Steppage gait (High stepping, Neuropathic gait) is a form of gait abnormality characterised by foot drop or ankle equinus due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking

1. neuropathic Gait & foot drop
BY: SAURABH
BOT

2. INTRODUCTION
• Steppage gait (High stepping, Neuropathic
gait) is a form of gait abnormality characterised
by foot drop due to loss of dorsiflexion.[1] The foot
hangs with the toes pointing down, causing the toes
to scrape the ground while walking, requiring
someone to lift the leg higher than normal when
walking.
• It can be caused by damage to the deep peroneal
nerve.
• Characterize by excessive flexion of hip and knee in
swing phase,

6. EXAMINATION:
• First, observe the patient entering the room - speed,
stride, balance.
• Ask them to walk across the room, turn, and come back.
• Ask them to walk heel-to-toe in a straight line. This may
be difficult for older patients even in the absence of
disease.
• Ask them to walk on their toes in a straight line, and
then to walk on their heels in a straight line.
• Ask them to hop in place on each foot.
• Ask them to do a shallow knee bend.
• Ask them to rise from a chair and walk forwards across
the room, turn and come back to you.

7. OBSERVATION:
• Nature of steps - look for a steppage gait due to
foot drop (loss of dorsiflexion) leading to
needing to lift the leg higher than normal when
walking. This is associated with conditions such
as peroneal nerve injury, fibular injury, multiple
sclerosis, Guillain-Barré syndrome, and
prolapsed intervertebral disc.

8. Conditions associated with a steppage
gait:
• Foot drop
• Charcot–Marie–Tooth disease
• Polio
• Multiple sclerosis
• Guillain-Barré
• Spinal disc herniation
• Anterior Compartment Muscle Atrophy
• Deep fibular nerve Injury
• Spondylolisthesis

9. Increased variability of continuous
overground walking in neuropathic patients
is only indirectly related to sensory loss
• The present study was conducted to determine if
peripheral neuropathy leads to significant changes in
locomotor variability. Fourteen patients with severe
peripheral neuropathy and 12 gender-, age-, height-, and
weight-matched non-diabetic controls participated.
Sagittal plane angles of the right hip, knee, and ankle
joints and tri-axial accelerations of the trunk were
measured during 10 min of continuous overground
walking. Standard deviations of stride times and stride-
to-stride standard deviations of each kinematic variable
were calculated. Neuropathic patients walked slower and
exhibited some increases in locomotor variability
compared to control subjects. However, these increases
in gait variability were primarily linked to reductions in
self-selected walking speed and were not directly
attributable to sensory loss itself.

10. Neuropathic patients do not have reduced
variability in plantar loading during gait

11. Effects of experimentally induced plantar
insensitivity on forces and pressures under
the foot during normal walking
• Pressures under the foot during level walking were
measured in 15 healthy young adults (8 females, 7 males,
mean age 25.7, S.D. 5.3) before and after immersing the
feet in ice-cold water (2 °C) for 30 min to evaluate the
role of plantar insensitivity on gait patterns. Following
ice water immersion, there was a significant decrease in
walking speed. Maximum forces and peak pressures
under the foot decreased, with the exception of an
increase in loading under the third to fifth metatarsal
heads. Contact times increased under all regions of the
foot, and force–time and pressure–time integrals
increased under the second and third to fifth metatarsal
head regions

12. • . It is concluded that plantar insensitivity
significantly alters the distribution, duration,
and to a lesser extent, the magnitude of forces
and pressures under the foot when walking.
These results suggest that in the neuropathic
foot, gait changes caused by plantar insensitivity
may be partly responsible for the redistribution
and altered duration of loading, whereas the
increase in the magnitude of forces and
pressures are primarily due to other disease-
related factors.

13. FOOT DROP
• Foot drop / Drop foot
• The inability to lift the front part of the foot
• Not a disease.
• A symptom of some other medical problems.
• A sign of an underlying neurological, muscular
or anatomical problem.
• Can happen to one foot or both feet at the same
time
• The ability to foot-lift is an essential part of the
swing phase of the gait cycle

14. THE GAIT CYCLE

15. CAUSES:
• Nerve injury: most common compression of the
nerve nerve can be injured during THR or TKR.
• Brain or spinal cord disorders: Neurological
conditions stroke, multiple sclerosis (MS)
cerebral palsy, Charcot-Marie-Tooth disease.
• Muscle disorders: muscular dystrophy, polio
amyotrophic lateral sclerosis (Lou Gehrig's
disease)

16. MUSCLES & NERVE
• Dorsiflexor anterior tibialis extensor hallucis
longus extensor digitorum longus.
• Peroneal Nerve

17. SYMPTOMS
• High steppage gait
• An exaggerated, swinging hip motion
• tingling, numbness & slight pain in the foot
• Difficulty performing certain activities that
require the use of the front of the foot
• Muscle atrophy in the leg
• Limp foot

18. TREATMENT:
Depends on the specific cause of foot drop
• Exercises: strengthen the muscles, maintain joint
motion and help to improve gait.
• Ankle Foot Orthotics (AFO): support the foot with
light-weight leg braces and shoe inserts.
• Electrical Functional Stimulations: electrically
stimulate the peroneal nerve during footfall.
• Surgery: repairs or decompresses a damaged nerve
fuses the foot and ankle joint or transfers tendons
from stronger leg muscles
The goal of treating foot drop is to get patients back to
a regular gait cycle.

19. PHYSICAL THERAPY- EXERCISE:
• usually when the problem stems from weak
muscles
• proper physical therapy exercises can
strengthen ankle muscles and improve
symptoms

21. ANKLE FOOT ORTHOTICS:
• The most common treatment.
• An insert in the shoe that holds the foot at 90
degrees.
• Stabilizes the ankle in stance and helps clear toes in
swing.
• A variety of materials:
1. Plastic AFO : light weight off the shelf - short term
use custom molded from a cast – long term use or
complicated case risk of skin irritation
2.Metal and leather AFO : heavy skin contact must be
kept a minimum good for fluctuating edema
patients

23. FUNCTIONAL ELECTRICAL STIMULATION
(FES)
• Electrical stimulation to the nerves controls the
dorsiflexor muscles.
• 1. it was first proposed as a treatment for foot drop in
1961
• 2.they send electronic pulses to fire the nerve response
for the front of your foot to lift.
• 3.it's programmed to each individual separately it
provides normal range of motion to the foot and ankle
during walking .
• 4.stroke and multiple sclerosis patients with foot drop
have had success with it.
• Contraindication : pacemaker, uncontrolled epilepsy,
pregnancy, broken skin

24. WALKAIDE
• Utilizes patented tilt sensor technology
• Initiating stimulation when the leg is tilted bac
• Terminating stimulation when the leg is tilted
forward.
• Creates a more natural and efficient walking
pattern.