Stepper gait is a typical gait alteration resulting from paralysis of the foot elevators. This compensatory movement process can be caused by many diseases and injuries.
What is stepper gait?
Stepper gait is a typical gait change resulting from paralysis of the foot jacks. Stepper gait occurs when the foot elevators (dorsal extensors) fail due to neurological disease or lesions. A gait alteration occurs that is characterized by a compensatory mechanism to compensate for the lack of function of the paralyzed muscles. When the foot lifters are no longer supplied, the foot can no longer be lifted when walking, it then hangs limply down and the toes drag across the ground in the swing leg phase. To avoid this process, affected people lift their legs so much that the toes float in the air. The increased lifting occurs primarily through increased hip flexion. The second aspect that characterizes this change in gait pattern can be observed when the feet are placed on the ground and can also be heard if the footwear is appropriate. The stance phase cannot be initiated as normal with the heel strike. Rather, the foot splatters the ground with the front area, sometimes with the entire sole of the foot. Typically, the term stepper gait is used only when both legs are affected. However, unilateral failure triggers the same changes unilaterally.
Function and task
Stepper gait is a protective mechanism designed to reduce the risk of falls during walking, especially when motor deficits are accompanied by sensory disturbances. In some disorders that cause flaccid paralysis of the foot jacks, surface and depth sensibility may also be affected. In both cases, no or less information about the conditions of the foot is sent from the receptors to the central nervous system. Sufferers do not feel the foot dragging across the floor and they do not receive information about the position of the foot in the joints and in space. Especially in the early stages, when other senses, especially the sense of sight, have not yet taken over the compensatory orientation, the risk of falling is very high as a result of the sensory and motor deficits. Raising the legs reduces the risk of foot catching while walking and decreases the concern of falling. Gait modification also has the purpose of ensuring that the movement sequence can be completed as smoothly and quickly as possible under the circumstances. If one foot is dragged across the ground with the toes in every swing leg phase, this greatly impedes gait flow and gait tempo, and effort increases. Nevertheless, the normal gait tempo is usually no longer achieved, due to the altered motor processes and because the movements are performed with much more deliberation. The gait automatism is disturbed. Another aspect that also plays a role in the stressed lifting of the leg is the unpleasant feeling that arises when the shoe is dragged across the floor and damaged. The compensation possibilities through the stepper gait reach their limits when walking uphill or up stairs. The height that must be overcome in these requirements already requires increased hip flexion, which is already almost completely exhausted in steep terrain, even with normal function of the foot lifts.
Diseases and complaints
Failure of the foot jacks can have several causes. Pressure damage to the common fibular nerve, which is a branch of the sciatic nerve and supplies the dorsal extensors, often occurs when a cast is applied too tightly to the lower leg. The impairment is often noticed too late, so that the nerve is irreversibly damaged and the motor impairment cannot be reversed. As a result of external force or errors during leg surgery, injury to the nerve structures and temporary or permanent paralysis of the supplied muscles can also occur. The consequences of the described damage are purely motor and usually affect only one side, resulting in a half-step gait. Polyneuropathy is a disease caused by diabetes, increased alcohol consumption, drug abuse or other factors. It attacks both the motor and sensitive branches of nerves and destroys the protective insulating layer.As a result, the impulses to the muscles and the information from the receptors to the spinal cord are partially or completely lost. The disease often affects the foot and its surroundings and causes an increasing unsteadiness of gait due to the gradual loss of foot muscles and sensitivity, which can be compensated for a while by a moderate stepping gait. Polio (poliomyelitis), which in Europe is usually only seen in older people, can also affect the foot jacks. It is an inflammatory disease caused by the poliovirus. This can have consequences for the central nervous system, but also for the 2nd motor neuron (the fast nerve conduction that transports movement impulses from the spinal cord to the muscles). Failure of certain branches leads to bilateral paralysis of the foot muscles and thus also of the foot lifters. Rare muscle diseases, such as genetic neural muscular atrophies or myotonic dystrophy, also affect the foot lifters and usually lead insidiously to muscle atrophy, which affects the gait pattern. It is in these diseases that double-stepped gait occurs.
