Body processes

Stepper Gait – Function, Abandonment & Diseases

Stepper walk

Stepper gait is a typical change in gait as a result of paralysis of the foot drop. This compensatory movement process can be caused by many diseases and injuries.

What is the stepper walk?

Stepper gait occurs when the foot droppers (dorsiflexors) fail due to neurological disease or lesions. A change in gait occurs, which is characterized by a compensatory mechanism that compensates for the lack of function of the paralyzed muscles .

If the dorsiflexor is no longer supplied, the foot can no longer be lifted when walking , it then hangs limply and the toes drag over the floor in the swing leg phase . To avoid this process, affected people raise their legs so far that their toes are hovering in the air. The increased lifting is mainly due to increased hip flexion.

The second aspect that characterizes this change in gait can be observed when the feet put down and can also be heard if the shoes are appropriate. The stance phase cannot be initiated as normal with the heel strike. Rather, the foot splashes with the front area, sometimes with the entire sole of the foot on the ground.

Usually, the term stepper gait is only used when both legs are affected. However, a unilateral failure triggers the same changes unilaterally.

function & task

Stepper gait is a protective mechanism designed to reduce the risk of falling when walking, especially when motor deficits are accompanied by sensory disturbances. In some disorders that cause flaccid paralysis of the drop foot, surface and deep sensitivity may also be affected. In both cases little or no information about the conditions in the foot is sent from the receptors to the central nervous system . Patients do not feel that the foot is dragging across the floor and they receive no information about the position of the foot in the joints and in space. 

Especially in the initial phase, when other senses , especially the sense of sight , have not yet taken over the compensatory orientation, the risk of falling is very high due to the sensory and motor deficits. Elevating the legs reduces the risk of catching your foot while walking and lessens the risk of falling.

The gait modification also has the purpose that the movement sequence can be completed as fluently and quickly as possible under the given circumstances. Dragging a foot with the toes over the ground during each swing leg phase severely impedes gait flow and gait pace and increases effort. Nevertheless, the normal walking speed is usually no longer reached due to the changed motor processes and because the movements are carried out with much more care. The gear mechanism is disturbed.

Another aspect that also plays a role in raising the leg is the uncomfortable feeling of dragging the shoe across the floor and damaging it.

The possibilities of compensating by walking on a stepper reach their limits when walking uphill or upstairs. The height that has to be overcome with these demands already requires increased hip flexion, which is almost completely exhausted in steep terrain even with normal function of the foot lifter.

Diseases & Ailments

The failure of the foot lifter can have various causes. Pressure damage to the common fibular nerve, which is a branch of the sciatic nerve and supplies the dorsal flexors, often occurs when a plaster cast is applied to the lower leg that is too tight . The impairment is often noticed too late, so that the nerveis irreversibly damaged and the motor impairment cannot be reversed. Damage to nerve structures and temporary or permanent paralysis of the muscles supplied can also occur as a result of external violence or mistakes during leg operations. The consequences of the damage described are purely motor and usually only affect one side, resulting in half a stepper gait. 

Polyneuropathy is a condition caused by diabetes , excessive alcohol consumption , drug abuse, or other factors. It attacks both the motor and sensory 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, due to the gradual loss of foot muscles and sensitivity , causes increasing insecurity when walking, which can be compensated for by a moderate stepper walk for a while.

Child paralysis (poliomyelitis), which in Europe can usually only be observed in older people, can also affect the drop foot. 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).

A failure of certain branches leads to paralysis of the foot muscles on both sides and thus also the dorsiflexor.

Rare muscle diseases, such as genetically caused neural muscle atrophy or myotonic dystrophy also affect the drop foot and usually gradually lead to muscle atrophy, which affects the gait pattern . It is precisely with these diseases that the double-sided stepper gait occurs.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.