“Whenever I walk it feel as if my sole has become thick, senseles and sometimes it quite weak to hold my legs firmly on the ground. It makes me insecure and afraid of falling”
A Case Study.
A lady of around 52 years of age came to us with complain of numbness on both the sole of the foot. she also complained of slight difficulty in moving legs during the stance phase of the gait cycle.
She described that “Whenever I walk it feel as if my sole has become thick and sometimes it quite weak to hold my legs firmly on the ground. It makes me insecure and afraid of falling” told the lady who complains of the problem since past 8 years.
They have many history of treatment within the span of eight years without any benefit. Recently they consulted neurologist and an MRI scan and X-ray was suggested for Low back. The report revealed a low to mild central disc bulge at L4-L5 level and based on this report a spinal extension exercises were prescribed.
Surprisingly, spinal extension exercises also did not prove to be beneficial.
The MRI report says it is an L4 –L5 disc bulge but still the spinal extension exercise did not help, why?
By the time when I discharged her after 17 sittings she had reported around 70%- 805 of improvement. If you read further you will understand that being the tricky case, still its treatment is so simple.
What we found?
When she came to us she seemed to be exhaust, after all nothing improved her ailment. But she was cooperative. I checked through all her previous treatment records and her diagnostic report.
As I have already mentioned that MRI report suggests low to mild L4-L5 disc bulge, this prompted us to direct our assessment towards this. But, none of her complains and our assessment supported it. Here is the set of questions i asked her as a part of my assessment process we carried out.
Q 1: how did you start your problem?
Ans- It all started eight years back spontaneously and become worse with time.
Q 2: do you have pain in your back now?
Ans: No I don’t.
Q3: Do you before ever had any serious back pain?
Ans: No.
Q4: That means you never had pain in your low back and back of thigh and leg?
Ans: Yes, I never had any such complain.
Q5: Do you feel any kind of tingling sensation on the back of the leg?
Ans: No.
Q6: When do you feel numbness on your sole of the foot?
Ans: I feel it all the time but I appreciate it more when walking, along with slight weakness on legs.
Our Physiotherapy assessment.
Movement: All the lumbar movement (forward bending, side bending, extension) is pain-free with no other symptoms.
Central PA (Posterior to Anterior mobilization) at L4-L5 – No Abnormality Detected.
Treatment
Our assessments lead us to nowhere. MRI report says she has low to mild disc bulge but there is no symptoms of it.
Still, we planned the treatment in the line of the disc bulge.
We advised for:
1. Intermittent Lumbar Traction.
2. TENS
3. Spinal extension exercises.
After five treatment session, we were still puzzled as there was no sign of improvement.
But ultimately we got the result.
Do you think our previous treatment plan worked?
No!
This prompted us to look at the case from the different angle. This time, we planned to treat her symptomatically.
She has symptoms of numbness on the sole of the foot (Please note that she is not a Diabetic and all other neurological condition is ruled out), so we decided to go for Galvanic stimulation.
We gave 15-20 minutes session of galvanic stimulation on the back of the leg. On the third session, she indicated the sign of improvement.
By the end of the 17th visit, she reported about 70% to 80% of improvement.
Final word
We are still puzzled that was it really due to disc bulge or a completely different issue. But good thing is that she improved by giving us a lesson to learn.
If you have any further information on your insight you can light upon this case you are welcome to drop comments below.
Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.
