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I had an interesting case walk into my rooms last week. A 17y.o. girl who c/o an intermittent tremor in her right foot. Not present during weight bearing activities, but present at rest.
negative plain x-rays.
History: trauma 15months ago where a piece of plastic pierced the skin whilst she was at the dump. Was treated in emergency rooms with a cleanse and steri-strips.
Tremors only really began 3/52 ago when she suffered what sounds like a mild inversion sprain (no evidence of this on presentation)
On exam: double heel raise - left is supinated, right (affected side) stays mildly pronated.
resisted muscle testing - slightly weaker invertors, and plantar flexors.
also: distinct muscle wastage in medial leg muscle group on affected side, with a 10mm circumference difference and obvious changes visually.
Tinels: mild response when percussing inferior to medial malleolus.
After discussing with GP referring on to foot and ankle specialist and requesting MRI.

Any thoughts would be greatly appreciated.
Cheers,
Matt

 

Haven't heard how quickly she will get a consult yet. Does anyone have any treatment ideas?

 

Issue is, can't treat without knowing the cause.

 

Yes agreed. I was actually just trying to stimulate some response to the case with my second post!