Blunt S B, Richards P G, Khalil N
Department of Neurology, Hammersmith Hospital, London, England.
Mov Disord. 1996 Nov;11(6):723-5. doi: 10.1002/mds.870110620.
We describe a patient who developed involuntary, painless, dystonic contraction of the toes of the right foot on standing or walking. The development of this abnormal movement had been preceded by sensory disturbance on the soles of both feet, triggered by dorsiflexion of the feet. Examination showed that weight bearing on the right foot and walking brought on clawing of the toes of the right foot, which was relieved within seconds of taking pressure off the right foot. There was sensory and reflex evidence of bilateral S1 root disturbance confirmed by electrophysiology. Magnetic resonance imaging of the lumbar spine showed marked stenosis of the lumbar canal with compression of the L5 and S1 nerve roots bilaterally. The patient underwent a lumbar laminectomy with nerve root exit foramina decompression, which abolished the foot dystonia and has considerably improved the sensory disturbance. This case demonstrates that lumbar canal stenosis and/or nerve root compression, may be responsible for foot dystonia. Amelioration of the abnormal movement by surgical decompression argues strongly in favour of this hypothesis.
我们描述了一名患者，其在站立或行走时右脚脚趾出现不自主、无痛性的肌张力障碍性收缩。这种异常运动的出现之前，双脚脚底存在感觉障碍，由足部背屈引发。检查发现，右脚负重和行走会导致右脚脚趾呈爪状，而在解除右脚压力后数秒内这种情况就会缓解。电生理检查证实存在双侧S1神经根障碍的感觉和反射证据。腰椎磁共振成像显示腰椎管明显狭窄，双侧L5和S1神经根受压。该患者接受了腰椎椎板切除术及神经根出口减压术，术后足部肌张力障碍消失，感觉障碍也有显著改善。本病例表明，腰椎管狭窄和/或神经根受压可能是足部肌张力障碍的原因。手术减压使异常运动得到改善，有力地支持了这一假说。
