Maverikk

ASA Member
5+ Year Member
Jun 20, 2013
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Hi Physiatrists,

I've a clinical scenario: 30 yo M, only PMHx is type 1 diabetes for 8 years, extremely well controlled (highest HbA1C is 7.2). Was in for fractured radius due to trauma (bike accident), day of d/c I see him and he's uncomfortable. Complains of his toe 'locking up', I look at it and it is indeed plantarflexed, the plantar surface of his foot feels tight. He tells me that this is something that has been going on for 5 years, lasts about 5-10 minutes and goes away by itself, and happens about once every 2 weeks. Happens to his 1st and second toe. I thought this was an odd symptom, not really requiring pain meds or intervention. Is this normal? I told him to try warm compresses and told him to f/u with a physiatrist if he wanted a better evaluation. Thanks for any help
 
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Maverikk

ASA Member
5+ Year Member
Jun 20, 2013
158
49
Status
Attending Physician
Wow >100 views and no help, am I asking the wrong people?
 

PMR2008

PM&R
10+ Year Member
Aug 17, 2007
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Most likely focal dystonia. Treatment is usually Botox if painful.
 

DRacula

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Apr 16, 2007
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Texas
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I had a very similar case 2 weeks ago. Healthy 34 year old male who came to see me for mid-back pain and casually mentions cramping causing toe flexion intermittently for years. In going through his activities of daily living, I found he was exercising often and drinking copious amounts of water. I asked him to replace his electrolyte intake. On his follow-up appointment yesterday, that alone resolved his intermittent cramping. Had that not worked, Botox would have been my next plan of attack.

Hope that helps!
 

lobelsteve

SDN Lifetime Donor
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May 30, 2005
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Canton GA
www.stevenlobel.com
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Unsure if I'd recommend Botox for an intermittent cramping problem. I'd ask him to exercise/aggravate the problem and present to office for eval. Prevention rather than treatment makes more sense.