High-stepping gait

Mô tả: A high stepping gait (i.e., steppage gait) is characterised by pronounced hip and knee flexion, in order to clear the lower limb or limb(s) with foot drop during leg swing.43,28 RELEVANT NEUROANATOMY AND TOPOGRAPHICAL ANATOMY

Nguyên nhân: Common • Common peroneal nerve compression mononeuropathy • L5 radiculopathy • Length-dependent peripheral neuropathy (e.g. alcohol, diabetes mellitus) Less common • Sciatic nerve palsy • Hereditary peripheral neuropathy (e.g. Marie–Charcot–Tooth disease) • Myopathy (e.g. scapuloperoneal muscular dystrophy)

Cơ chế: High stepping gait is associated with foot drop. Foot drop is caused by weakness of the anterior compartment muscles of the leg (e.g. tibialis anterior, extensor hallicus longus, extensor hallicus brevis muscles). Causes of high stepping gait include: 1 L5 radiculopathy 2 common peroneal nerve palsy 3 sciatic nerve palsy 4 length-dependent peripheral neuropathy 5 Charcot–Marie–Tooth disease 6 scapuloperoneal muscular dystrophy. L5 radiculopathy The L5 nerve root nerve fibres supply the muscles of the anterior compartment of the leg. The most common causes of L5 radiculopathy are intervertebral disc or intervertebral foramen disease (e.g. osteoarthritis). Other causes of radiculopathy include neoplasia, epidural abscess and trauma. Associated features of L5 radiculopathy include ankle dorsiflexor weakness and sensory abnormalities (e.g. pain, sensory loss) in the L5 dermatome (i.e., lateral aspect of the foot). Common peroneal nerve palsy The common peroneal nerve branches into the deep and superficial peroneal nerves, which innervate the muscles of the anterior and lateral compartments of the leg, respectively. The common peroneal nerve is vulnerable to traumatic injury due to its superficial location adjacent to the fibular head (see Figure 5.44). Common causes of peroneal nerve palsy include penetrating or High stepping gait (steppage gait) 331 Deep peroneal nerve Common peroneal nerve Superficial peroneal nerve Anterior tibial muscle Extensor hallucis longus muscle Extensor digitorum longus muscle Peroneus tertius muscle Peroneus longus muscle First dorsal interosseous muscle Extensor digitorum brevis muscle Peroneus brevis muscle Medial cutaneous branch Lateral cutaneous branch Dorsal digital cutaneous nerve

Ý nghĩa lâm sàng: High stepping gait is associated with foot drop.