Disclosures: Milan Ristic, DO: No financial relationships or conflicts of interest

Case Description: Patient initially presented as a referral from podiatry for extra depth shoes and bracing due to his severe rigid equinovarus foot deformity. Patient reported two year history of foot deformity but denied any earlier history of foot abnormality. Physical exam revealed bilateral equinovarus foot deformity and increased tone to his lower extremities as well as bilateral patellar tendon hyperreflexia. Pain in his feet necessitated him to ambulate with a rolling walker. Upon asking, he reported mild to moderate neck pain but denied paresthesis.

Setting: Ambulatory Shoe Clinic

Patient: 83 year-old male with past medical history of osteoarthritis who presented to shoe clinic, found to have acquired bilateral equinovarus deformity. Assessment/

Results: Ankle x-rays showed mild osteoarthritis. Cervical MRI was ordered for possible cervical myelopathy and was significant for multilevel cervical degenerative changes and canal stenosis most pronounced over C3-C4 with moderate cord compression. The patient was referred to neurosurgery for evaluation.

Discussion: Cervical spondylosis can lead to stenosis and, if severe enough, cervical spinal cord compression producing cervical myelopathy. Presenting symptoms can be quite variable including pain; sensory and motor abnormalities in the arms and or legs; and bowel or bladder dysfunction. One retrospective study of twenty-two patients showed gait abnormality to be the earliest consistent symptom in cervical myelopathy. Another study of 31 cases with syringomyelic syndrome, most involving the cervical spine, found foot deformities such as pes cavus or equinovarus in five pediatric cases. To the best of our knowledge, no cases have been reported of adult onset rigid equinovarus due to cervical myelopathy.

Conclusion: Cervical spondylotic myelopathy can have a variable presentation with retrospective studies indicating gait abnormality as the most common earliest symptom. This case demonstrates an unusual presentation of rigid equinovarus as a symptom of progressing cervical myelopathy, and as such should be further investigated and correlated with a thorough neurologic exam.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/equinovarus-as-a-presenting-symptom-in-cervical-myelopathy-a-case-study/