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To the Editor.—
Conveniences in the West make tourists to the Third World susceptible to some unusual problems.While recently practicing medicine in Kathmandu, Nepal, I saw a 23-year-old woman tourist. She had severe dysentery caused by Shigella sp, with ten to 15 bowel movements daily. With appropriate therapy, her symptoms gradually improved, but on the eighth day of her illness she noted the appearance of a left foot drop. Examination showed complete inability to evert or dorsiflex the foot, consistent with a common peroneal nerve palsy. Further questioning revealed that she was staying in budget accommodations that had only Asian squat-style toilets. As there were no other significant findings, it is likely that repeated squatting in an unusual position caused compression neuropathy of the peroneal nerve as it passed over the head of the fibula. Rest and moving to a hotel with western-style toilets resulted in some improvement of
David J. Kumaki. The Facts of Kathmandu: Squatter's Palsy. JAMA. 1987;257(1):28. doi:10.1001/jama.1987.03390010032017