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Neurology (Expert Forum)
no ankle reflex
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no ankle reflex
by Chase, Aug 06, 2002 12:00AM
When my son was 3 months old I remember the pediatrician in Florida saying that he could not find a reflex in his foot but it has to be there. As he began to walk he clawed his toes on right foot. 6 months later we returned to the pediatrician because I was concerned that he still clawed his toes on right side, sometimes dragged his foot to the side on the inside of his foot and his overall gait. I was assured that it was nothing to worry about and he would walk out of it. 5 months later we were amazed to notice that his right leg below the knee and his foot were wasted and the foot appeared smaller. We have since had an MRI of the spine, a brain scan and nerve conduction tests that came back normal. An ultra sound of muscles showed the gastrocnemius and soleus to be abnormal (they appeared less fibrous). He still has no ankle jerk and the foot is pes cavus. He wears an orthotic in his shoe and he is very active I have him bike riding, swimming, jumpimg on the trampoline etc. Apparantly an EMG wouldn't be suitable for a little boy and we may never know what is causing this or be able to put a label on this. I have been told that it is nonprogressive and when he is older they could do a peroneal transfer to try and strengthen the calf muscle and surgery for pes cavus. Would you have any idea what this could be and is there anything else that we could be doing for him. Thankyou I appreciate your advice.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Aug 07, 2002 12:00AM
Glad your son is active and able to play. Weakness of one limb is typically caused by a problem of the spinal cord or peripheral nerve. Charcot Marie Tooth is a peripheral nerve disorder that can present with foot deformity and leg weakness, but is typically picked up by nerve conduction studies. There is also a disease called spinal muscular atrophy that has a segmental form in which only one limb is affected. Although it presents later in life 10-20yrs old, that's a consideration. Another possiblity is that this could be an atypical presentation of a neuromuscular syndrome such as a muscular dystrophy.
Consider an evaluation by a pediatric neuromuscular specialist at a major academic center. If the EMG is too difficult at this time, other studies can be done such as blood work to look for CK protein and other muscle enzyme markers, genetic markers, and possibly a muscle biopsy. Best of luck,
Consider an evaluation by a pediatric neuromuscular specialist at a major academic center. If the EMG is too difficult at this time, other studies can be done such as blood work to look for CK protein and other muscle enzyme markers, genetic markers, and possibly a muscle biopsy. Best of luck,
