Between brain and foot

[staley]

Occasionally while walking, the toes on my left foot will scuff the ground when coming forward. It's like my brain doesn't tell my foot to raise up when coming forward causing contact with the ground. Does this sound like beginning of parkinson's or ms or something?

[staley]

The only reason I mentioned compartment syndrome was because it can cause calf pain and lead to drop foot. However, the calf muscle does not hurt when pressed so maybe we can rule that out too. Can you give me any additional advice on what to have checked, or what kind of doctor (specialist) to see? It is getting worse. Just today at the mall, the front of my left shoe kept catching on the ground. I have to make a conscious effort to avoid tripping. Once again, I appreciate all of your help.

[Abhijeet Deshmukh, MD]

Since there is no clonus at the ankle, we can think of some other cause. Why do you think this could be a compartment syndrome? Do you have the typical symptoms of compartment syndrome? Can you observe if there is pain when you press on the leg muscle? And I do not see a possibility of DVT either.

Regards

[staley]

I checked and the doctor's office indicated that the examination found no evidence of the clonus. I noticed that the left calf muscle hurts while walking, which may be from straining to keep the foot from hyperpronating. Do you think that comparment syndrome or dvt are possibilities?

[Abhijeet Deshmukh, MD]

Hi.

I am sorry for not explaining the meaning of clonus earlier.

Clonus is a tremor like movement, much slower and rhythmic, when stimulated by th examiners hands. The ankle is lifted up, and the foot is lightly pressed from the soles. It is usually a sign of upper motor neuron loss.

The lumbar spine MIR does appear to be the culprit.

Regards

[staley]

I'm not sure about the clonus and don't know if it is a good or bad thing to have. However, my lumbar spinal showed mild diffuse disc bulge with small herniation at L1-L2 and mild diffuse disc bulge at L4-L5, but the Dr. wasn't concerned. Thank you once again.

John

[Abhijeet Deshmukh, MD]

Hello.

This seems to happen only on walking. A week dorsiflexion can happen on walking if there is a nerve compression in the walking phase. A lumbar spinal MRI would help in confirming the diagnosis.

Also, did you notice any ankle clonus when the doctor was examining?

Regards

[staley]

The toe/foot drop is only upon walking, and not sitting or lying down. While walking, it seems like the push off phase on my left foot is not as strong, which may be causing the occassional drag and limp. While seated, I can move my foot against resistance (doctor's hand) in all directions with good strength, so the weak link may be the dorsiflexors, from what I have read tonight about feet. I just tried an arch support shoe insert, which seems to give support when standing, but doesn't really help the walking.  

Also, I've noticed that when I wake in the morning, one of two things happen before getting out of bed: 1) my legs have periodic limb movement, flexing repeatedly at the hips, knees, and ankles, without me thinking about it; or 2) my calves begin hurting.

What do you think? Thank you once again.

[staley]

The toe/foot drop is only upon walking, and not sitting or lying down. While walking, it seems like the push off phase on my left foot is not as strong, which may be causing the occassional drag and limp. While seated, I can move my foot against resistance (doctor's hand) in all directions with good strength, so the weak link may be the dorsiflexors, from what I have read tonight about feet. I just tried an arch support shoe insert, which seems to give support when standing, but doesn't really help the walking.  What do you think? Thank you once again.

[Abhijeet Deshmukh, MD]

Hello.

The possibility of a sciatic nerve injury looks distant as the nerve conduction is normal. It would have shown up in the NCS.

Do you have the foot drop only on walking? The lumbar MRI is also normal. This helps us to rule out cord compression and sciatic or any other nerve injury.

Do you have toe foot drop only on walking? Does it come while you are sitting or lying down?

Regards

[staley]

As I reported, my EMG/NCV is normal. A lumbar MRI has now been found to be normal. I just learned that some people have had sciatic nerve injury including drop foot after  receiving gluteal intramuscular injection. Well, I had a few injections (RIG) in my hips/back of my hips in August 2005. Could my symptoms be a sciatic nerve injury despite the normal test results? Note that my EMG/NCV is normal and I can walk on my toes and heels all around and across the room, but my left foot arch has somewhat collapsed so that it hyperpronates when walking. If so, is there anything that can be done now? Some people have a procedure to try to free the nerve, but usually this is done right away. I'm not sure if the sciatic nerve was injured, or maybe could scar tissue have formed in the gluteal area that is pressing on the nerve?

[caregiver222]

Chances are you have what is commonly called "drop foor" and the cause is nerve compression secondary to disc deterioration in the lumbar region. You have textbook symptoms. I see no point in a muscle biopsy at this point, unless you are a masochist and enjoy pain and discomfor to pay for sins in a previous life. . What you need is an MRI , prefarably with dye contrast (not a CAT scan) and not an x-ray of the lumbar vertabrae. Often a protcedure called a laminectomy is considered. You need to get this done because if it goes on too long the condition may be permanant.

[staley]

Hello again. I will ask for a muscle biopsy when I go back next week. Which muscle should it be performed on. The foot or calf or ankle area? Also, I have noticed that the condition really comes on when I have anxiety flare up. Thanks.

[Abhijeet Deshmukh, MD]

Hello.

I won't say stroke, but if you consider a transient ischemic attack, it still does not fit into the picture. A stroke will usually have other more distinct features associated.

Since the EMG has come back normal, a peripheral nerve disorder also does not seem to be the cause. Can you ask for a muscle biopsy ?

Regards

[staley]

Well, I had the EMG/NCV today, which was normal. According to what I've read, some of the possibilites are stroke, diabetes, rheumatoid arthritis, parkinson's, ms, and hyperpronation. I have had recent blood tests for diabetes and stroke. If someone has a stroke, it's hard to miss right. I mean, I would know it, right. Any advice?

[staley]

Thank you for the information. On Friday, I was given a referral to a neurologist, but the appointment is not yet. Do you think it is more of a perpipheral nervous system disorder or a central nervous system disorder?

[Abhijeet Deshmukh, MD]

Hello.

Well, it seems you do not have symptoms due to a possible diabetic neuropathy. But there is certainly a neuropathy, which has caused to loss of arch.

Can you get Electromyography (EMG) and nerve conduction study (NCS) done ? These two will be helpful in finding out if you have some nerve problem.

Regards

[staley]

Thanks for the quick reply. I do have pain in the back, generally from the lower thoracic to the lumbar areas. I am able to walk on my toes and heels equally, but this exacerbates the pain in the back. My reflexes are normal including at the knee and ankle. Babinski reflex is normal. Occassionally, there will be a brief numb-like sensation in the left foot, but when I touch the foot I can feel the touch of a feather, pin, etc. Sometime, the sole of the left foot gets tingly. During my physical in the summer my fasting glucose was 104 mg/dL and AIC at 6%, which they said was okay, so I don't think I have diabetes. I do not recall a specific back injury. My coordination and motor skills seem fine. Interestingly, the arch on the left foot has somewhat collapsed over the past few months. Does this help any?

[Abhijeet Deshmukh, MD]

Hello.

If it is only the left foot that is problematic, you should consider some lower spine problem. A pinched nerve in the lower back can lead to weakness of the muscle that elevate the foot while walking.

Do you have any other symptoms ? Was there any back injury ?

Are you a diabetic ? Does your left foot have sensations ?

Regards