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Suggest Treatment For Hyper-dorsiflexion
Question: Hi, I'm a podiatrist in the VA system. One of my patients is a 27 y/o male c/o pain when walking. The only abnormal finding is a strong hyperreactive dorsiflexion of the foot including dorsal contraction of toe 2-5 with a light touch of plantar foot bilateral. Any thoughts? EMG is normal
Brief Answer:
Is it a positive Babinski's sign?
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your patient's clinical details. Based on this, it could be a positive Babinski's sign. Dorsiflexion of big toe with fanning of other toes is the usual finding in this. Does it look like that?
I presume the tone of muscles and deep tendon reflexes are normal.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Is it a positive Babinski's sign?
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your patient's clinical details. Based on this, it could be a positive Babinski's sign. Dorsiflexion of big toe with fanning of other toes is the usual finding in this. Does it look like that?
I presume the tone of muscles and deep tendon reflexes are normal.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Raju A.T
No, the big toe stays neutral or moves slightly plantarflexed. The entire foot reacts to very light plantar touch. I have not seen this before and I've been in practice 25 years. Have you?
Often times I put pressure on the plantar arch to see if hammertoes are reducible. I could not complete this exam due to his hyper-reaction to light touch. This was noted in both feet. He also c/o of knee pain but MRI is neg.
I was just wondering if this reaction is associated with neurological issues (?)
He is coming back next week. Are there any other tests I should consider?
Often times I put pressure on the plantar arch to see if hammertoes are reducible. I could not complete this exam due to his hyper-reaction to light touch. This was noted in both feet. He also c/o of knee pain but MRI is neg.
I was just wondering if this reaction is associated with neurological issues (?)
He is coming back next week. Are there any other tests I should consider?
Brief Answer:
In this case, it seems to be a normal variation.
Detailed Answer:
Thank you for getting back with more information.
This description is more like "withdrawal response" we see in some cases, who are hyper-sensitive to touch, and we are unable to complete the complete the normal elicitation of plantar reflex. This is a normal variation and is not associated with any neurological disease. So, you can reassure your patient in the next visit.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
In this case, it seems to be a normal variation.
Detailed Answer:
Thank you for getting back with more information.
This description is more like "withdrawal response" we see in some cases, who are hyper-sensitive to touch, and we are unable to complete the complete the normal elicitation of plantar reflex. This is a normal variation and is not associated with any neurological disease. So, you can reassure your patient in the next visit.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
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