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Q&A 37 - Extended toe and bent knee
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Q&A 37 - Extended toe and bent knee

It seems as if you and your MS team have neglected your spasticity management.
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Case study

I am a 48-year-old woman with secondary progressive MS. I have been using a wheelchair for four years. I have spasticity in my legs, and my left big toe is turned upward and outward, making it challenging to wear shoes or slippers. My left leg is now bent at the knee and won’t straighten, affecting my ability to lie flat at night. I am on baclofen three times a day: 20mg on waking, 20 mg in the afternoon and 30mg at night. Despite the extra dose at night, I get breakthrough spasms that wake me at about 3-4 am. When I wake, my legs are bent at the knees and spasm. It is very uncomfortable, and it can be painful.  The baclofen is sedating during the day, and I often doze off. Is there anything I can do to help with my toes and bent leg, the early morning spasms, and my daytime drowsiness?

Prof G’s opinion

In this Q&A, I will explain what a striatal toe is, patterns of spasticity, and how to manage these problems. If you have spasticity, what is the pattern of your associated weakness? This helps localise where the damage is in the nervous system.

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