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I recently had a 70 year old patient come in with Parkinson's. Her left foot was painful because her hallux was fixed in extension and the lesser toes were all splayed and clawed or hammered and in addition deviated either medially or laterally. I am a student on placement and I simply gave her toe props to alleviate the pressure on the lesser toes and referred her to an MSK specialist. I have looked for some papers on this subject but the only similar condition I can find is where this pattern occurs during waking but is relieved by rest which was not the case. Does anyone know of any research done on foot deformities in Parkinsons? I have looked in all the obvious places to no avail.
Cheers for reading.
Botulinum toxin for foot dystonia in patients with Parkinson's disease having deep brain stimulation: A case series and a pilot study.
Gupta AD, Visvanathan R. J Rehabil Med. 2016 Apr 28
Six patients with Parkinson's disease with deep brain stimulation who were experiencing disabling foot dystonia were referred to the spasticity clinic for a trial of botulinum toxin. The foot and ankle muscles were injected with onabotulinum toxin (Botox) to determine the effects on foot dystonia, pain and lower limb functional outcomes.
Six patients with Parkinson's disease with deep brain stimulation experiencing disabling foot dystonia.
Dystonic foot and ankle muscles were identified and injected with 250-400 units botulinum toxin and re-coded pre- and 3 weeks post-injection with the Burke Fahn Marsden Dystonia score, visual analogue score of pain, Unified Parkinson's Disease Rating Scale (UPDRS) - lower limb score, Timed up and Go test (TUG), 6-Minute Walk Test (6MWT), gait velocity, cadence in an instrumented walkway, and Goal Attainment Scale (GAS).
Three weeks after botulinum toxin injection, significant improvements were noted in dystonia, pain, UPDRS, 6MWT, gait velocity, and cadence. Five out of 6 patients improved on the TUG test. Patients also reported improvements in their GAS goals.
Botox injection significantly improved foot dystonia, pain and lower limb functional outcomes in patients with Parkinson's disease with deep brain stimulation.