Case 12. A floppy ankle
Case
A 50 year old man who was an inpatient with a gastrointestinal problem developed ankle weakness making it difficult to walk.
He had been admitted to hospital after several weeks of weight loss, abdominal discomfort, and altered bowel habit, passing loose stools several times daily. Initial examinations indicated dehydration and cachectic body habitus, but he had been neurologically intact. Investigations suggested an acute phase response with elevated inflammatory markers. Colonoscopy and biopsies identified colitis. He was treated with steroid therapy and rehydration and spent the next four weeks in hospital and was almost completely bedbound bar short trips to the bathroom.
One morning he noted difficulty walking, with weakness in the left ankle, and inability to elevate the foot properly on taking steps. The foot would noisily slap against the floor. There was no pain, including no back pain or pain shooting down the leg. He had noted a numb, tingly feeling over the lateral foot and shin.
On examination he had: