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Pierre R. Bourque, MD; Peter James Dyck, MD

Arch Neurol. 1990;47(1):79-80.

Abstract
• Four patients, referred as having peripheral neuropathy, were noted to be able to walk on their heels but not on their toes. In each, intraspinal disease was found: ependymoma of the filum terminale, spinal muscular atrophy, spinal stenosis, and meningeal carcinomatosis. By comparison, in 86 cases of hereditary motor and sensory neuropathy type 1, ankle plantar flexors were never weaker than ankle dorsiflexors. Patients with greater weakness in plantar flexors than in dorsiflexors should be suspected of having intraspinal disease rather than peripheral neuropathy. Physiologic and biomechanical factors may explain why muscles innervated by the peroneal nerve are weaker, or graded weaker, in peripheral neuropathy.

Author Affiliations
From the Peripheral Neuropathy Research Laboratory, Mayo Clinic and Mayo Foundation, Rochester, Minn. Dr Bourque is now with the Department of Neurology, Ottawa (Canada) Civic Hospital.

Footnotes
Accepted for publication June 5, 1989.

Presented in part before the third meeting of the Peripheral Nerve Association of America, Halifax, Nova Scotia, Canada, July 12,1988.

Reprint requests to Department of Neurology, Ottawa Civic Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9 (Dr Bourque).

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