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Yesterday I saw a patient, female 50's, no prior health issues, except this:
she had an extensor tenotomy done (orthopedic surgeon) 6 months ago (2nd to 5th toe - right foot); after that, she developed intense involuntary spasms (flexors) - causes discomfort and pain and she cannot walk long distances. There's one maneuver she discovered that helps - passive dorsiflexion of the hallux stops/diminishes the spasms while doing it.
She did all sort of exams, including neurological, but nothing has been found.
I did a silicone digital orthosis to avoid the "flexor curling" - she felt a lot better - lets see how it goes...
Any ideas? Does someone know a similar case?
Thank you and best regards,
__________________
Romeu Araújo
Podiatrist - Portugal
Science increases our power in proportion as it lowers our pride.
Hola:
I would suggest that her unopposed flexor tendons are beginning to spasm. If the short and long extensors were tenotomized this would increase the chance of spasm.
I've seen this before and it does tend to be self limiting and resolve itself. In the meantime passive stretching and NASAs as needed.
Good luck
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Hola:
I would suggest that her unopposed flexor tendons are beginning to spasm. If the short and long extensors were tenotomized this would increase the chance of spasm.
I've seen this before and it does tend to be self limiting and resolve itself. In the meantime passive stretching and NASAs as needed.
Good luck
Steve
... NASA (I suppose you are referring to Norepinephrine Antagonist Serotonin Antagonists). How long would you guess to see improvements?
Thank you.
Best regards,
__________________
Romeu Araújo
Podiatrist - Portugal
Science increases our power in proportion as it lowers our pride.
Hi
No
Sorry, typo!
NSAI...non steroidal anti inflammatories.
I'm a better surgeon then typist.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Hi
Don't see the reason..... For NSAID?
Well, most have analgesic as well as anti inflammatory
Properties. The anti inflammatory for the tendon
Sheaths for those tendons in spasm, and
Analgesic because it's always good to make
Your patient feel better!!
Like I said, these are usually self limiting.
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Hi
Don't see the reason..... For NSAID?
Well, most have analgesic as well as anti inflammatory
Properties. The anti inflammatory for the tendon
Sheaths for those tendons in spasm, and
Analgesic because it's always good to make
Your patient feel better!!
Like I said, these are usually self limiting.
My apologies - I was out of context. I thought I'd already wrote that the patient has taken different NSAID's for quite a long time... She felt no difference at all.
When she came to me, a Neurologist had just prescribed medication (she forgot the name) - I'll know next Monday and I'll post it here.
Regards,
__________________
Romeu Araújo
Podiatrist - Portugal
Science increases our power in proportion as it lowers our pride.
No Problem:
Your patient is likely on a muscle relaxant.
If they do not improve you may consider tenotomizing the FDL at the digits.
Did your patient ever return the the original surgeon? What did he tell her?
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Did your patient ever return the the original surgeon? What did he tell her?
Yes she did. He said he'd never seen such a case - medicated her with NSAID's - and then sent her to me (more than 6 months passed from the surgery)...
Cheers
__________________
Romeu Araújo
Podiatrist - Portugal
Science increases our power in proportion as it lowers our pride.
Muscle Spasms after Extensor Tenotomy
Re: Muscle Spasms after Extensor Tenotomy
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