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Fertility Preservation

Management Team

Fertility Preservation

Women are born with roughly five hundred thousand eggs; by the time a woman turns 40, this reserve is depleted.

The “biological clock” is directly associated with the gradual depletion of the egg supply that each woman is born with. The ticking of their ovarian biological clock, i.e., with ageing, and not knowing their position on this clock represent two of the most prominent dilemmas that women face. To address these issues, cryopreservation technology, which is rapidly manifesting as ‘fertility insurance’, is attracting widespread attention.

What if it was possible to stop eggs from ageing? A 42-year-old woman could serve as her own egg donor: a gift from her 30-year-old self.

For career-oriented women or women about to undergo chemotherapy, halting the biological clock is a viable option. Thus, a woman can work or recover from a specific condition and choose to conceive later. This option has finally been made possible by science owing to vitrification.

  • Occurrence of malignancies for which gonadotoxic therapy (including chemotherapy, radiation, and/or surgical resection), immunotherapy, and/or bone marrow transplantation are required:
    • Haematological malignancies (leukaemia, lymphoma, and multiple myeloma)
    • Breast cancer
    • Sarcomas
    • Certain pelvic cancers
    • Central nervous system tumours
    • Ovarian-focussed cancer radiotherapy

Oncofertility is a branch of gynaecologic oncology that represents the combination of dedicated cancer and reproductive care to ensure that after cancer diagnosis, patients and/or survivors can preserve their fertility and achieve maximum reproductive potential. Oncofertility preservation involves a discussion of the effects of cancer treatment on the male/female reproductive systems and the associated risks and complications. Agents used for cytotoxic chemotherapy exert progressive, often irreversible, effects on the ovaries, causing the degeneration of the primordial follicles, loss of eggs, decrease in the levels of the anti-Müllerian hormone, and exhaustion of the ovarian follicle reserve. The type of chemotherapeutic drug used, its dosage, the duration of chemotherapy, and the age of the patient during treatment determine the extent of these effects. Radiation affects the primordial follicles, leading to early ovarian failure. Considering these adverse effects, counselling regarding the risk of infertility after cancer treatment and the appropriate methods for preserving fertility must be administered to the patients. Cryopreservation of oocytes, embryos, and/or ovarian tissues (or sperms, semen, and/or testicular tissues) represents a valuable modality for preserving reproductive potential. On the basis of specific factors, such as the age of the patient, time to initiate anticancer treatment, risk of the occurrence of early ovarian insufficiency, and the possibility of using hormones to stimulate eggs, an appropriate method for preserving fertility is suggested.

  • Presence of non-oncological diseases:
    • Systemic diseases for which chemotherapy, radiation therapy, and/or bone marrow transplantation are required (for example, clotting disorders)
    • Ovarian conditions: Presence of bilateral benign tumours in the ovaries, severe and recurrent ovarian endometriosis, and/or risk of developing ovarian torsion
    • Family history or increased risk of developing premature ovarian insufficiency
    • Genetic diseases that can affect future fertility (E.g.: Turner syndrome, galactosaemia, thalassemia, sickle cell disease)
    • Autoimmune conditions, such as systemic lupus erythematosus
  • Societal reasons:
    • Age
    • Desire to postpone childbirth to a later stage in life
    • Exposure to toxic chemicals
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Fractional Exhaled Nitric Oxide (FeNO)

Management Team

Fractional Exhaled Nitric Oxide (FeNO)

Overview

FeNO or fractional exhaled nitric oxide testing has become a valuable tool in the management of asthma, providing clinicians with additional information beyond traditional diagnostic methods.

  • Nitric Oxide (NO) Production: NO is produced by various cells in the respiratory tract, particularly epithelial cells, in response to inflammatory triggers, such as allergens or irritants. Most of the NO present in exhaled air originates from the nasal airways and it can be measured.
  • Airway Inflammation: In conditions like asthma, the levels of NO increase owing to the increased production of an enzyme called inducible nitric oxide synthase (iNOS) in inflamed airway epithelial cells and inflammatory cells (e.g., eosinophils).

The principle behind FeNO testing lies in the relationship between NO production and airway inflammation. Thus, when we breathe out, our breath can show if our airways are inflamed.

In FeNO testing, the amount of NO present in exhaled breath, which correlates with the degree of airway inflammation, is calculated. Elevated FeNO levels suggest ongoing inflammation, whereas lower levels may indicate controlled or less severe inflammation.

Monitoring: FeNO testing serves as a non-invasive method to monitor airway inflammation over time, guiding treatment adjustments and assessing the response to therapy.

Predicting Flare ups: High FeNO levels may indicate an increased risk of asthma flare ups, prompting the initiation of proactive management strategies.

FeNO testing is particularly useful in the following scenarios: 

  • Monitoring Treatment: Assessing the effectiveness of corticosteroid therapy and guiding step-up or step-down in treatment intensity.
  • Identifying Treatment Non-adherence: High FeNO levels despite symptoms can suggest poor adherence to the prescribed corticosteroids.

In asthma management, FeNO testing plays a crucial role in personalising treatment and tailoring medication dosages to the level of airway inflammation indicated by FeNO levels or considering alternative therapies with biologics. FeNO testing enhances the precision of asthma management by providing quantitative data on airway inflammation.

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Flexible Bronchoscopy

Management Team

Flexible Bronchoscopy

Overview

Flexible bronchoscopy is a vital procedure in Pulmonary Medicine, offering both diagnostic and therapeutic benefits.

Its use is recommended for a range of conditions, including persistent cough, unexplained lung infiltrates and haemoptysis. Flexible bronchoscopy is especially useful for assessing and biopsing suspicious lung lesions or masses, lung cancer diagnosis and staging, and investigating ILDs. Additionally, it aids in the detection of infectious diseases, such as tuberculosis and fungal infections.

Flexible bronchoscopy is a minimally invasive procedure for examining the airways and lungs. It involves the insertion of a thin, flexible tube called a bronchoscope through the nose or mouth, down the throat, and into the lungs. The bronchoscope is equipped with a light and a camera, allowing the doctor to view the airways on a monitor in real-time. Local anaesthesia is applied to the patient's throat, and they may receive a sedative to help them relax. It is a day-care procedure which shortens the duration of hospital stay.

  • The clinical outcomes of flexible bronchoscopy are highly favourable. The procedure boasts a high diagnostic yield for conditions, such as lung cancer, infections and Interstitial Lung Disease (ILD) s, leading to accurate diagnoses.

  • It can provide significant symptom relief for patients experiencing airway obstruction or haemoptysis.

  • Furthermore, the procedure’s ability to offer precise diagnostic information helps in forming specific treatment strategies and adjusting them based on disease extent and response.

  • In forming and adjusting treatment plans, flexible bronchoscopy is indispensable. The diagnostic insights gained from the procedure guide personalised treatment strategies, ensuring targeted therapies for conditions like lung cancer or appropriate antibiotics for infections.

  • Its therapeutic capabilities often reduce the need for more invasive surgeries, providing a minimally invasive management option.

  • Follow-up bronchoscopies are valuable in monitoring treatment effectiveness and guiding subsequent management steps.

  • For patients with advanced respiratory diseases, the procedure also offers palliative care options, significantly improving their quality of life.

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Fungal Diseases of the Lung

Management Team

Fungal Diseases of the Lung

Overview

Fungal diseases of the lung are caused by various types of fungi and can range from mild to severe.

  • Histoplasmosis: Caused by Histoplasma capsulatum, typically found in soil contaminated with bird or bat droppings. Symptoms can range from mild flu-like symptoms to severe lung infections.
  • Coccidioidomycosis (Valley Fever): Caused by Coccidioides species, common in the southwestern United States. Symptoms include cough, fever, and chest pain.
  • Blastomycosis: Caused by Blastomyces dermatitidis, often found in moist soil and decomposing organic matter. It can cause symptoms such as fever, cough, and weight loss.
  • Aspergillosis: Caused by Aspergillus species, found in soil, decaying vegetation and dust. It can cause a range of conditions from allergic reactions to severe infections in individuals with weakened immune systems (immunocompromised).
  • Cryptococcosis: Caused by Cryptococcus neoformans, commonly found in soil and bird droppings. It primarily affects immunocompromised individuals and can lead to severe lung and central nervous system infections.
  • Pneumocystis pneumonia (PCP): Caused by Pneumocystis jirovecii, it mainly affects individuals with weakened immune systems, such as in those with HIV/AIDS.
  • Mucormycosis: Caused by fungi belonging to the order Mucorales. It is a very rare but serious infection that often affects immunocompromised individuals and can cause severe lung damage. 

Diagnosis typically involves imaging-based techniques like chest X-rays or CT scans, as well as laboratory tests such as fungal cultures, serology and molecular methods.

Treatment often includes antifungal medications and addressing any underlying conditions that predispose the patient to infection.

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F

Foetal Growth Restriction/Intrauterine Growth Restriction

Management Team

Foetal Growth Restriction/Intrauterine Growth Restriction

Overview

Foetal growth restriction (intrauterine growth restriction; IUGR), refers to the failure of the foetus to grow at the expected rate during pregnancy. Essentially, this means that the baby is smaller than it should be for its gestational age, i.e., the number of weeks into the pregnancy. Babies with IUGR often weigh less than 90% of other babies at the same stage of pregnancy. Nevertheless, it is important to note that just because a baby is “smaller in size” (than usual), it does not necessarily mean that it has IUGR; in some cases, the parents may have certain underlying medical conditions that result in the foetus being smaller than usual. Often, IUGR not only affects the size of the baby but also the growth of organs and tissues. Thus, if not managed properly, IUGR could lead to several complications, such as breathing problems, increased susceptibility to infections and heart/blood vessel problems, and/or premature delivery or emergency C-section; in some serious cases, stillbirth or death could also occur.

There are two types of IUGR:

  • Symmetrical IUGR: The baby’s entire body is growing smaller than normal.
  • Asymmetrical IUGR: The baby’s head is growing at a normal rate, but the rest of the body is smaller.

Several factors can contribute to IUGR. Some are related to the baby’s health, others to the placenta, and some to the mother’s overall health. Here are a few common causes:

  • Placental issues: The placenta is responsible for delivering oxygen and nutrients to your baby. If the placenta is not functioning as it should, the baby’s growth can be affected.
  • Maternal health conditions: Hypertension, diabetes, or some infections may increase the risk of the development of IUGR.
  • Lifestyle factors: Smoking, drinking alcohol, or poor nutrition during pregnancy can contribute to growth restriction.
  • Multiple pregnancies: If you are carrying twins or more than 2 babies, the babies may have to compete for space and nutrients, increasing the risk of IUGR.
  • Chromosomal abnormalities: Sometimes, a baby’s growth is restricted because of genetic issues.

The tricky part about IUGR is that usually, there are no outward symptoms that a mother can feel. This makes regular prenatal check-ups essential. However, there are signs your doctor can detect, such as:

  • Smaller-than-expected baby bump: If your belly is measuring smaller than expected for your stage of pregnancy, it might indicate IUGR.
  • Low amniotic fluid levels: This can be another clue that your baby is not growing at the usual pace.

IUGR is typically diagnosed through careful monitoring during your prenatal check-ups; one or more of the following methods may be used:

  • Measuring the fundal height: Your doctor measures your belly from the top of the uterus to the pubic bone. If the measurement is smaller than expected for your stage of pregnancy, further investigations are needed.
  • Ultrasound: An ultrasound yields a more detailed view of the foetal growth; the foetal head, abdomen, and femur can be measured to check for signs of growth restriction.
  • Doppler ultrasound: This test is used to check the blood flow in the umbilical cord and other vessels to see if the baby is getting enough oxygen and nutrients.
  • Non-stress test: The baby’s heartbeat is monitored to ensure that it is not under stress.
  • Amniocentesis: In rare cases, this test may be performed to check for any genetic abnormalities that could be affecting the baby’s growth.

Here are the key approaches:

  • Frequent monitoring: If the IUGR is mild, the doctors may recommend close monitoring with more frequent ultrasounds and tests to keep a close watch on your baby’s growth.
  • Improving maternal health: If high blood pressure or diabetes is the cause, the doctors will focus on normalising blood pressure and diabetes treatment.
  • Nutritional support: A healthy, balanced diet is crucial. In some cases, extra nutritional support or supplements might be needed.
  • Bed rest: In some situations, bed rest is advised, which can help in improving the blood flow to baby.
  • Early delivery: If the baby’s health is at risk, sometimes, it is safer for the baby to be delivered early. This might involve inducing labour or performing a caesarean section delivery. The timing of delivery will depend on how far along the patient is and how the baby is coping inside the womb.

The availability of high-risk pregnancy care is extremely important for the timely detection and treatment of IUGR.

Regular prenatal visits are key to detecting IUGR early. However, you should seek medical advice if:

  • You notice a significant decrease in foetal movements (you should feel about 10 movements every 12 hours in the later stages of pregnancy).
  • You have sudden or severe symptoms like intense headaches, vision changes, or swelling, especially if you have conditions like hypertension (high blood pressure).

One or more of the following methods are recommended for the prevention of IUGR:

  • Healthy diet: Baby’s growth depends on a nutritious and balanced diet throughout pregnancy.
  • Quitting smoking and avoiding alcohol: These substances directly affect your baby’s development and should be avoided entirely during pregnancy.
  • Regular prenatal care: Keep all your scheduled appointments and follow your doctor’s recommendations to check your health and your baby’s development.
  • Manage chronic illness: During pregnancy, work closely with your doctor to manage the chronic illness such as hypertension, diabetes, or other disorders.
  • Stay active: Gentle, regular exercise can promote healthy blood flow, which benefits both you and your baby.
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F

Fibroids

Management Team

Fibroids

Overview

Uterine fibroids (leiomyomas or myomas) represent non-cancerous growths that develop in the uterine wall. They can vary in size and have been reported to be small (pea-sized) and sometimes, quite large (melon-sized). In many cases, fibroid formation does not cause any symptoms; however, depending on their size and where they are present, fibroids may cause discomfort or complications. Fibroids are quite common; in fact, research suggests that fibroid formation will occur in up to 70–80% of women by the age of 50 years. While fibroid development can be concerning, most fibroids do not increase the risk of cancer; they are often manageable with the right approach.

Based on their location in the uterus, fibroids may be categorised as follows:

  • Subserosal fibroids: The most common type of uterine fibroids; they grow on the outside lining of the uterus.
  • Intramural fibroids: They grow within the muscular uterine wall.
  • Submucosal fibroids: They grow within the space inside the uterus.
  • Pedunculated fibroids: They grow on a long stalk inside or outside the uterus.

Several factors have been reported to contribute towards fibroid formation in the uterus:

  • Hormonal factors: Fibroids are sensitive to hormones, particularly oestrogen and progesterone. These hormones stimulate the growth of the uterine lining during the menstrual cycle, and fibroids often shrink after menopause when hormone levels drop.
  • Genetic predisposition: If you have a family history of fibroids, you may be more likely to develop them yourself. Certain genetic mutations have also been linked to fibroid formation.
  • Cellular changes: Fibroids arise from smooth muscle cells in the uterus that proliferate rapidly. This growth may be influenced by various growth factors and hormones.
  • Environmental factors: Research is ongoing regarding lifestyle and environmental factors that may contribute to fibroid development, including diet, obesity, and exposure to certain chemicals.

  • Heavy menstrual bleeding
  • Pressure in the pelvis or pelvic pain
  • Frequent urination: when fibroids press against the bladder
  • Dyspareunia (painful sexual intercourse) 
  • Lower back pain
  • Constipation

Usually, the diagnosis of fibroids involves a physical examination to check for any abnormalities in your uterus and pelvic area. The following accessory methods may also be used:

  • Ultrasound: Sound waves are used to create images of the uterus; this will help ascertain the presence of fibroids and their size and location.
  • Magnetic resonance imaging (MRI): This also helps provide detailed images of the uterus and can help differentiate between fibroids and other conditions.
  • Hysterosalpingography (HSG): This is an X-ray-based procedure involving the injection of a contrast dye into the uterus to examine its shape and check for fibroids or blockages.
  • Hysteroscopic surgery: A thin, lighted tube is inserted into the uterus through the vagina; thus, the doctor can directly view the inside of the uterus.

The approach to treating fibroids largely depends on their size, location, symptoms, and whether you plan to become pregnant in the future. Here are some common treatment options:

  • Watchful waiting: If the fibroids are small and do not cause notable symptoms, the doctor may recommend that they be monitored over time.
  • Medications: Hormonal therapies, such as birth control pills, can help alleviate symptoms such as heavy bleeding. Gonadotropin-releasing hormone (GnRH) agonists may be used to temporarily shrink fibroids.
  • Minimally invasive procedures: Uterine artery embolisation (UAE) may be performed to block the blood supply to the fibroids; this will cause them to shrink.
  • Laparoscopic myomectomy: Fibroids may be removed using this minimally invasive surgery; this surgery is beneficial as it helps preserve the uterus.
  • Traditional fibroid surgery: Abdominal myomectomy may be recommended to remove fibroids through an incision in the abdomen; this is usually recommended for larger fibroids or those present in challenging locations.
  • Hysterectomy: In some cases, removal of the uterus may be necessary, especially if the fibroids cause significant problems or if a woman does not wish to get pregnant in the future. Laparoscopic hysterectomy is a minimally invasive surgery.

  • You experience heavy or prolonged menstrual bleeding that disrupts your daily life.
  • You experience severe pelvic pain or discomfort.
  • You experience changes in your menstrual cycle or bleeding patterns.
  • You exhibit symptoms of anaemia, such as fatigue or weakness, due to heavy bleeding.
  • You observe any concerning changes in bladder or bowel habits.
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F

Fever in Children

Management Team

Fever in Children

Overview

Fever in children is a frequent cause for medical consultation, prompting concern among parents. It is defined as an increase in the body temperature above the normal temperature of 98.6°F (37°C). While fever itself is not a disease, it is a sign of an underlying condition, typically an infection. In a tertiary care hospital setting, proper evaluation and management of paediatric fever are critical due to the potential severity of underlying causes.

Fever in children can be triggered by various conditions, most commonly infections.

  • Viral infections: Influenza, respiratory syncytial virus (RSV), and enteroviruses are the leading viral causes of fever in children.
  • Bacterial infections: Conditions, such as urinary tract infections (UTIs), streptococcal pharyngitis, bacterial meningitis, and sepsis can cause high fever.
  • Non-infectious disease: Autoimmune diseases, malignancies, and inflammatory conditions can also present with fever but are less common in the paediatric population.
  • Immature immune system: The epidemiology of paediatric fever varies with age, geographic location, and season. Young children, particularly those aged under 5 years, are susceptible to febrile illnesses due to their underdeveloped immune systems.
  • Exposure to pathogens: Communal settings like daycare centres and schools increase the risk of infection.

Symptoms accompanying fever in children can vary depending on the underlying cause.

  • General symptoms: Irritability, lethargy, poor feeding, vomiting, cough, diarrhoea, and rash.
  • Localised symptoms: In older children, localised symptoms, such as sore throat, ear pain, or abdominal pain can help identify the source of infection.
  • Severe symptoms: Signs of serious illness, such as high fever, difficulty breathing, or persistent vomiting may indicate more severe underlying conditions.

The diagnostic of fever in children involves systematically evaluating the cause and severity.

  • Medical history: Recording details, such as fever duration, pattern of fever, associated symptoms, recent exposures, and vaccination status is crucial.
  • Physical examination: This helps detect any localised signs of infection or other abnormalities.
  • Laboratory tests: Blood tests, urine analysis and cultures, and inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can guide diagnosis.
  • Imaging: Chest X-rays, abdominal ultrasounds, or other radiological studies are useful for identifying infection or inflammation.
  • Specialised tests: These include lumbar puncture for cerebrospinal fluid analysis in suspected meningitis cases or viral panels to detect specific viral pathogens.

Managing fever in children focuses on treating the underlying cause, alleviating discomfort, and preventing complications.

  • Severe illness: Supportive care for severe illnesses includes adequate hydration, administering antipyretics, such as paracetamol or ibuprofen for fever and discomfort, and monitoring for severe illness.
  • Viral infections: Viral infections usually require supportive care as most viral infections are self-limiting.
  • Bacterial infections: Antibiotics are prescribed based on the suspected pathogen, especially for serious conditions like sepsis or meningitis.
  • Non-infectious causes: Management may involve specific therapies, such as immunosuppressive agents for autoimmune diseases or chemotherapy for malignancies.
  • Hospital monitoring: Children with fever and signs of severe illness or underlying chronic conditions need to be closely monitored in a hospital setting. Advanced supportive care, including intravenous fluids, oxygen therapy, and intensive care, may be necessary for critically ill patients.

Preventing fever in children largely involves preventing the infections that cause it.

  • Vaccination: It is the most effective measure for many common pathogens, such as influenza, measles, mumps, rubella, varicella, and pneumococcus, and decreases the incidence of fever-causing infections.
  • Hygiene practices: Good hygiene practices, including regular hand washing, respiratory etiquette, and avoiding close contact with sick individuals, can also reduce the spread of infectious diseases.
  • Public health education: Education must be provided for parents and caregivers on recognising warning signs of serious illness, appropriate use of antipyretics, and the importance of vaccinations.
  • Child health initiatives: Promoting breastfeeding, proper nutrition, and overall health reduces the incidence and severity of febrile illnesses.
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F

Frontotemporal Dementia (FTD)

Management Team

Frontotemporal Dementia (FTD)

Overview

FTD affects individuals between 45–65 years. Fifty percent of cases show autosomal dominant inheritance pattern. Those individuals with parkinsonian features present with tau mutations on chromosome 17. FTD shows MND link association to chromosome 9.

Caused by anterior temporal and frontal lobe atrophy.

  • Family history in case of familial FTD
  • Head trauma
  • Thyroid disease
  • Other risk factors including cardiovascular comorbidities, diabetes, and autoimmune condition

Symptoms differ based on the types of disease:

  • Frontotemporal dementia
    • Altered personality, personal behaviour and social skills. (apathetic/disinhibited/overactive)
    • Progressive non-fluent aphasia
    • Perseveration
    • Loss of insight
    • Pure language deficit
      • Effortful and non-fluent speech
      • Impairment of well-rehearsed series, e.g. days of the week
      • Anomia
      • Comprehension intact
      • Impaired repetition
  • Semantic dementia
    • Loss of understanding of words
      • Cannot recognize faces/objects
      • Effortless and fluent speech, but without content
    • Semantic paraphasia, e.g. cat for dog
      • Impaired comprehension
      • Anomia
  • Frontotemporal dementia with MND
    • Amyotrophic lateral form of MND presented after dementia onset

Neurologist

  • Normal EEG
  • Anterior temporal and frontal lobe atrophy seen on MRI
  • FDG PET scan- shows hypometabolism of frontal and temporal areas

  • No specific treatment
  • Supportive care for behaviour abnormalities
  • Cognitive therapy
  • Social support
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F

Friedreich’s Ataxia

Management Team

Friedreich’s Ataxia

Overview

Friedreich’s ataxia refers to an autosomal recessive condition caused by trinucleotide (GAA) mutation in Frataxin gene. It causes difficulty in walking with imbalance, speech disturbance and multiple systemic complications.

Caused by a gene defect that is inherited from both parents.

  • Family history
  • Chronic and excessive alcohol intake
  • Hypothyroidism or hypoparathyroidism
  • Multiple sclerosis
  • Celiac disease
  • Sarcoidosis
  • Cancer-triggered paraneoplastic syndrome
  • Multiple system atrophy
  • Anti-seizure sedatives and medications
  • Exposure to heavy metals (mercury or lead), or solvents (paint thinner)
  • Deficiency of vitamin E, B6, B12, or B1
  • Excess intake of vitamin B-6

  • Pyramidal weakness
  • Gait ataxia
  • Optic atrophy
  • Deafness
  • Axonal peripheral neuropathy
  • Altered eye movements- nystagmus, hypometric saccades, macrosaccadic square wave jerks, broken pursuit
  • Skeletal abnormalities: high arched foot, spinal deformities like scoliosis
  • Diabetes or glucose intolerance
  • ECG alterations: widespread T wave inversion

Neurologist

  • Clinical examination
  • Electrophysiological testing for peripheral neuropathy
  • ECG, echocardiogram
  • Blood tests for glucose levels, vitamin E levels
  • X-ray for scoliosis
  • MRI/ CT scan for brain and spinal cord
  • Genetic testing

  • Symptomatic treatment, physiotherapy, gait training
  • Surgical procedures for ankle contractures
  • Orthosis and assistive devices
  • Managing cardiac complications
  • Newer therapy: Omaveloxolone (currently not available in India)
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F

Foot Drop

Management Team

Foot Drop

Overview

Foot drop is the inability to lift the front part of the foot. It is characterized by weakness or paralysis of muscles of foot that help to lift the foot off the ground. It results in dragging of the foot while walking.

  • Muscle or nerve damage
  • Neurological disorders (stroke, spinal cord injury, multiple sclerosis, peripheral neuropathy as a part of diabetic neuropathy, multiple motor neuropathy, CMTD, HNPP)
  • Trauma to the leg or foot
  • Nerve compression as a result of positioning/ surgery

  • Nerve injuries from sports injuries, a slipped disc, or wearing a cast that puts pressure on the nerve
  • Sitting with legs crossed, kneeling, or squatting for long periods of time
  • Unmanaged type 2 diabetes
  • Other medical conditions such as cerebral palsy, multiple sclerosis, Parkinson's disease, or stroke
  • Hip or knee replacement surgery can sometimes compress nerves
  • Immobility

  • Difficulty lifting the front of the foot
  • Dragging or slapping of foot while walking
  • May be associated with tingling or numbness of foot
  • May be associated with pain in foot

Neurologist

  • Severity and intensity of nerve injury assessed by nerve conduction studies
  • MRI neurography to determine the level area of nerve injury/ compression
  • MRI spine to rule out radiculopathy/ root compression

  • Physiotherapy
  • Orthotic or braces to support foot and ankle
  • Assistive devices to aid walking
  • Surgery to repair/ decompress damaged nerves/ muscles
  • Electrical stimulation therapy
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