Foot Drop - Baseball: 135 May 27, 9

HISTORY: A 13 year old baseball player with foot numbness and inability to dorsiflex his ankle after falling on his right buttock during a baseball game. He was seen initially by his Pediatrician who prescribed a steroid burst. His numbness progressively worsened, days later extending to involve the ankle and calf. He was then sent to the ED for further evaluation with x-rays of the tibia/fibula and lumbar spine. After films were obtained he was placed in a short leg posterior splint and was instructed to follow-up in Sports Medicine clinic. PHYSICAL EXAMINATION: Inspection of his right lower extremity revealed no abnormalities. No tenderness to palpation. Full passive range of motion in right ankle but unable to actively dorsiflex the ankle with 0/5 strength against resistance. Absence of sensation to light touch over 1st, 2nd, 3rd toes extending proximally along dorsum of foot into anterior ankle and lateral lower leg. Examination of the lumbar spine revealed no abnormalities. DIFFERENTIAL DIAGNOSIS: 1. Peroneal neuropathy 2. Sciatic neuropathy 3. L4-5 radiculopathy TEST AND RESULTS: AP and lateral radiographs of the tibia/fibula and lumbar spine were normal. NCV and EMG studies conducted showing electrodiagnostic evidence of right sciatic neuropathy with demyelinating and axonal components. The tibialis anterior was markedly involved while the peroneus longus was relatively spared but showed evidence of axonal injury. No evidence of peripheral neuropathy or lumbar radiculopathy. FINAL WORKING DIAGNOSIS: Right sciatic neuropathy with predominant peroneal portion involvement. TREATMENT AND OUTCOMES: 1. Off-the-shelf posterior leaf spring AFO, heel cord stretching, and activity modification. 2. Electrodiagnostic studies ordered at follow-up four weeks later after minimal improvement. 3. After his diagnosis was obtained he was provided a prescription for a custom posterior leaf spring AFO and due to axonal component of his injury his care was transferred to PM&R 4. He was seen by PM&R in follow-up one month later showing marked improvement and at that time was instructed to continue exclusive use of his leaf spring AFO for one more month then start to wean from the orthotic the following month.