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BeachBum

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Gait Abnormality.. Is this Foot Drop?

I will keep this as short as possible out of respect for those reading.

I have had fasciculations in right hand starting in December, went away for a while, then came back in January and moved to left hand, arch of right foot. Twitching spread everywhere, but today is mostly in right foot and calves, with buzzing and rumbling twitches here and there. I've also had pins and needles, cold sensations and other sensory symptoms (I am aware these are not typical ALS symptoms). I went to a neuro who gave me a clean clinical and an EMG on my left hand. It came out normal.

I went back to the neurologist because I have started having difficulty walking. She did not note weakness in foot and my reflexes were normal, so she gave me a clean clinical but offered to do an EMG for my peace of mind.

My right foot is flattening (arch collapsing) and my right leg seems noticeably smaller. My right foot is now bonier than my left and my arch has a dent in it. I have sharp pains in arch when seated. My toes spasm, especially the pinky. The pinky toe will take a few seconds to relax after I contract it. The only way I can describe my gait is that the weight feels like it's distributed to the inside of my foot and that I'm consciously trying to roll my ankle outwards when I walk. I feel like I'm pushing off my big toe, which gives me the feeling that it's dragging when I push off, although I haven't tripped or stumbled or fallen over.

I can walk on my toes and I can walk on my heels without issue. One note: I have broke this ankle and fibula 2 years ago, and now have 2 pins in it. My Achilles has been tighter and I also have less mobility turning the foot inwards since then.

My question is: Does this story sound familiar to anyone who developed drop foot? What steps should I take after a clean clinical exam? I am scheduled for an EMG test in late May, but I want to know if my story sounds like any stories of people diagnosed later down the road. If so, time is of the essence.

Thank you for reading.
 
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KarenNWendyn

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Twitching, pins and needles, clean EMG all means no ALS.

If you can stand on your heels, you probably don’t have drop foot. The other test is to walk on your toes. If you can walk on your toes successfully without the heels dropping, you’re good.

I started with drop foot. I experienced needing to walk with a high stepping gait to keep feet from dragging, and I couldn’t stand on toes or heels.

Your symptoms in right arch could represent plantar fasciitis.
 

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Thanks for your response Karen! Its obviously very concerning that I have problems walking after experiencing fasciculations for months now. Did your neurologists suspect MND right away or did you need multiple opinions before it was suspected? I want to believe that there is something else going on within my body, but I understand that people can be given incorrect diagnoses at onset. I am questioning how to proceed other than seeking the opinion of a podiatrist.
 

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BeachBum,

My recommendation is to find a physio who can help you try to figure out what is causing your gait issues, and what may assist you in improving or adjusting to these changes. Physios can pretty quickly suss out structural/mechanical issues and separate them out from other issues. While they can improve strength, balance and gait, they can also provide a clearly documented structural assessment and inform you if they feel it's more than a mechanical or nerve compression problem. They know bodies and can provide direct feedback on muscle response, reflex and all sorts of other functional issues. They see you for an hour, sometimes more, for an initial assessment and will likely be able to give you some idea of what they see- more than a doctor may possibly be able to in the small amount of time you go in to a medical clinic.

While I can not speak to what you may have wrong with you, neurological or structural, I can speak of my experience- My physio was one of the first people to say to me I had a neurological problem and he would not work with me further till I saw a neurologist. He offered to provide me with a detailed letter outlining his observations, objective strength and muscle response data, and noting where he felt there was something to direct the neuro's attention to while explaining why he thought so. There are actually physiotherapists who have an extra neuro component to their training. Find an experienced one- not just a sports physio at an exercise centre, but a rehabilitative physiotherapist who works with a broad variety of patients or who specializes in complex cases.

Best wishes.
 

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I second ShiftKicker’s recommendations. I’d like to add that I don’t see ALS in your post. Apparently neither does your neurologist. With the normal neuro exam and EMG, you should be reassured.

To answer your question about when MND was suspected in my case —- my neuro exam and EMG were abnormal from the outset as soon as I began pursuing an evaluation.
 

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Thank you both for thoughtful and detailed responses to my question. I met with a podiatrist this afternoon (family friend who accepted an emergency appointment), and he explained to me he thought that my discomfort was probably structural because of the way my bones have healed and my naturally high arches -- weight is more distributed on heel and ball of foot in broken leg. Although that was great to hear, I'm not sure how much experience he has with neurological disorders. I will be seeking the opinion of a physiotherapist as well.

ShiftKicker, if you don't mind me asking -- did your first symptoms present in your foot? What concerned your physio from the outset?
 

ShiftKicker

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BeachBum, each person is different. You can see my entire story here in the forum if you search.

My left leg became rapidly spastic after an illness and I kept tripping and falling up stairs. My physio had rehabbed me before for a variety of sports related injuries over the years. I went to him, thinking I had a pinched nerve or uneven muscle strength for some reason. He detected spasticity and weakness immediately. Confirmed shortly after, as these things go, by a variety of neurologists (4)- none of whom said everything was normal, and also with abnormal patterns on an emg.

Folks don't seem to realize just how "wrong" spasticity will feel to a therapist/doctor who is familiar with muscles and how they respond. It's not just stiffness, hyperreflexes or weird feelings- the muscles respond poorly or strangely to stimulus. A physio can detect it with passive movement of a limb. The muscles feel weird to their palpation.

Now, that should be enough to satisfy your curiosity- please go see a physio and get yourself seen to. It may take a few sessions if the physio is unfamiliar with you and how your body normally is. They need to take baseline measurements and track changes over a few sessions. Please stop researching here and start searching for why your function is not 100%. Anecdotal tales here will do you no good and may serve to increase anxiety, all while distracting you from seeking healing for your own body.

Best wishes
 
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BeachBum

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Abnormal EMG

Hi,

I met with my neurologist today and got results from an EMG performed on Friday. I do not have the full report, but the summary I have states:

"This is an abnormal study. The findings are consistent with chronic right C7-T1 cervical and L5 lumbar radiculopathies. There are no electrophysiologic signs of motor neuron disease on this study. Clinical correlation is recommended."

I understand that "There are no electrophysiologic signs of motor neuron disease on this study." is cause for celebration. BUT I have read that a diagnosis of pinched nerves can later on be revealed to be early ALS."

My question is, does anyone recommend a second opinion for an EMG if there is abnormality associated with radiculopathy? Has anyone had results like this with a later revelation of ALS? I understand that an EMG is only as good as the doctor prescribing the test.

Here is a description of my symptoms from a previous post.

https://www.alsforums.com/forum/do-i-have-als-als/41467-clean-clinical-exam-now-gait-abnormality.html
 

lgelb

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Re: Abnormal EMG

BeachBum,

Not sure what you are reading but I can't think of any EMGs that straight up said spine problem, that became ALS with the localized history you have described. I would proceed with PT or whatever is recommended for the radiculopathy, and rejoice.

Best,
Laurie
 

ShiftKicker

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Mod note: merged threads. BeachBum, please continue posting in your original thread here to keep your symptom and posting history in one place. This makes it easier for members to see the entire picture and give informed answers.
 

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What I am confused about is the difference between cervical and lumbar radiculopathy and the potential for ALS based on an EMG. I've read that ALS can often look like as radiculopathy, especially in distinct limbs. My neurologist said that the patterns don't resemble ALS, but I do not understand why?

Does anyone with medical knowledge know the difference between chronic radiculopathy and potential ALS readings in an EMG? I feel more confused now than before my EMG.

I did not ask my neuro this question because I literally didn't know I had radiculopathy until I left the appointment. He just said that my nerves are pinched in my back.
 

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I would think radiculopathy would show slowing of nerve conduction velocities as nerves are being compressed. However, I’m not an electromyographer. Bottom line: talk to the doctor who did the tests.
 

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Did my neuro read my EMG results wrong?

The Interpretation and Findings section reads there is "increased recruitment" but the EMG table says recruitment is normal -- the column titled "Amplitude" is where there is increased activity.

Does anyone think there may be a mistake in the "Interpretation and Findings" section based my table? Or am I missing something?

Does anyone know what "Gr. Increase" means?

I left a message with my neuro, but if anyone familiar with these readings has an opinion to whether or not he may have made a mistake in the conclusion, please let me know.
 

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KarenNWendyn

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EMG report interpretation says “no motor neuron disease”. Those are the golden words you're looking for. They also mention mention radicuopathy (pinched nerves).

I dont know how to interpret the nerve conduction velocities.

I think you're cleared of motor neuron disease. If you have a followup visit with the neurologist, you can ask specific questions about the test results. Or you can call and let them know you have questions.
 

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I'm not sure how to get in touch with the member, Nikki J, but I'd like to ask her about her onset. My ankle is collapsing in a similar way she describes in her posts.

Nikki, my EMG was not done specifically on my ankle but on muscles in legs and calf. Would these have shown traces of MND if present or would I need another one on the ankle specifically? I am not tripping or falling, but my ankle is turning inwards, my weight is being distributed on the inside of my foot and my calf is definitely slackening.
 
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