Foot Drop as an Atypical Presentation of Rectal Cancer: The Importance of Digital Rectal Examination in Early Diagnosis

Rectal cancer is a major health concern with an increasing incidence in the younger population. It is typically diagnosed through screening or through common symptoms, such as rectal bleeding and changes in bowel habits. Rarely, rectal cancer may present with atypical symptoms such as neurological deficits. We report the case of a 77-year-old female with a history of abdominal pain and constipation, who presented with foot drop, a rare neurological manifestation. Clinical examination and imaging revealed an irregular mass in the rectum and metastatic lymphadenopathy. Digital rectal examination (DRE) plays a crucial role in identifying primary malignancies despite the absence of typical symptoms. The patient was diagnosed with moderately differentiated adenocarcinoma of the rectum, which was confirmed by colonoscopy and biopsy. Further staging with PET-CT revealed metastatic lymph nodes. Owing to obstructive symptoms, she underwent palliative loop sigmoid colostomy and started chemotherapy. This case highlights the importance of considering rare neurological presentations such as foot drop in the diagnosis of rectal cancer. Early recognition through DRE and imaging can lead to timely diagnosis and intervention, and improve patient outcomes.