timely intervention and favorable outcomes.