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Unilateral Pes Cavus as an lnitial Sign of Tethered Cord Syndrome in an Adolescent: A Case Report

편측 첨족을 첫 증상으로 보인 계류척수증후군: 증례 보고

  • Park, Seung-Wan (Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center) ;
  • Moon, Jeong-Bo (Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center) ;
  • Ryu, Byung-Ju (Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center)
  • 박승완 (삼육서울병원 재활의학과) ;
  • 문정보 (삼육서울병원 재활의학과) ;
  • 류병주 (삼육서울병원 재활의학과)
  • Received : 2018.05.07
  • Accepted : 2018.07.03
  • Published : 2018.12.31

Abstract

A 14-year-old student presented with a 2-year history of progressive left foot deformity. High elevated medial arch, hindfoot varus deformity and second to fourth claw toes were idenfied in the left foot without a familial history. Neurologic examinations showed left distal lower extremity weakness and bilateral increased deep tendon reflexes. MRI of whole spine demonstrated thickened filum terminale and spinal defect covered with pulled skin which findings consistent with tethered cord syndrome (TCS). He was referred to neurosurgery department and had a detethering operation of the spinal cord. Two years later, he underwent foot surgery because his foot deformity progressed despite the detethering operation. It is very rare for TCS to present with pes cavus as the only symptom, also in Korea. We suggest that TCS should be considered as one of the differential diagnoses associated with unilateral pes cavus in adolescence so as not to miss the proper period of surgery.

Keywords

References

  1. Yamada S, Won DJ, Pezeshkpour G, Yamada BS, Yamada SM, Siddiqi J, et al: Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus 2007: 23: E6
  2. Burns J, Crosbie J, Hunt A, Ouvrier R: The effect of pes cavus on foot pain and plantar pressure. Clin Biomech Bristol Avon 2005: 20: 877-882 https://doi.org/10.1016/j.clinbiomech.2005.03.006
  3. Sanchez T, John RM: Early identification of tethered cord syndrome: a clinical challenge. J Pediatr Health Care Off Publ Natl Assoc Pediatr Nurse Assoc Pract 2014: 28: e23-33
  4. Yundt KD, Park TS, Kaufman BA: Normal diameter of filum terminale in children: in vivo measurement. Pediatr Neurosurg 1997: 27: 257-259 https://doi.org/10.1159/000121263
  5. Yamada S: Tethered cord syndrome in adults and children. Neurol Res 2004: 26: 717-718 https://doi.org/10.1179/016164104225017938
  6. Eleswarapu AS, Yamini B, Bielski RJ: Evaluating the Cavus Foot. Pediatr Ann 2016: 45: e218-222 https://doi.org/10.3928/00904481-20160426-01
  7. Amiri AR, Kanesalingam K, Srinivasan V, Price RF: Adult tethered cord syndrome resembling plantar fasciitis and peripheral neuropathy. BMJ Case Rep 2013 Dec: 5: 2013
  8. Joo SY, Choi B-O, Kim DY, Jung SJ, Cho SY, Hwang SJ: Foot deformity in charcot marie tooth disease according to disease severity. Ann Rehabil Med 2011: 35: 499-506 https://doi.org/10.5535/arm.2011.35.4.499
  9. Tynan MC, Klenerman L, Helliwell TR, Edwards RH, Hayward M: Investigation of muscle imbalance in the leg in symptomatic forefoot pes cavus: a multidisciplinary study. Foot Ankle 1992 Dec: 13: 489-501 https://doi.org/10.1177/107110079201300901
  10. Gharedaghi M, Samini F, Mashhadinejad H, Khajavi M, Samini M: Orthopedic lesions in tethered cord syndrome: the importance of early diagnosis and treatment on patient outcome. Arch Bone Jt Surg 2014 Jun: 2: 93-97