The Distribution of the Permanent Paralysis in the Lower Limb in Poliomyelitis

Though a striking feature of the paralysis that may result from an attack of poliomyelitis is its diversity, the belief that some order exists in the apparently irregular distribution of the permanent paralysis has been expressed by several authors. Wickman (1913) stated that ‘ ‘ although a great variety of combinations of paralyses are found, certain types appear more often than others ; in the leg the peroneal group and certain muscles of the thigh-in my experience the quadriceps femoris especially-tend to be implicated.” Lovett and Lucas (1908), Lovett (1913, 1917), Jahss (1917), Mitchell (1923) and Legg (1929, 1937) showed tables indicating the relative frequency of paralysis and paresis in the muscles of the lower limb. All show a high incidence of paralysis in tibialis anterior, tibialis posterior, the long extensors of the toes and the peronei. A lower incidence of paralysis but a greater combined total of paralyses and pareses is shown in the quadriceps and in the gluteal muscles. No satisfactory explanation has yet been offered to account for these findings. It is the object of this paper to review the distribution of paresis and paralysis in the muscles of the lower limb, to account for its disposition in terms of the destruction of motor nerve cells in the lumbo-sacral spinal cord, and to indicate the practical application of the findings in the management of poliomyelitis.