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Lower Limb Neuro
 
 

Distal Function Assessment

February 15th, 2021
 
 
 
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Heel Walking

  • How to Perform

  • Ask the patient to walk on their heels.
  • Significance

  • Inability to walk on the heels suggests distal weakness.
  • Causes of Inability to Heel Walk

  • Central Nervous System

  • CNS lesion - ischaemia, haemorrhage, tumour, trauma, multiple sclerosis, infection, vasculitis
  • Peripheral Nerves

  • L5 nerve root lesion - radiculopathy, spinal trauma, tumour
  • Common peroneal nerve palsy - compression, trauma, tumour
  • Mononeuritis multiplex - vasculitis, diabetic neuropathy, infection, paraneoplastic
  • Peripheral polyneuropathy - Charcot-Marie-Tooth, Guillain Barre, CIDP, motor neurone disease, polio
  • Other

  • Myopathy - inflammatory myositis, muscular dystrophy, paraneoplastic

Toe Walking

  • Interpretation

  • Ask the patient to walk on their toes.
  • Significance

  • Inability to maintain plantar flexion is indicative of muscular weakness or an S1 lesion.
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