Bilateral drooping foot: causes, symptoms, diagnosis

In contrast to a one-sided hanging stop that may be of central or peripheral origin, a bilateral hanging stop always indicates damage to the peripheral nerves or muscles. The onset of the disease can be slow, so that the patient gradually gets used to changing gait, or sharp.

I. Chronic:

1. Polineuropathy.
2. Hereditary motor-sensory polyneuropathy of types I and II (Charcot-Marie-Tooth disease).
3. Dystrophic myotonia (Steinert-Butten disease).
4. Myopathy (scapuloperoneal syndrome).
5. Disease of the motor neuron.

II. Sharp:

1. Medial intervertebral hernia of the lumbar region.
2. Polineuropathy.

I. Chronic two-sided hanging stop

Polyneuropathy

Chronic development of the hanging foot is observed with polyneuropathy, especially metabolic nature, including diabetes mellitus, or toxic nature, including alcohol. There are also other clinical (subclinical involvement of the hands, sensitive disorders) and EMG signs of polyneuropathy.

Hereditary motor-sensory neuropathy (Charcot-Marie-Toot's disease) is a common cause of the chronic, slowly progressing bilateral syndrome of the hanging foot. Its clinical manifestations are quite typical and are often supplemented by a family history. EMG allows you to specify its type.

Dystrophic myotonia (Steinert-Butten disease)

The degenerative muscular disease, which was described by Kurshman and Steinert, is characterized by a particularly slow development of the hanging foot, and is called dystrophic myotonia or Steinert-Butten disease. The name implies the presence of two components - dystrophic and myotonic in the clinical picture, which is very characteristic. The unusual gait of these patients is striking. Heavy paresis and paralysis of the extensor muscles of the foot are a special obstacle when the patient tries to turn around. He can not turn on his heel, as in the norm, since it requires lifting the foot, which is impossible for these patients. Instead, they turn slowly, in small steps, always lifting their knees excessively to overcome the hanging foot.

On examination, a special habit attracts attention: a characteristic posture and a weak musculature of these patients. Men are usually bald, women have very rare hair. The face is thin and does not express anything (facies myopathica - the face of the myopath), the corners of the mouth are sometimes omitted ("sad face"). The retina may not be available for inspection because of the lens cataract. The dystrophic process affects in particular the following muscles: the sternocarpoid and brachial muscles, extensors and foot promoters. However, dystrophy is widespread, almost all muscles of the face, trunk and extremities are affected. Reflexes are reduced or absent. EMG reveals a myopathic pattern.

The myotonic component is present in patients who complain of the impossibility of rapid relaxation after compression. The examination reveals a slowing down of relaxation after a strong contraction, which is also the most convenient test for these patients. "Percussion myotonia" can also be evaluated with a rapid impact by a neurological hammer on the tenar or tongue located on the tongue. The reaction consists of a prolonged contraction that takes place after a period of more than three seconds. The myotonic reaction is very easily recognized by EMG, when the installation or any movement of the needle causes a flow of action potentials.

Myopathy

Scapulo-peroneal form of myopathy, described by S.N. Davidenko, among other manifestations, is characterized by the slowly growing weakness of the peroneal muscles, which leads to a syndrome of a chronically progressing bilateral hanging stop.

Some forms of amyotrophic lateral sclerosis may also lead to the hanging leg.

II. Sharp double-sided hanging stop

Medial herniation of the lumbar intervertebral disc

With a bilateral hanging stop, the diagnostic solution must be rapid and effective, as there may be a need for immediate surgical intervention. These are the cases when the cause of the paralysis of the extensor muscles is the medial - in contrast to the posterolateral - the hernia of the lumbar intervertebral disc.

The patient can complain of pain in the lumbar region with irradiation along the flexor side of both legs, revealing the reflex tension of the muscles of the trunk. Achilles reflexes are reduced or absent, Lasega's symptom is positive. Urination is usually blocked. Disturbance of sensitivity (numbness, decreased pain and tactile sensitivity) quickly spreads from the foot, covering both legs. Immediately, magnetic resonance imaging should be performed, because in this case there is no real therapeutic alternative to surgical treatment, and the only issue is the level of lesion.

Polyneuropathy

Sometimes, in very rare cases, polyneuropathy leads not only to the hanging feet, but also to violations of urination. There is no severe pain or muscle tension in the lumbar region. Electro-neurology will not help in diagnosis during the first few days of the disease. In case of doubt, it should be borne in mind that a mistake can have very serious consequences for the patient. It is better to perform myelography to a patient with polyneuropathy than to miss an acute disk hernia. If the pressure on the horse tail fibers is not removed immediately, the consequence of the delay in the operation will be only a partial restoration or a complete lack of recovery.