:santa:Can anyone shed some light on the following presentation: We suspect some kind of ataxia and have referred him for further investigations but would be interested if anyone has come across this in clinic:
Members do not see these Ads. Sign Up.
13 yr old otherwise healthy and normal looking boy, attended clinic yesterday. Father complaining that he has started intoeing since September and starting tripping over his own feet.
Begins when tired, after walking for a few minutes or when distracted. Able to walk straight for a while if he concentrates.
NB; this in-toeing is new. No previous history during development.
Hx: Recent growth spurt - 10-15 cm over summer, normal height for age and normal BMI
extreme wear of medial heel on shoes on both shoes - as if to produce a deep valgus wedge
Cramping like pain in triceps surae and Right peri-patellar pain
No pins, needles or numbess, no neural tension
RF affected more than LF
In relaxed stance Rcalc slightly varus, Lcalc slightly valgus
Left patella slightly valgus
No Genu valgum
Slight hypermobility
Main foot obs: BF metatarsus adductus moderate to severe worse on Right
no equinus, slight FnHL.
No femoral anteversion
No hip restrictions
Found single support difficult on right foot
flexsion and extension in knees, hips and back normal
slight stiffness L3 and T11 and hypertonia L3-5 on right
Slight weakness in glut med on right
Nothing particularly remarkable anatomically except the metatarsus adductus which we appreciate is a potential primary cause of intoeing but this is a new presentation.
Other Hx: fell out a tree onto his back last winter landing on a well rotted branch under leaves across his lower lumber area from which he recovered quickly - we don't think this is relevant.
On treadmill at 1.8kmH (he couldn't manage faster) he started reasonably well but the gait was unpropulsive.
He placed his feet and lifted without forefoot activation and produced a quadraceps stepping gait with lack of activation of triceps surae and short stride length. After 3 minutes the right foot started to adduct and his hallux began to adduct in an extreme way. Followed by his left foot. Worse on right. Began to lose balance and trip. Arms remained limp at sides as all propulsion originates from quads, there wasn't much vertical transmission to ilicit arm swing. Abnormal wear on medial heels is not from abnormal pronation or medial loading - it's from scuffing and lack of ground clearance.
He is generally unstable.
There is not any family history of neurological problems. Both parents are hypermobile.
It's certainly very unusual. He was examined simultaneously by myself, a physio and osteopath and we are all confused.
Any thoughts gratefully received. He's attending an appt with an orthopedic paediatric consultant next week.
Loading...
- Similar Threads - Abnormal toeing old
-
- Replies:
- 0
- Views:
- 520
-
- Replies:
- 1
- Views:
- 590
-
- Replies:
- 5
- Views:
- 1,315
-
- Replies:
- 0
- Views:
- 881
-
- Replies:
- 9
- Views:
- 3,057
-
- Replies:
- 19
- Views:
- 6,039
-
- Replies:
- 85
- Views:
- 11,910