Ankle Sprain Leads to ALS Diagnosis

A poster presented at the American College of Foot and Ankle Surgeons Scientific Conference details how an ankle sprain led a patient to a diagnosis of amyotrophic lateral sclerosis (ALS).¹
 
The poster is a case study of a 64-year-old woman who fell and twisted her ankle. Researchers noted her foot was in a varus position that was irreducible and later presented for an attempt at reducing the foot into a rectus position. She ended up unable to evert the foot and was experiencing continued pain and falls, according to the poster.
 
Nerve conduction studies and electromyography revealed normal function in sensory nerves and reduced amplitude to the peroneal nerve, as well as reduced recruitment in almost all the muscles assessed in the right lower extremity, note the authors. The patient got a referral to neurology and got a diagnosis of ALS via the Awaji criteria, which considers clinical or electrophysiological evidence. The patient died of complications of the disease 14 months later.
 
The poster notes ALS is frequently misdiagnosed because early in the onset of disease, lower motor neuron abnormalities are more hidden and more difficult to determine via clinical exam. The authors emphasize the importance of performing a thorough clinical workup for chronic ankle instability.
 
Reference
 
1. Stanley B, Jones S, Miggantz S, Kishman L. The fatal ankle sprain: how a common lower extremity injury led to a diagnosis of ALS. Presented at the American College of Foot and Ankle Surgeons Scientific Conference, Los Angeles, Feb. 9–12, 2023.