(Kiosk 2) Gamer with Progressive Right Foot Weakness: A Case Report

Case Diagnosis: A 17-year-old male gamer with right foot weakness who was found to have foot drop secondary to prolonged leg crossed positioning while gaming.

Case Description or Program Description: 17-year-old male with ADHD presented with 1 month of progressively worsening right foot weakness. Denied injury. Able to move some of his toes but overall felt like his foot was dragging. He frequently played video games and sat in a prolonged legs crossed position with the left leg straight on the right leg underneath. He also reported recent weight loss over the last several months due to ADHD medications. No numbness or tingling but had pain and difficulty with ambulation and switching between foot pedals when driving. No fever, chills, or recent illness. Physical exam significant for 3+/4+ patellar and achilles reflexes bilaterally, negative straight leg raises and slump test, full passive range of motion of lower extremities, positive Tinel’s at the fibular head, and inability to heel walk on the right leg due to foot weakness. Electromyography showed demyelinating right common peroneal neuropathy, involving both the peroneus longus and tibialis anterior muscles. Patient started physical therapy and home exercise program with progressive return of strength and mobility.

Setting: Outpatient Tertiary Care Center

Assessment/Results: He returned for follow-up at 1 and 2 months after starting physical therapy and home exercise program focused on strengthening and neuromobility with gradual improvement in his strength and mobility of the right foot and ankle. Further developments will be discussed.

Discussion (relevance): This gamer’s significant weight loss and sitting in cross legged position for prolonged periods added compression to the peroneal nerve resulting in foot drop. It’s important to consider compressive neuropathies in the gamer population and those whose daily activities include prolonged immobility and positioning.

Conclusions: Atraumatic foot drop in a young, healthy male includes a broad differential including but not limited to viral, autoimmune, and hereditary neuropathies which could lend to extensive work-up. This case highlights the importance of collecting a complete functional history during the initial evaluation of presumed foot drop.