Foot Drop in a Cheerleader After a Yoga Pose

Abstract

HISTORY: 15-year-old healthy female referred for right foot drop and numbness of the right lower leg x 1 month and occurred during yoga. She is a cheerleader and is quite flexible, and the instructor had her do advanced poses that she had not done; she subsequently experienced pain in her anterior shins. She has experienced pain in anterior shins before; however, this time she had numbness and difficulty with ambulation and noticed she was tripping on the right. Of note, she was on oral antibiotics for recurrent ear infections that eventually required tubes to be placed. The antibiotics upset her stomach causing 15 pound loss from 12/2015 - 3/2016. PE: Thin female, alert, in no distress Extremities warm, well-perfused with 2+ pulses in DP, PT bilaterallyFull range of motion in lumbar spine and bilateral hips without pain Atrophy of the right tibialis anterior, no subluxation of right fibula, no swelling 5/5 in strength in bilateral hip flexion, knee extension, knee flexion, ankle plantarflexion, left ankle dorsiflexion, and left 1st toe extension. 0/5 strength in right ankle dorsiflexion, right ankle eversion and right 1st toe extension. 5/5 in right ankle inversion Sensation: intact in left leg, minimally decreased over the right medial malleolus, significantly decreased over the right lateral malleolus, and absent along dorsum of right foot Reflexes 2+ and symmetric in bilateral patella and Achilles, toes downgoing, no clonus Beighton scale: 9/9 DIFFERENTIAL: Peroneal neuropathy Plexopathy Radiculopathy Peripheral neuropathy Myelopathy Cauda Equina Lesions ALS Multiple Sclerosis Conversion Disorder TESTS: XR lumbar spine normal MRI of the right leg suggestive of common peroneal neuropathy; no focal mass seen compressing the nerve EMG/NCS: evidence of right common peroneal neuropathy proximal to the fibular head FINAL WORKING DIAGNOSIS: Peroneal neuropathy across the fibular head TREATMENT AND OUTCOMES: She was started on a short course of a corticosteroid taper and physical therapy. At 1-month follow-up, the patient reported significant improvement with decreased numbness and is able to perform maneuvers with cheerleading. Strength has also improved to 3/5 in right ankle dorsiflexion, 4/5 in right ankle eversion. She continues with PT and close follow-up with ortho and primary care sports medicine.