Differential Diagnosis for Paralysis of Ankle and Toes

Single Most Likely Diagnosis

• Peripheral Neuropathy: This is often the most common cause of paralysis of the ankle and toes, resulting from damage to the peripheral nerves, which can be due to various factors such as diabetes, trauma, or infection.

Other Likely Diagnoses

• Radial Nerve Palsy: Although more commonly associated with wrist drop, variations in nerve damage can lead to paralysis of the ankle and toes.
• Peroneal Nerve Palsy: Direct compression or injury to the peroneal nerve can cause foot drop, leading to paralysis of the ankle and toes.
• Lumbar Disc Herniation: Herniation of the lumbar discs, especially at L4-L5 or L5-S1, can compress nerves that control the muscles of the ankle and toes, leading to paralysis.

Do Not Miss Diagnoses

• Guillain-Barré Syndrome: An autoimmune disorder that can rapidly progress to paralysis, starting with the lower extremities. Early diagnosis is crucial for treatment.
• Spinal Cord Compression: Conditions like spinal stenosis, tumors, or abscesses can compress the spinal cord, leading to paralysis of the lower limbs, including the ankle and toes.
• Cauda Equina Syndrome: A serious condition that occurs when the nerves in the spinal canal are compressed, requiring immediate medical attention to prevent permanent damage.

Rare Diagnoses

• Charcot-Marie-Tooth Disease: A group of inherited disorders that affect the peripheral nerves, leading to progressive muscle weakness and atrophy, including paralysis of the ankle and toes.
• Amyotrophic Lateral Sclerosis (ALS): A progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord, leading to loss of muscle control, including the muscles of the ankle and toes.
• Poliomyelitis: Although rare in areas with widespread vaccination, polio can cause paralysis, including of the ankle and toes, especially in unvaccinated individuals or those traveling to endemic areas.