STEPPAGE GAIT
Steppage gait refers to the inability to lift the foot while walking due to the weakness of muscles that cause dorsiflexion of the ankle joint.
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Steppage Gait
When your child has “foot drop”, he or she will walk with a steppage gait pattern. The anterior tibialis muscle, which is located in front of the shin bone, is what causes foot drop. Therefore, in order for your child to lift their foot and ankle when walking, the anterior tibialis muscle contracts. By doing this, your child may avoid catching their toes on the ground and ensure that the foot clears the floor. A steppage gait may occur if the anterior tibialis is weak or paralyzed. For example, this indicates that your child moves forward with considerable hip and knee flexion. In order to clear the foot over the ground and prevent tripping, your child lifts their leg sharply off the floor. If your child has a steppage gait pattern after a sickness or accident, a physical therapist can assist and potentially reverse the abnormal gait .
Causes of Steppage Gait
The muscles responsible for elevating the front of the foot are weak or paralyzed, which leads to foot drop. Foot drop may result from several factors, such as:
Nerve Injury
The nerve in your child’s leg that handles the muscles involved in elevating the foot is most frequently the cause of foot drop (peroneal nerve). Injuries to this nerve can also occur during knee or hip replacement surgery, which can result in foot drop. Foot drop can also result from a spinal “pinched nerve” damage to a nerve root. Diabetes makes people more prone to nerve conditions that are linked to foot drop.
Muscle or Nerve Disorders
Foot drop is a condition that actually gets worse through several types of muscular dystrophy, a genetic condition that causes gradual muscle weakening. Likewise, conditions like polio and Charcot-Marie-Tooth disease are also possible.
Brain and Spinal Cord Disorders
“Foot drop” can also occur as a result of conditions that damage the spinal cord or brain, including ALS, MS, and stroke.
Specific Causes of Bilateral Foot Drop and Steppage Gait
In addition to the above causes, bilateral foot drop and steppage gait are specifically associated with certain medical conditions. Amyotrophic Lateral Sclerosis (ALS) and Charcot-Marie-Tooth (CMT) disease are prominent culprits. Severe peripheral neuropathies and certain forms of muscular dystrophy also play significant roles.
Understanding the underlying causes of bilateral foot drop and steppage gait is crucial for effective diagnosis and management. Each condition presents unique challenges and requires a tailored approach for treatment and rehabilitation.
Severe polyneuropathies can also lead to a steppage gait that includes elements of both sensory ataxia and foot drop. Typically, a steppage gait arises when an individual experiences foot drop, which occurs frequently. However, when polyneuropathies become severe, they can affect both the sensory and motor components of walking. This combination can result in a gait pattern that reflects not only the challenges of lifting the foot (due to motor deficits) but also balance issues related to sensory ataxia. This dual-impact on mobility underscores the complex nature of severe nerve disorders.
QUESTIONS AND ANSWERS
What causes steppage gait in children, and how serious is it?
The causes of steppage gait in children point to various factors, including nerve damage or weakness in the muscles that lift the foot. Common causes include conditions such as peripheral neuropathy, muscular dystrophy, or other neurological disorders. It’s important to consult with a healthcare professional, such as a pediatrician or a neurologist, to determine the underlying cause.
For more specific conditions that can cause unilateral foot drop and steppage gait, peroneal nerve palsy and L5 radiculopathy are often identified. These conditions involve nerve issues that can result in the inability to lift the foot, leading to the characteristic high-stepping walk.
The severity of the underlying condition will determine its classification — serious concern or not. Early diagnosis and intervention can often lead to better outcomes, so doctors urge parents to seek medical advice promptly.
Understanding these causes and their implications is crucial for developing an effective treatment plan and improving mobility and quality of life.
What diagnostic tests do doctors use to determine the cause of a child's steppage gait?
To identify the underlying cause of a steppage gait, the healthcare provider may recommend various diagnostic tests. These may include a thorough physical examination, nerve conduction studies, electromyography (EMG), and imaging studies such as MRI or CT scans. Blood tests may also be conducted to rule out certain metabolic or autoimmune conditions. The specific tests recommended will depend on the child’s medical history, symptoms, and the suspected cause of the gait abnormality.
What are the treatment options for a steppage gait, and can it be corrected?
The treatment approach will depend on the underlying cause of the steppage gait. If the gait abnormality appears because of a reversible condition, such as inflammation or compression of nerves, addressing the underlying cause may improve or correct the gait.
Doctors often recommend Physical therapy to strengthen muscles, improve coordination, and enhance overall mobility. In some cases, doctors may recommend assistive devices such as braces or orthotics to provide support. It’s important to work closely with healthcare professionals to develop an individualized treatment plan based on the specific needs of the child.
Parents should seek prompt medical attention if they notice any changes in their child’s gait or have concerns about their child’s motor development. Early intervention and a comprehensive evaluation can help identify and address the underlying issues contributing to the steppage gait.
Schedule an Appoint at Medical City Children’s Orthopedics and Spine Specialists if your child has an unusual gait
Symptoms of Steppage Gait
A foot drop might make it difficult to walk. Your child can’t lift the front of their foot, so to prevent dragging his or her toes or tripping, your child lifts their leg higher than usual. Therefore, when the foot strikes the ground, it generates a slapping sound. This is called a steppage gait.
In more detail, this type of high-stepping gait occurs because the foot cannot dorsiflex, meaning the toes can’t naturally lift. To compensate, there’s exaggerated flexion of the hip and knee, lifting the foot high enough so the toes clear the ground during each step. Unlike normal walking where the heel strikes the ground first, with foot drop, the toes hit the floor first, creating a distinct ‘double tap’ as the heel follows.
This altered walking pattern is essential to prevent tripping and maintain balance. This highlights the significant adjustments needed for those with this condition.
Treatment for a Steppage Gait
Physical treatment directed at the anterior tibialis muscle is used to treat steppage gait patterns. Your child can strengthen the anterior tibialis by performing certain ankle workouts. When a patient performs calf stretches, the ankle’s range of motion will continue without reduction. A physical therapist could suggest gait training or other activities to help your child walk better. To enhance your child’s total proprioception (the awareness of the position and motion of the body), they can recommend balance activities. To help your child’s anterior tibialis muscle function better, the physical therapist may decide to employ neuromuscular electrical stimulation.
Your child’s muscle is artificially contracted during this form of electrical stimulation, which helps it work properly. The physical therapist may suggest back exercises to relieve pressure on your child’s sciatic nerve. This will treat anterior tibialis weakness brought on by sciatica. The exercises are intended to enable proper signal transmission up and down the sciatic nerve in your child’s lower back. What is causing foot drop determines how to treat it. In certain instances, curing the underlying issue will also cure foot drop. “Foot drop” could be irreversible if the underlying condition is persistent or chronic. Physical and occupational therapy could help certain patients.
Possible Treatments for a Steppage Gait:
- In order to support the foot and keep it in a more natural posture, use braces, splints, or shoe inserts.
- Physical therapy can improve your child’s walking by stretching and strengthening your child’s muscles.
- By using nerve stimulation, the nerves and muscles of the foot can be retrained with the use of nerve stimulation.
- To try to heal the nerve or release the strain on it, surgery may be required. Your doctor could advise fusing the ankle or foot bones to treat long-term foot drop. Your child could also have tendon surgery. This involves moving a functioning tendon and its accompanying muscle to a different area of the foot.
Conclusion
The Pediatric Orthopedic Doctors at Medical City Children’s Orthopedics and Spine Specialists, with offices conveniently located inArlington, Dallas, Flower Mound, Frisco, and McKinney, TX. treat kids with steppage gait by diagnosing the cause and treating the child to a speedy recovery.
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Footnote:
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