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BACKGROUND: A 56-year-old man was referred to physical therapy for analysis of unusual gait, first noticed 3 years previously when running. Prior to this evaluation, the patient had seen multiple orthopaedic, sports medicine, and neurological specialists while undergoing repeated and extensive testing. Ten months of testing and treatment, including conservative and surgical management, did not provide an explanation for the gait abnormality or result in improvement of the patient’s condition.
DIAGNOSIS: The patient’s physical examination was relatively unremarkable, considering the severity of the gait abnormality. Distinct abnormalities were apparent with computerized gait analysis and dynamic electromyography, and, when combined with the physical examination findings, led to a suspicion of the task-specific disorder of runner’s dystonia. The patient was referred to a neurologist specializing in movement-related disorders, with a final confirmed diagnosis of primary task-specific dystonia with first onset during running (ie, runner’s dystonia).
DISCUSSION: Idiopathic, task-specific dystonia of the lower extremity is documented as a very rare occurrence, yet increasing trends in running participation may result in a higher incidence of this condition. Improved awareness of runner’s dystonia in the present case might have enhanced the clinical decision-making process and resulted in more timely and effective treatment solutions. Clinical examination findings, including computerized gait analysis and electromyography, in conjunction with imaging, blood, and genetic testing, can aid in the diagnosis of runner’s dystonia
Difference of Foot Posture in Two Cases of Exercise-Induced Foot Dystonia.
Rana AQ, Boke BN. Eur Neurol. 2012 Nov 14;69(2):65-66. (free access)
No abstract available.
BACKGROUND:
Adult-onset focal lower extremity (LE) dystonia is rare, but there have recently been a number of case series that have reported an idiopathic variant triggered during ambulation.
METHODS:
We describe nine patients with idiopathic, focal task-specific LE dystonia. We conducted a comparative analysis that included our cohort and several recently published case series to further characterize the disorder.
RESULTS:
A total of 48 patients (37 female, 11 male) were compared. The average age of onset was 48 years; 36 patients had distal extremity involvement (75%), 5 proximal (10%), and 7 both proximal and distal (15%). Among 33 patients in which the dystonic side was known, 20 were affected on the left (61%). Inversion of the foot with flexion of one or more toes was the most prevalent pattern in those with distal extremity involvement.
DISCUSSION:
This is a novel task-specific dystonia triggered during ambulation that is often misdiagnosed as an orthopedic or psychogenic issue.
Dystonia in a Runner
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