Article

The functional consequences of spasticity can be corrected by local,
pharmacological or surgical treatments once the spastic muscle has been
identified. However, this diagnosis can be tricky when the muscle in question is
rarely involved in spasticity or when its mechanical action is unusual or poorly
characterized. Here, we present the case of a man presenting with left hemiplegia
after an ischaemic stroke. His gait was perturbed by foot clonus in the sagittal
plan, which persisted after selective neurotomy of the gastrocnemius and soleus
but disappeared after neurotomy of the peroneus longus. Clonus triggered by
pushing up under the whole of the forefoot in the direction of dorsiflexion may
not be related to spasticity of the triceps surae.
We recommend screening for
foot clonus by first pushing up on the sole of the foot under all five
metatarsals. In a second step, selectively pushing up under the first metatarsal
joint enables the physician to evidence spasticity of the peroneus longus.
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