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A case report
Spasticity is a characteristic and early component of the lesions of the pyramidal tract of demyelinising diseases such as multiple sclerosis, and is included in the chief neurological scales to evaluate this disease. We report the case of a woman with a clawed toes deformity caused by spasticity of the extensor digitorum (longus and brevis) muscles.
Key words: Sclerosis, multiple - Clawed toes deformity Spasticity.
Spasticity is a characteristic and early component of the lesions of the pyramidal tract of demyelinising diseases such as multiple sclerosis, and is included in the chief neurological scales to evaluate this disease (Fog-scale, Patzold-scale, Lowitzsch-scale, etc).1,2
It generally takes on the characteristics of an asymmetrical spastic paraparesis that, in the less severe forms, may be limited to the involvement of only one lower limb or segment of a limb (such as the foot). In these localised forms of spasticity it is very important to determine the sources of nociceptive input, because the painful stimulus may be a factor that amplifies spasticity.3 The literature stresses the frequent involvement of the flexor digitorum longus and brevis and the flexor hallucis muscles (for example within an equinovarus supinate foot) or of the extensor hallucis muscle, in the hyper-extension deformity of the hallux (Striatal toe or Hitchhiker's Great Toe).
On the contrary, in cases of spasticity of the lower limbs, the problem of clawed toes deformity, generally with involvement of the flexor digitorum muscles, is rarely reported.4,9
The case reported is one of a clawed toes deformity caused by spasticity of the extensor digitorum (longus and brevis) muscles.
Case report
G. L. is a woman patient, aged 50 years, who was diagnosed with multiple sclerosis approximately 11 years ago. The multiple sclerosis had caused slight paraparesis (with sensory ataxia) with spasticity of the distal extremity of the left leg, which caused dorsal flexion of the metatarsophalangeal joint and plantar flexion of the interphalangeal joints (clawed toes deformity). During walking this deformity produced pain localised at the nails and digital pulp of the toes of the left foot, at the dorsal surface of the interphalangeal joints and at the metatarsal plantar region. The functional consequences were that walking was limited to 100 metres and required the use of...