Ahmad Cannot Run

Ahmad Cannot Run

1. Anatomy of foot

   • Bones
     • Tarsals
     • Metatarsals
     • Phalanges
     • Hindfoot
     • Midfoot
     • Forefoot
   • 1st layer of muscles
     • Abductor hallucis
     • Flexor digitorum brevis
     • Abductor digiti minimi
   • 2nd layer of muscles
     • Lumbricals
     • Quadratus plantae
     • tendons of flexor digitorum + hallucis longus
   • 3rd layer of muscles
     • Flexor hallucis brevis
     • Adductor hallucis
     • Flexor digiti minimi brevis
   • 4th layer of muscles
     • 4 Dorsal interossei
     • 3 palmar interossei

2. Joints of the foot

   • Ligaments
     • MCL
       • Very strong , resists eversion of the foot
     • LCL
       • Anterior talo-fibular
       • Posterior talo-fibular
       • Calcaneofibular
   • Arches of the foot
     • Distribute the body weight equally
     • Shock absorption
     • Adjust to walking on uneven surfaces

3. Pathophysiology of DMD

   • (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness due to the alterations of a protein called dystrophin
   • This disease involves mutations in dystrophin gene
     • Most likely deletion mutations
     • The cell membrane permeability increases and the cell bursts
   • Dystrophin is an important protein that maintains the cell membrane integrity and strength

4. Clinical presentation of DMD

   • These usually begin in childhood
   • Clinical features
     • Difficulty walking
     • Frequent falls
     • Toe-walking
     • Lumbar lordosis
     • Pseudohypertrophy of calf muscles

5. Diagnosis of DMD

   • Primary investigations
     • CK serum levels
       • Normal range (160 IU/L)
       • Elevated in DMD patients (15000-35000 IU/L)
     • Cardiac assessment
       • ECG
       • Echocardiogram
       • Chest X-ray
   • Secondary investigations
     • PCR
       • Checking for presence of the mutated gene
     • Immunohistochemical stain

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