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I had a male patient in his mid 20's present this week, with a very significant left foot drop. He reports that he has yet to receive a diagnosis and reason for this occuring.
He has reduced periphery sensation at the left anterior shin area, ankle reflex is absent and is unable to dorsi flex at the ankle joint.
He reports that he suffers tingling in the left limb, left hip and also left hand.
He reports that the foot drop basically occurred overnight about 6 -8years ago.
Just wondering if anyone knows if CMT can occur virtually overnight? OR Does anyone have any other suggestions?
Thanks
Kirsti

It does not sound like CMT.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
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Here is a good article from eMedicine:
http://emedicine.medscape.com/article/1234607-overview

and a somewhat basi one from Wikipedia (I am sure a mod will be along soon and embed it):
http://en.wikipedia.org/wiki/Foot_drop

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Dear Kirsti,
CMT does not occur 'overnight' or in a unilateral distribution. I suggest you investigate nerve compression on the affected side.
Kind regards
Josh

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Joshua Burns PhD, B App Sc (Pod) Hons
NHMRC Australian Clinical Research Fellow
Institute for Neuromuscular Research, The Children's Hospital at Westmead
Locked Bag 4001, Westmead NSW 2145 Australia

Conjoint Senior Lecturer, Discipline of Paediatrics and Child Health
Sydney Medical School, The University of Sydney, Australia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Kirsti:

Foot drop combined with left limb and left hand neurological findings makes one think first of cerebrovascular accident (CVA), even though this is not common in someone in the mid 20's. A fairly common cause of unilateral foot drop (without the upper extremity symptoms) is a tight and too high below knee cast that causes a compression neuropathy of the peroneal nerve at the superior fibula.

This patient needed a neurological consult 6-8 years ago and probably still does. It is not likely Charcot-Marie Tooth Disease.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
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Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
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The neurological signs involving both the arm & leg would tend to indicate a R) sided brain pathology, however in having said that you indicate that he has 'not yet had a diagnosis'. What assesments & testing has he had previously?

Did all the symptoms appear at the same time i.e. did he start experiencing the tingling sensations in the leg & arm at the same time as the foot drop occurred? If not these may represent a distraction & may not necessarily be related to the footdrop. Also is the tingling constant or does it occur intermittently? Intermttent symptoms may possibly indicate a demyelinising syndrome such a multiple sclerosis.

What happened 6-8 years ago when he first experienced the footdrop? I would explore the possibility of a compression neuropathy. Given he is now in his mid twenties that puts the time of onset about when he was 17 or 18 years old. I have seen several cases of patients who have had similar symptoms in their arms from lying in one position for a long period of time, usually with their arm compressed against something e.g compressed against the metal frame of a fold out bed. It tends to occur more commonly in patients who have been drinking heavily or have taken drugs (ilicit or prescription CNS depressents) which tends to put then in a very deep sleep (or significantly altered conscious state) & they tend to sleep / stay in the one position for many hours causing the nerve compression & subsequent damage. If he had fallen asleep with his leg against something (especially a hard surface) this may have caused the acute foot drop & other neuro signs in his leg. He is in the right age group when the symptoms first occurred for experimenting with illicit drugs & heavy (binge) drinking.

If not already done I would make sure to press for a really thorough understanding of the exact circumstances behind the onset of the symptoms.

Regards,

David Kelly

Thanks everyone!
As you can all probably appreciate, getting a thorough history from this patient was quite difficult. From what was reported to me, he has had 2 different neurological assessments, MRI of his spine and other neurological tests (descriptions of these were vague).
I have asked him to contact his GP and get a copy of reports from previous practitioners and hope he has them next week.
I have explained AFO is the logical treatment, but he really is after a diagnosis.
Craig,
Wondering why you don't think it could be CMT?

If MRI's; CT's etc are ok I would also consider a vascular problem such a vasculitis. Vascularitic neuropathy can occur asymetrically and affects the common fibular nerve in about 65-80% of cases causing foot drop. It can also affect the ular, median & radial nerves which may explain the neurological symptoms he is experiencng in his left arm.

Hi
I've been reading this discussion with interest and have just pulled out my medical textbook ( need some R & R after the trauma of the` Britains got Talent` final ) and this patients problems sound like a type of peripheral neuropathy/polyneuropathy?multifocal neuropathy. Tendon reflexes are often affected usually as a result of sensory loss rather than motor impairment and if the radial nerve is affected a wrist drop can occur. Were the lower limbs involved before the upper limbs? Is there any wasting or weakness or effect on pain/ temperature or touch and pressure sensation?

Silly question but has the patient been screened for diabetes?
Am very interested to know what final diagnosis turns out to be.
Regards
Deborah

Pretty much for the reason's that Josh gave. He is the CMT star

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Thanks