On Lower Extremity Dystonia and the Left AIC Pattern…

I was wondering if there is any correlation or known cases regarding right LE dystonia and the Left AIC pattern.  I just evaluated an 18 year-old female with a 3 year history of right LE dystonia (right foot is plantarflexed and inverted).  She also presents with a very clean L AIC and bilateral BC pattern.  Her right LE is 2 1/4 inches shorter than the left.  She has been treated unsuccessfully for 2 years with traditional physical therapy (US, stretching, massage) and botox injections.  I have started her on a repositioning program in supine and sidelying, but was wondering if there was anything I could try to inhibit the posterior tibialis tone and engage the right peroneal group.

I don’t know of any specific case studies or research or publications that are related to right LE dystonia and the Left AIC pattern…although I’ve seen a number of patients who have a Left AIC pattern with cervical dystonia, focal dystonia of an extremity, thoracic dystonia, etc.  I get the official dystonia publication monthly and am always looking for articles related to your question.

I would reduce as much right adduction activity out of her life as possible and integrate left AF IR , left adductor upright stance activity with right abduction or introduce simple techniques as the left sidelying IO/TA and left adductor with right glute max.  Where she really has to work hard at maintaining right FA ER without losing right calcaneal eversion, so that she can adduct her left LE with FA IR.  She would probably benefit from more awareness of her left LE during left AF IR stance and needs to be more aware of left sided balance, load, etc.