Steppage Gait

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The patient with a steppage, or equine, gait lifts one or both feet higher than normal. This kind of high-stepping gait occurs under two very different circumstances. A patient with severe foot drop cannot dorsiflex the foot. To permit the toes to clear during the stride phase and avoid tripping, he lifts the foot as high as possible by exaggerated flexion of the hip and knee, then throws the foot out as he puts it down. In normal walking, heel strike occurs first; with a foot drop, the toes fall to the floor first. The touching of toe then heel creates a characteristic “double tap.”

Causes of unilateral foot drop and steppage gait include peroneal nerve palsy and L5 radiculopathy. Causes of bilateral foot drop and steppage gait include ALS, CMT disease and other severe peripheral neuropathies, and certain forms of muscular dystrophy. This patient had severe CMT disease with marked atrophy below the knee and 0/5 strength in the foot dorsiflexors bilaterally. There is also marked atrophy of the hand muscles.

Sensory ataxia may also cause a steppage gait because the patient lifts the feet up high and then slaps or stamps them down smartly to improve proprioceptive feedback. The gait of sensory ataxia may also cause a double tap but in that case the heel strikes first and smartly as the patient stamps the foot to the ground to improve proprioceptive feedback. The sound of the two varieties of double tap is quite different. A pronounced steppage gait due to foot drops is much more common than a steppage gait from sensory ataxia. In severe polyneuropathies, the steppage gait may have components of both sensory ataxia and foot drop.


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