Can foot dragging while walking be an early sign of dystonia?

Question

Hi doctor,

Can foot dragging while walking be an early sign of dystonia in a 16-year-old boy? My nephew started dragging his left foot about three months ago. Teachers thought he was being lazy, but now it is clearly getting worse. The neurologist mentioned dystonia as a possibility but wants more tests. His brain MRI came back normal, which confused us. 4

He plays football and says his left leg just does not respond like it used to. Creatine kinase levels are slightly elevated at 320 U/L. There is no family history of any movement disorder. The pediatric neurologist referred him to a movement disorder specialist, but the appointment is two months away, and his gait is deteriorating fast. Is dystonia something that can progress quickly at this age, and what tests should we be asking for before that appointment?

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

Thank you for your query, and I can understand your concern.

Foot dragging in a 16-year-old can be an early sign of a neurological condition such as dystonia, especially when it is progressive and affects one side. It is important to note that a normal MRI (magnetic resonance imaging) brain does not exclude this diagnosis. However, other possibilities, such as nerve-related foot drop, early weakness, or, less commonly, neuromuscular conditions, should also be considered, particularly with a mildly raised creatine kinase (CK) level. Since the symptoms are gradually worsening, it would be reasonable to follow up with your neurologist regarding a trial of Levodopa to rule out Dopamine-responsive dystonia, which is a treatable condition.

In addition, further evaluation may include an MRI of the spine or nerve conduction studies, if clinically indicated, to gain a broader understanding of the underlying issues. Monitoring for any rapid progression, true weakness, or involvement of other parts of the body is crucial to managing symptoms effectively. Keeping a video record of his walking pattern and any other observable changes can provide valuable insights for the specialist.

Furthermore, it might be beneficial to keep a log of any additional symptoms that arise, such as fatigue, muscle cramps, or changes in coordination. Early specialist assessment is recommended, so you may also consider requesting an expedited appointment if symptoms continue to progress. Engaging with physical therapy could also help with mobility and provide supportive exercises tailored to his condition. It is important to maintain open communication with the healthcare team and advocate for the best possible care and timely interventions.

I hope you find this guidance helpful.

Do follow up whenever needed.

Thank you.