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Author: Elise Chong, BS
Co Author #1: Justin Mark Young, M.D.
Senior Editor: Warren Bodine, DO, FAMSSM
Editor: Timothy Tiu, MD

Patient Presentation:
A 43-year-old male recreational athlete presented to the sports medicine clinic with a 4-day history of foot drop.

History:
A 43-year-old male recreational athlete presented to the sports medicine clinic with a 4-day history of foot drop. He was traveling from Japan to receive his COVID-19 vaccine, and had no significant medical history. He was an avid runner, biker, and golfer and picked up surfing while in Hawaii. He was in his usual state of health up until 6 months ago when he experienced intermittent lower back, upper thigh, and hip pain with radicular symptoms. He did not know what may have caused the original injury but has attributed the pain to "overtraining" from frequent runs in addition to trampoline and plyometric cardio. When his pain worsened over the next 3 months, he received an MRI that showed a herniated disc in the lumbar region. When conservative therapy did not resolve his pain, he was given an epidural injection that offered no relief. The pain radiated down his calf/shin over the past month.

Physical Exam:
General : Alert and not ill-appearing
Extremities: Decreased range of motion on spinal flexion and moderate muscle spasms on both sides of the lumbar spine. There is a positive straight leg raise test on the left.
Cranial nerves: II-XII were grossly intact.
Motor: Bulk and tone were normal. Dorsiflexion strength was 3/5 on the left and 5/5 on the right.
Sensation: Sensation was equal through the upper extremities. There was a decrease in sensation from the left lateral thigh through the left leg into the medial plantar arch, with a mild decrease over the left great toe
Reflexes: Babinski was absent.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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