Cellulitis May Present As Foot Drop In A Diabetic Patient

Abstract

We are presenting a diabetic patient who was admitted with right hemiparesis because of a stroke and after a few days in hospital developed left foot drop. After thorough investigation, it turned out to be a complication of a smoldering cellulitis around the left ankle. A 62-year-old Afro-American lady was transferred from another hospital where she presented complaining of right sided weakness. The night before, she went to bed without any complaints. When she woke up in the morning, she had right upper and lower extremity weakness, right side of face weakness and slurred speech. Brain CT showed acute hemorrhage in the left basal ganglia. She was on anticoagulation and received fresh frozen plasma for reversal. After a few days in hospital and some improvement in right hemiparesis she developed a left sided foot drop. She was unable to dorsiflex her ankle or extend her toes. She had decreased sensation to light touch in her first web space but did have normal sensation throughout the dorsum of her foot as well as the reminder of her leg. The skin appeared normal. She did have some generalized tenderness of her foot but no acute swelling. She did not have any palpable defect in the tendons before or behind her lateral malleolus. MRI and 3-phase bone scan revealed acute changes in the soft tissues of the left leg, ankle and foot. The findings were compatible with cellulitis. According to the “double crush” theory, diabetic neuropathy is the first crush and compression of the nerve by soft tissue edema is the second crush.