Ankle spine syndrome "Raffet Syndrome II". Ipsilateral calf muscle weakness induces contralateral lumbar radiculopathy

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Background and Purpose Lumbar disc herniation and radiculopathy are considered worldwide health conditions. Due to its high prevalence and recurrence, clinicians should have an understanding of the underlying pathomechanics to prevent permanent neurological deficits. Although the body is recognized as a kinetic chain, a limited research body explored the biomechanical impact of a distal problem can have on the spine. This study aimed to describe a new clinical condition called Ankle Spine Syndrome or “Raffet Syndrome IIˮ by investigating the potential biomechanical mechanism underlying the radiculopathy contralateral to the side of calf muscle weakness, and to propose the treatment for this condition in patients with Lumbar disc herniation and radiculopathy. Material and methods A study focused on six patients (2 males and 4 females) who suffered from chronic ankle injury and calf muscle weakness on the side opposite to the lumbar disc herniation and radiculopathy. Initially, the patients underwent open and closed chain strengthening exercises for the calf muscle, such as double and single leg raises, wall sits calf raises, and seated calf raises for 6 to 8 weeks. Subsequently, supplementary treatments, including lumbar stabilization exercises, core training, and myofascial release therapy, were added for another 2 to 3 months. The intensity of perceived pain and disability index were assessed before and after each treatment. Results Substantial improvement in back pain, radiculopathy, and functional disability was observed after the initial treatment. Symptoms were completely resolved with the addition of adjunctive treatment. Furthermore, a follow-up after six months of a personalized home exercise program showed sustained recovery based on clinical outcome measures. Conclusion Calf muscle weakness can induce contralateral lumbar radiculopathy through a series of abnormal biomechanical mechanisms affecting the lumbopelvic rhythm and consequently the lumbar spine.

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