Hi Gabriel,

sounds interesting. Before answering there are many questions.

1. How do you think are the symptoms related, in terms of occuring simultaneously, historically? What happened within this month? What kind of symptoms occured directly after that "trauma"?

2. Can we think of two "building sites"?

3. How are other signs, like reflexes, neurodynamic tests (SLR, or prone knee bend tests).

4. How is the health status in general, any red flag signs you worry about? Lungs?

Best regards

Markus

Hi Gabriel,

Indeed a very interesting case.  I would like to ask two questions before coming to conclusions.

1. Would it be possible to ask a PT to set up a S/D curve of the tibialis anterior?  What AQ does he get?

2. Are the signs for restricted motion of the sacro-iliacal joint positive?  I have seen the craziest symptoms from it, including a restricted motion of the proximal tibio-fibular joint.  You can imagine what that can do to the peroneal nerve.

Best Regards,

Patrick 

I think to answer this consultation are missing some details, the foot drop is deficit of the anterior tibial and extensor muscles of the foot, the gluteal musculature deficit that is gluteus maximus muscle ?, loss of sensation in that area is? You can play a nerve root. If you do not have a good semiology can not suspect lesion level and lack of data unless the etiology

I think the cause and effect as it relates to the case described do not match. Foot drop is mainly the deficit of anterior tibial and extensor foot muscles. Relationship of hip musculature in concurrent relationship with foot drop may be overestimating the clinical condition. Lack of clinical data makes the etiological diagnosis unsubstantiated. 

It may good to clear the knee joint area near the head of the fibula (peroneal nerve involvement) which may be effecting the foot drop. Did you ask if he had a knee injury and may have wrapped the lateral knee with an ace bandage with ice for a prolonged period of time? Just a thought.

the anwers gives the nerve Dynamics there have to be a entrepment

This looks like two different condition which have no possible connection. Please go through the patient's history. Foot drop is a manifestation of so many conditions ranging from Leprosy to a Case of Neurotoxin Poisoning. Please play around with Dermatomes and find out the segment involved in the area of sensation loss. NCV Might help in this case to determine the cause of Foot drop.

Hi,

Good responses so far. This sounds quite typical for a lumbar radiculitis. Assuming that rule out contraindication, include specific spinal adjustments (SMT, CMT,OMT) as a treatment consideration. Many think that SMT is contraindicated for disc herniations, which is not the case. 

See below for further reading about this option.

 Spine J. 2006 Mar-Apr;6(2):131-7. Epub 2006 Feb 3.

Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.

Santilli V1, Beghi E, Finucci S.

Author information

Abstract

BACKGROUND CONTEXT:

Acute back pain and sciatica are major sources of disability. Many medical interventions are available, including manipulations, with conflicting results.

PURPOSE:

To assess the short- and long-term effects of spinal manipulations on acute back pain and sciatica with disc protrusion.

STUDY DESIGN/SETTING:

Randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and suburbs.

PATIENT SAMPLE:

102 ambulatory patients with at least moderate pain on a visual analog scale for local pain (VAS1) and/or radiating pain (VAS2).

OUTCOME MEASURES:

Pain-free patients at end of treatment; treatment failure (proportion of patients stopping the assigned treatment for lack of effect on pain); number of days with no, mild, moderate, or severe pain; quality of life; number of days on nonsteroidal anti-inflammatory drugs; number of drug prescriptions; VAS1 and VAS2 scores; quality of life and psychosocial findings; and reduction of disc protrusion on magnetic resonance imaging.

METHODS:

Manipulations or simulated manipulations were done 5 days per week by experienced chiropractors, with a number of sessions which depended on pain relief or up to a maximum of 20, using a rapid thrust technique. Patients were assessed at admission and at 15, 30, 45, 90, and 180 days. At each visit, all indicators of pain relief were used.

RESULTS:

A total of 64 men and 38 women aged 19-63 years were randomized to manipulations (53) or simulated manipulations (49). Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p

Hello together,

so far a lot of helpful further questions, but I'd like to know whether Gabriel is still joining this conversation?

Gabriel, I think we are all eager to learn from your patient.

Please let us know, what happend so far!!

all the best

Thanks for all contributions so far made.

...MRI is been recommended for the patient but due to the patient's financial state, he is yet to do this. Further laboratory studies are been recommended. As stated earlier, no history of of direct trauma aside that earlier stated. no recent illness; not suffering any known chronic disease.

The patient was initially referred by an orthopaedic surgeon for muscle charting/assessment . my curiosity made me threw open the question. the patient was recently referred  back for rehab.; no definitive diagnosis yet from the physician aside foot drop.

Relevant info about the patient would be posted to guide reasoning and discussion

The patient has not been forthcoming; as at last visit weakness of the contra-lateral lower limb was noticed. the need for MRI was reemphasized to the patient. I hope he would be able to do it and that he would continue with his therapy. It s a typical case for new clinical knowledge; if there is any useful info, i will oblige everyone, for input and much learning