Differential Diagnosis for Inability to Dorsiflex Great Toe
Single Most Likely Diagnosis
- Foot Drop due to Peroneal Nerve Injury: This is the most likely diagnosis because the peroneal nerve controls the muscles responsible for dorsiflexion of the foot and toes. Injury to this nerve can result in weakness or paralysis of these muscles, leading to an inability to dorsiflex the great toe.
Other Likely Diagnoses
- Extensor Hallucis Longus Tendon Rupture: A rupture of the extensor hallucis longus tendon, which is responsible for extending the great toe, could lead to an inability to dorsiflex the toe.
- Anterior Compartment Syndrome: Increased pressure within the anterior compartment of the leg can compress the muscles and nerves, including those responsible for toe dorsiflexion, leading to weakness or paralysis.
- L5 Radiculopathy: Compression or damage to the L5 nerve root can affect the muscles controlled by this nerve, including those involved in foot and toe dorsiflexion.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less common, this condition involves compression of the nerve roots in the lower spine and can lead to severe neurological deficits, including loss of motor function in the lower extremities. It is a medical emergency.
- Deep Vein Thrombosis (DVT) with Compartment Syndrome: A DVT can lead to compartment syndrome if not recognized and treated promptly, resulting in severe and potentially permanent damage to the affected limb.
Rare Diagnoses
- Charcot-Marie-Tooth Disease: A group of inherited disorders that affect the peripheral nerves, leading to muscle weakness and atrophy, which could potentially cause difficulty with toe dorsiflexion.
- Amyotrophic Lateral Sclerosis (ALS): A progressive neurological disease that affects nerve cells in the brain and spinal cord, leading to loss of muscle control. While rare, ALS could potentially present with symptoms including difficulty dorsiflexing the toes.
- Diabetic Amyotrophy: A condition associated with diabetes that affects the nerves, leading to muscle weakness, which could include the muscles responsible for toe dorsiflexion.