Background: In this study, our purpose is to evaluate patients who were followed by acute developing single-sided foot drop and improving with conservative management or spontaneously.
Methods: Between 2019 and 2020, 10 patients were evaluated for a unilateral weakness of the lower extremity in the form of absent dorsiflexion at the ankle joint and were given a diagnosis of foot drop without any etiological cause. Patients were followed for a period of 18 months. All patients were evaluated for acute foot drop of the affected extremity by utilizing the following diagnostic modalities, EMG, MRI lumbar spine, MRI knee, peripheral MRI neurography and non-contrast brain MRI. Each patient was evaluated for a history of Covid-19 infection over the past year. Patients with any identified cause were excluded.
Results: Initial evaluation of muscle strength in all patients revealed 0/5 by the MRC muscle testing grading scale. (1) In 2 patients, the muscle strength was 3/5 at the 6th month, and in the other 8 patients 4/5 at the 6th month. The muscle strength of all patients improved as 5/5 in 1 year. Six of the patients were dispensed an AFO device and nine patient’s performed physical therapy. Evaluation of EMG results identified significant neuropathy at the level of the common peroneal at the fibular head in all patients. In comparison with peroneal nerve stimulation below and above the fibular head in the lateral popliteal fossa; 50% reduction in sensory amplitude, and motor conduction slowing of >10 m/s was present. Evaluation of knee MRI revealed, no masses, edema, or anatomical variations at the level of the fibular head.
Conclusions: In patients diagnosed with unilateral acute foot drop without an etiological cause, one should keep in mind that spontaneous resolution of this condition can occur within one year period.
Background: Supination-adduction (SAD) type injuries are pylon variant injuries and lie between partial intra-articular pylon fractures and rotational ankle fractures. We aimed to evaluate functional outcomes of SAD type 2 bimalleolar fractures in comparison to supination–external rotation (SER) type 4 fractures.
Methods: We retrospectively reviewed data of 42 cases with SER type 4 and 20 cases with SAD type 2 injuries. Patients with a history of rheumatic disease, open fractures, pathologic fractures, nonbimalleolar fractures, neuropathic disease, and talus osteochondral lesion, and those operated on after greater than 72 hours because of skin lesion or managed with a two-stage surgical protocol after external fixation, were not included in the study. We compared these two groups in terms of the mean age, follow-up time, visual analog scale pain and American Orthopedic Foot and Ankle Society scores, Kellgren-Lawrence arthrosis classification, union time, and complications.
Results: The groups did not differ in terms of mean age (P = .115) and sex (P = .573). There was no significant difference in terms of union time between the groups (P = .686). American Orthopedic Foot and Ankle Society score was significantly higher in the SER group (91.2 ± 9.9) than in the SAD group (86.1 ± 13.2; P = .034). Visual analog scale pain scores were similar in the SAD (0.3 ± 0.92) and the SER (0.26 ± 0.7) groups (P = .897).
Conclusions: Supination-adduction bimalleolar fractures may have worse functional outcomes in the intermediate term than do SER bimalleolar fractures, implying pylon variant fractures as a mechanism of injury. Supination-adduction bimalleolar fractures might be associated with a high rate of intra-articular cartilage impaction, resulting in varus deformity after surgery.