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Hi Forum

Sorry to trouble you but I wanted to ask if anyone can shed some light on a clinical scenario

Young Man 21
no significant PMH
no medication. fully active and fit
all lower limbs reflexes normal

However I discovered reduced dorsiflexion in left foot 10 degrees and right foot 33 degrees when walking on heels (neuro test). No evidence of boney bloc or dorsal lipping of the tibia. Occasional running about 14K per week. Denies any back pain, pain running into the power limb and foot. No paresthsia of signs of neurological deficit.

Well hydrated nourished etc. There is no evidence or neurological injury or pathology. Any suggestions as the right seems 'normal' as opposed to the left.

thanks

David

 

What is the presenting complaint?

 

Craig
There is none. It was an incidental finding picked up on an employment medical which he failed. I was asked for my opinion. He is perfectly fit and well. The reality is that it may never have been noticed apart from a neuro assessment. I thought stretching the gastroc and possibly using a slant board. An X-ray may rule out some bony anomaly but in not convinced. Thoughts?

 

In gait was there an early heel off on the limited motion side? Even if he did have an early heel off, it might not be bad enough to cause pathology.

Why did he fail the physical? Was it related to the difference in range of motion between his feet? If not, he probably has more important problems than asymmetrical range of motion. Why is asymmetry bad?

Eric

 

Eric

No, there was no early heel off. He is perfectly "normal". I've got to get that symmetrical dorsiflextion on heel walking. I think he failed the medical as it is a military medical. I am of the assumption there was some concern of an underlying neurological issue. However this does not appear to be the case. There is nothing wrong with asymmetry on the contrary I don't think there is such a thing as pure symmetry in the skeletal system. I just wondered if anyone had come across this before and did they have any advice re-exercises and stretching. As a side I'm worried the GP will go down a route of Neuro/Ortho referral and they request an unessecary batch of scans. As we all know he may have some bulging disks or narrowing (that we all probably have with no symptoms which we all take to our grave) and he'll be medicalised forever.

www.bodyinmind.org/spinal-mri-and-back-pain/amp/?client=firefox-b

 

Any thoughts? Anyone?