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Advice for neuropathy of the hallux

Discussion in 'General Issues and Discussion Forum' started by sezza, Nov 19, 2014.

  1. sezza

    sezza Member

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    I was wondering if anyone has any ideas for help with a patient:

    Med Hx: Prostate cancer; aortic aneurysm; AF
    Medications: recent chemotherapy; Vitamin B12 injection

    The gentleman is suffering from motor & sensory neuropathy of bilateral hallux R>L
    The aetiology of the neuropathy is currently unknown - it is thought it may be due to chemotherapy or Vitamin B12 deficiency
    He is having nerve conduction studies in a few weeks

    His problem is that his halluxes are plantarflexed (like a footdrop, but a toe-drop!). He has altered his gait to compensate for this, and as such has developed a 'high-stepping', slapping-type gait. Even so, his hallux still 'drags and catches' on the ground and has caused him to have numerous falls.
    He is a very active gentleman who has lessened his activity reluctantly to reduce likelihood of falls, but would obviously like a solution that would enable him to stay active.
    His foot posture, apart from the plantarflexed halluxes, is fairly non-remarkable.

    Upon first presentation, I have trialled a dorsiflexion taping of the hallux but I am yet to review how this went.

    Just wondering if anyone has come across this in the past, and if anyone has any ideas about how best to address the plantarflexed hallux and enable a more normal gait pattern?

    Thanks in advance,
  2. Craig Payne

    Craig Payne Moderator

    This needs a neuro consult.

    First thing I thought of was joplins neuroma (which it isn't)

    A chemotherapy induced neuropathy would high on list of causes

    Other thing high on list would be dystonia:
    Focal dystonia: http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=78296

    Is it "static" or moving? Consider this:
  3. sezza

    sezza Member

    Thanks Craig. I agree, he needs a neuro consult and is having one soon (after his nerve conduction studies).

    Aside from working out what's going on (which his GP & specialists are onto), I was more wondering if anyone has any ideas for helping to address the 'toe drop' and subsequent gait issues?

    Thanks in advance
  4. Craig Payne

    Craig Payne Moderator

    Given neuro aetiology, not sure a lot can be done.
    Something like this might end up being a candidate for botox
  5. Shane Toohey

    Shane Toohey Active Member

    Hi Sarah,

    At risk of stimulating a couple of pages of ridicule I'd also add into the mix about three sessions of acupuncture to look for any indications of improvement in motor and sensory function. There will be a few pods around with some experience out in this arena.

  6. efuller

    efuller MVP

    Is his tripping over the toe only barefoot or in shoes as well. Just putting a shoe on should keep the toe dorsiflexed enough so that he might not trip on it. However, if EHL is weak, Ant tib could be weak as well. There are some dorisflexion assist devices that attach to shoes. If the shoe was stiff enough it could prevent the tripping until the cause is worked out. Chemo, as Craig pointed out, was the first thing that popped into my mind.

    If the toe is plantarflexed then there is either not enough EHL or too much FHL.


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