Communication Affichée: Poster Tour 1

Le 14/10/2021 de 11:00 à 11:30

Retour Session


Le muscle tibial postérieur clé du diagnostic étiologique du steppage

Mohamed Habib Elleuch (Sfax, Tunisie), Fatma Elleuch (Sfax, Tunisie), Wafa Elleuch (Sfax, Tunisie), Houssem Harbi (Sfax, Tunisie), Sameh Ghroubi (Sfax, Tunisie)

Objective : The steppage gait (or foot drop) is due to a nervous paralysis of the levator muscles of the foot and toes. The levator motor nerve can be damaged either at the L5 root level or at the (truncal) external popliteal sciatic (EPSN) nerve level.
the aim of this study is to show the contribution of the EMG of the tibial posterior muscle (PTM) in the etiological diagnosis of the steppage

Material / Patients and Methods : 2 case report

Results : Case 1: a 55-year-old patient with medical history of diabetes type 2 and L4-L5 discal hernia surgery in 2004. He presented in 2016 with left foot drop that appeared gradually 3 months postoperatively. The tibialis anterior and posterior muscles were deficient while the gluteus medius muscle was normal. The PTM EMG showed a poor neurogen plot. This means a left L5 root paretic impairment. The lumbar spine MRI revealed a left posterolateral hernial recurrence compressing the L5 roots.
Case 2: a 66-year-old man with medical history of diabetes presented with left foot drop. The tibialis anterior muscle was deficient while the PTM and the gluteus medius muscle were normal. The EMG confirmed normal PTM and showed a block of nerve conduction of the EPSN. The Ultrasound exploration revealed an intra-neural mucoid cyst of the EPSN

Discussion - Conclusion : The EMG of the PTM is mandatory in determining the level of the neurologic lesion that causes steppage gait. The ultrasound guidance is of a very precious help and greatly facilitates the PTM exploration particularly for young practioners

Keywords : posterior tibial muscle - ultrasound - electromyography - steppage gait