Cauda Equina Syndrome - Hypotonic No Clonus

Bilateral AFOs. – Orthopedic Surgeon Referral

Cauda equina syndrome with bilateral drop-foot.

This 71-year-old male has no allergies. He is currently taking Xanax and is an insulin-dependent diabetic. He has had many surgeries, spine surgery in December 1999 and June 2000 to relieve pain in his lower limbs. However, his wife reports that this was unsuccessful and they discovered a syrinx at this time. He also had surgery for a broken hip. He has had the 2^nd toe on his left foot amputated. He has had surgery for cataracts and glaucoma. He also has a history of an ulcer on the 2^nd toe of his right foot and on his right heel. He has had no ulcers on his left foot. Today the patient has a small sore on the middle of his right tibia. The patient is a limited household ambulator, uses a walker. Out in the community, however, he does use a wheelchair. He will begin physical therapy after he receives the braces. He has had no previous braces.

The patient's feet present as pronated bilaterally. He is hypotonic with no clonus. Range of motion at his ankles is to 90 degrees with his knees straight. His heels are in valgus and his forefeet are slightly abducted. His right foot is flaccid, and his left foot has a trace of dorsiflexion. His quads are 3+. His skin appears to be somewhat thin. He has some peeling of the skin over his left heels. He has pitting edema in his feet and lower legs. The sensation stops at the top of the left calf and at the middle of the right calf. Traced the patient's legs for conventional AFOs, took impressions for custom inserts, and measured his feet for extra-depth shoes to be attached to the conventional AFOs. I observed the patient's gait with a walker in the office today. He has a very crouched gait and he takes small shuffling steps and drags his toes.

We will order Drew men's doubler shoes for the patient and fabricate custom inserts and bilateral conventional double-upright AFOs with double action ankle joints and an extended stirrup.