Ahmad Cannot Run

Ahmad Cannot Run

1. Anatomy of Foot & Ankle

   • Ankle Joint
     • ligaments
       • medial
       • lateral
     • blood supply
     • nerve supply
   • muscles of the sole of the foot
     • 4 layers
   • arches of the foot

2. Possible Causes of Muscle Weakness

   • infection
     • poliomyelitis
     • lyme disease
   • neurological
     • Guillain Barre Syndrome
   • Medications
     • Statin
     • Amiodarone
   • Electrolyte
     • Hyperkalemia
   • Metabolic
     • Acid Maltase deficiency
   • Genetic
     • Duchenne Muscular Dystrophy
       • Muscular Dystrophies: are inherited disorders which primarily but not exclusively affect the skeletal muscles
       • Clinical Characteristics
         • progressive weakness
         • intellectual impairment
         • pseudo hypertrophy of the calves
         • proliferation of connective tissue in muscle
       • X linked recessive
         • genetic defect in Xp21
           • deletion
           • duplication
           • point mutation
       • Pathogenesis
         • without dystrophin, sarcolemma becomes fragile, loss of calcium homeostaasis, cell death occurs
           • muscle cell degeneration will outpace regeneration
             • regeneration capacity is exhausted, fibres are replaced by connective tissue and fat
       • Clinical Progression
         • Prognosis
           • poor
           • 100% mortality at mid 20s
             • due to one of the complications
               • lung failure
               • heart failure
               • aspirations
               • airway obstruction
           • Management
             • no treatment, only improving quality of life by reducing complications
             • Pharmacological approach
               • Prednisone
             • physical and occupational therapy
       • Investigations
         • CK test
         • muscle biopsy
           • to check the myopathic changes
         • western blot
           • to detect and analyze dystrophin
   • Tested by Neurological Examination of the LL
     • Sensation
     • Motor Function
       • To test Muscle strength
         • Muscle Strength Scale
     • Coordination
     • Gait
       • abnormal gait
         • due to abnormalities in the
           • tip toe gait

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