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Peroneal Wasting?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Graham, Aug 30, 2010.

  1. Graham

    Graham RIP


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    Just had a lady with chronic lower back and thoracic/rib pain

    Biomechanically un-remarkable - FHL - Left leg short 7mm(ish) in-toed gait right abducted left, left arm swing only. Moderate stoop posture.

    Obvious wasting and weakness of Peroneals on the left (short) side.

    Any ideas of cause and possible treatment approach?

    thanks
     
  2. lucas87

    lucas87 Member

    Re: Peroneal Waisting?

    Hi,

    is there anything in her medical hx that suggests they had polio and is there any other muscle wastage on the left leg? could also be a congenital LLD.

    Not sure of any t/t plan thouh sorry

    Luke
     
  3. Graham

    Graham RIP

    Re: Peroneal Waisting?

    No other neurological, muscular/bony injury or systemic Issues.

    Client is 24 yrs old

    Average activity
     
  4. Re: Peroneal Waisting?

    Graham does she get pain when standing and walking ?

    Do you beleive that the weak Peroneals are the cause of the gait changes and have lead to the issues.

    if so, as the main action of the Peroneal are to cause Pronation at the stj( internal pronation moments at the STJ) maybe a lateral skive, to increase the external pronation moments will be the go to aid the peroneals in their action. As the peroneals also cause some limited planatflexion moments at the talocural joint a small lift added to the orthotic will deal with the LLD and further aid the Peroneals.
     
  5. Graham

    Graham RIP

    Re: Peroneal Waisting?

    Chicken and egg?

    Thanks for that. She has marked forefoot lateral wear. My initial Rx: thoughts are to 5deg Forefoot Valg post, reverse morton's ext and first ray cut aways plus a 5mm lift to the left device. Lateral skive may be a little too much as she stands in a relatiev valgus position.

    Any strengthening or manipulations that will help?
     
  6. Re: Peroneal Waisting?

    No Problems ,

    I guess if you can strengthen the Peroneals thats got to help, and maybe increased ROM of any joints medial of the STJ axis has to reduce the resistance to the action of the peroneals , I would have though .
     
  7. Graham

    Graham RIP

    Re: Peroneal Waisting?

    I am manipulating the ankle and the proximal fibular and have shown her some theraband exercises. The wasting is marked. Just wondered if any one else has seen this and how they managed it? There doesn't appear to be a neurological element but can't rule that out.
     
  8. efuller

    efuller MVP

    What was her chief complaint?

    Any sensation loss?

    Any palpable abnormalites of the first ray that could be explained by pain avoidance.

    Possible causes.

    Did she get out of cast recently. Cast too high causing peroneal nerve injury. Peroneal nearve injury for some other reason.

    profile is wrong, but think a little bit about Charcot Marie Toothe.


    Treatment should be based on the complaint.

    The high lateral wear could be from unopposed posterior tibial. Or more likely possibility is that she has a partially compensated rearfoot varus. The partially compensated rearfoot varus could be causing high load laterally, causing high pronation moment from the ground leading to low need of peroneal muscle activity. A bit of a reach. Need more info.

    Eric
     
  9. Graham

    Graham RIP

    Thanks Eric,

    Complaint is LBP/Rib cage pain

    No sensory loss, reflexes all wnl - not been in a cast - no palbale abnormalities.

    Only assymetrical presentation is LLD

    She has a very specific loss of the peroneal muscle belly?
     
  10. RobinP

    RobinP Well-Known Member

    Try a Fogg test. I have found in children with neurological disorders that, there is no real evidence of neuro damage but their Fogg test has been +ve which has led to investigation to confirm neurological damage. Could be a mild CP from birth and not picked up

    Admittedely it is unlikely in this case given that the arm swing is lost on the non affected arm but it is a very quick test and may make the treatment plan a little more different as strengthening etc will have a limited effect.

    Fogg Test - couldn't find a good description as unable to find articles that I didn't have to pay for.

    Have patient walk on outsides of feet - lateral borders and look for upper limb involvement. Usually, if positive, the wrists and elbows flex whilst the arms abduct out to the sides. It is not a diagnostic test but can be an indicator.

    Treatment - as you were doing

    Robin
     
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