(Kiosk 2) Case Study of Runner’s Dystonia with Foot Eversion: Diagnosis and Management Modalities

Case Diagnosis: Case study of Runner’s dystonia with foot eversion: Diagnosis and Management Modalities

Case Description: A 47 yo female and avid runner for 34 years running 60-70 miles per week developed sudden onset 10 miles into a run of a left foot slap, foot eversion and plantar flexion. Her condition progressed and 1 year later, she could only walk-run 10-20 miles per week. She underwent compartment release surgery and bilat L5-S1 laminoforaminotomies without any improvement. She was treated with chemodenervation to the peroneus brevis (PB) and peroneus tertius (PT) with some benefits but noted worsening of foot slap when the peroneus longus was included.

Discussion: An EMG exam showed dystonia of moderate severity in the PL and PB. She started taking Baclofen (10-30mg) 30 min before running depending on the distance. She also applied a FES unit (G4, XFT) to the left anterior tibialis and inverters when running. Video recordings showed significant improvements, and she is now running 40 miles/week.

Setting: Academic Medical Center Rehabilitation Medicine Clinic

Assessment/Results: The correct diagnosis was supported by electrodiagnostic studies. As per patient’s preference the treatment was noninvasive with limited antispastic medication to only before the start of exercise. The benefits of the FES unit may be attributable to sensory or motor “tricks”, antagonistic muscle stimulation and re-training of neural pathways.

Conclusion: We conclude that electrodiagnostic studies are important for diagnosis of runner’s dystonia and may avoid misdiagnosis and minimize surgical interventions. In our case, non-invasive treatment such as antispastic medications only before exercise and use of FES while running can be used successfully in management of runner’s dystonia.