Slap gait , Steppage Gait . Foot Drop - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the condition slap / steppage gait. Foot drop.
Slap gait occurs due to weakness of the foot and ankle dorsiflexors which allows the foot slap down on the floor with each step. Slap gait is a heel gait abnormality that can be diagnosed by hearing the patient walk. With a normal walking gait, the heel strikes the ground first followed by controlled relaxation of the foot and ankle dorsiflexors in order to allow the forefoot to come in contact with the ground. Foot drop gait or steppage gait is due to total paralysis of the ankle and foot dorsiflexors (tibialis anterior muscle).
Steppage gait
It is sometimes called “drop foot gait” or “ neuropathic gait”. A common symptoms of foot drop is a high steppage gait that is often characterized by raiing the thigh up in an exaggerated fashion while walking. The patient will have difficulty in clearing the toes during the swing phase. The patient must externally roatte the leg or flex the hip or knee to raise the foot high enough to avoid dragging the toes along the ground. The leg is brought up high off the ground by flexing the ipsilateral hip and knee so the toes will not drag on the ground during the swing phase. Steppage gait is due to complete paralysis of the ankle and foot dorsiflexors. If the patient has foot drop then they have to have a high steppage gait or else they will trip on the foot and fall forward.
The ankle and foot dorsiflexors are supplied by the peroneal nerve which is part of the sciatic nerve. The sciatic nerve starts in the lower back and runs through the buttock and lower limb. In the lower thigh, just above the back of the knee, the sciatic nerve divides into two nerves, the tibial and peroneal nerves, which innervate different parts of the lower leg. The common peroneal nerve then travels anterior, around the fibular neck, dividing into superficial and deep peroneal nerves. The deep peroneal nerve gives innervation to the tibialis anterior muscle of the lower leg which is responsible for dorsiflexion of the ankle. Conditions that cause foot drop :
•L4-L5 disc herniation: a herniated disc compressing the L5 nerve root may cause foot drop,
•Lumbosacral plexus injury due to pelvic fracture
•Sciatic nerve injury due to hip dislocation, the common peroneal division of the sciatic nerve is commonly injured during fracture dislocation injuries involving the hip.
•Injury to the knee as knee dislocation: in the event of knee dislocation it is important to check for common peroneal nerve and popliteal artery injury.
•Established compartment syndrome: foot drop is late finding. Ischemia more than 6-8 hours may cause irreversible changes to the muscle. Fasciotomy should be done early. 4 hours of ischemia may be tolerated, but by 8 hours, the damage is often irreversible.

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