Which conditions are listed as causing steppage gait?

• A. Cerebral palsy
• B. Polio
• C. Guillain-Barré syndrome
• D. All of the above

Answer: (D)

Steppage gait happens when the dorsiflexor muscles that lift the front of the foot during swing are weak or paralyzed, so the toes drop and the person lifts the knee higher to clear the foot. Each of these conditions can cause that dorsiflexor weakness or foot drop. Poliomyelitis damages the anterior horn cells, leading to weakness of distal leg muscles including tibialis anterior. Guillain-Barré syndrome is a neuropathy that can acutely weaken distal leg muscles, including dorsiflexors. Cerebral palsy can involve motor pathways or peripheral nerves that control ankle dorsiflexion, resulting in dorsiflexor weakness or unopposed plantarflexion in some individuals. Because all of these can produce the same problem—inability to clear the foot during swing—the correct choice is that all of the above can cause steppage gait.