Foot Drop In A Performing Arts Dance Girl

Abstract

HISTORY: A 12-year-old performing arts dance girl with history of cerebral cavernous malformations (CCM) presents with pain in left leg and suddenly foot drop. She is involved in a strict strength and conditioning program and her mom referred symptoms began two days after a dance session. PHYSICAL EXAMINATION: examination revealed stepagge gait with an ample sustentation base, left ankle with no active range of motion with stiffness at passive range of motion, strength of tibialis anterior muscle 0/5 in Lovett scale, extensor digitorum longus and extensor hallucis longus muscle 3/5 in Lovett scale. Pain with the manipulation of proximal tibiofibular joint, positive Tinel test and muscle atrophy in calf zone, no abnormal reflexes, no overlying erythema or skin changes were noted. Neurodynamic testing for peroneal nerve reproduced tingle and pain. DIFFERENTIAL DIAGNOSIS:1. Vasculitis 2. Peroneal stress fracture 3. L5 radiculopathy TEST AND RESULTS: laboratory and immunological test results were normal. Brain MRI showed the CCM and knee MRI showed increased intensity and thickness of common peroneal nerve and edema of the tibialis anterior, peroneous longus and extensor digitorum longus suggestive of edema. FINAL WORKING DIAGNOSIS: traction peroneal neuropathy TREATMENT AND OUTCOMES: 1. Splint immobilization at night. 2. Physical therapy with progressive neurodynamic peroneal nerve glide exercises and manual therapy in ankle joint.3. Proprioception exercises. 4. Range of motion and ankle strengthening exercises started 2 weeks post injury. 5. Return to sports 4 months post injury with total resolution of symptomatology.