1011 - An Osteopathic Approach to Foot Drop: A Case Report of Posterior Fibular Head

Case Diagnosis: Chronic foot drop can present a diagnostic challenge. We report a case of a 42-year-old female with an elusive cause of foot drop, a complex and engaging case that required extensive medical evaluations. The foot drop onset was associated with a gym injury, compounded by prior inconspicuous anatomical variations revealed by imaging. Despite exhaustive neurological evaluations, traditional treatments, and alternative medicine approaches, the etiology remained unclear, and the patient continued to suffer from debilitating symptoms.

Case Description: A 42-year-old caucasian female patient presented with treatment-resistant foot drop. She began experiencing cramp-like symptoms in her left leg around May 24th, 2022, initially occurring at night and later during the day, which she described as being "unable to move [her] legs.” On June 7th, 2022, during an aerobic exercise routine at the gym, she twisted her left leg while jumping sideways, resulting in excruciating pain and then paralysis in her left ankle and toes.

Discussions: Foot drop poses significant diagnostic and therapeutic challenges. Standard treatments often provide limited relief, particularly in complex cases like the one presented. The patient was offered surgery to remove her accessory navicular bone. While an accessory navicular bone may produce posterior tibial tendon irritation/inflammation, it cannot lead to posterior fibular head somatic dysfunction. She did not have pain around the inside of the ankle and lower leg, so she declined to undergo this procedure.

Conclusions: Posterior fibular head somatic dysfunction was exerting pressure on the common fibular nerve. This pressure was relieved through OMT, which restored the corresponding structures to their correct anatomical positions and normal functions. The underlying cause of her symptoms could remain unclear to those unfamiliar with the biomechanical osteopathic approach. The positive outcomes observed in this case represent a positive example for other healthcare providers seeking low-cost, non-invasive, first-line treatments for foot drop and similar neuromusculoskeletal issues.