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Hi there, I'm just after some advice about a patient I saw last week.

He is an 83 year old rower (hope I'm that active at that age!) and has noticed a developing foot drop on both feet in the last 2 years.

Muscle testing showed weakness with dorsiflexion, equal on both sides, but normal eversion/inversion and plantarflexion. All reflexes were normal.

He also mentioned that he has a tingling/numb feeling in his toes that is there all the time. Both feet are cavus/supinated posture when at rest/WBing.

He reported that when rowing he often hits the back of his legs on the track (bit that the seat slides on). He pointed to the lateral/posterior aspect of the fibula head that receives this repeated trauma.

Is it likely that this trauma could lead to neuropraxia/paralysis of the common peroneal nerve? Or should I be suspicious of systemic causes such as HMSN?

In terms of management at this stage I advised the use of an AFO for walking and to strengthen/stretch the anterior leg muscles. He is able to row fine still, but is a bit wary about walking as he sometimes catches his toes on the ground.

Thanks for any help!
Rory

 

His legs would have to be very skinny to hit the lateral side of his legs on the tracks. The tracks are less far apart than the hips and the shoes are usually separated by a couple of inches. When I row, the track hits me just a little off center in the calf. Different boats are different. So, if he had very skinny calves he might be able to fit it between the tracks so that it might get near his common peroneal nerve. The tracks can also leave a mark and sometimes a cut where they hit. Look for the marks. For an average size rower in an average size boat it would be very unlikely that the track is hitting the common peroneal nerve.


Eric