The Man With The Dropped Feet
|A 28 y.o. insurance salesman is referred to your office because of "dropped feet". He had consulted his primary care physician because he was having trouble lifting his toes when walking. He had begun to trip on curbs and climbing stairs. He had stumbled on a carpet at his in-laws house. On family history you find that his paternal uncles both needed canes to walk and that his paternal grandfather had been confined to a wheelchair before he died because of "paralysis". The patient's father had the same "funny" feet that the patient had, high arches and "hammer" toes. He had always been considered a poor athlete growing up because of incoordination.|
On examination, the only abnormalities are confined to the lower extremities. His calves have a "champagne bottle" shape suddenly tapering in mid calf to being very thin. He has the high arches and "hammer" toes. His deep tendon reflexes in the lower extremities are absent, but they are 2+ and symmetrical in the upper extremities. He has thick palpable deep and common peroneal nerves bilaterally which can be easily palpated as they cross the fiular border. He has a mild loss of all sensory modalities in a stocking distribution in his lower extremities.