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A slap gait is characterized by a distinct slapping sound of the foot during walking. What causes slap gait? Slap gait occurs due to weakness of the ankle dorsiflexors, which allows the foot to drop forcefully onto the floor with each step.

Slap gait is considered a heel gait abnormality and can often be diagnosed simply by listening to the patient walk. Normally, the heel strikes the ground first, followed by controlled relaxation of the foot and ankle dorsiflexors, which allows the forefoot to make contact with the ground. In slap gait, dorsiflexor weakness disrupts this controlled action.

Foot drop gait, also known as steppage gait, occurs due to complete paralysis of the ankle and foot dorsiflexors. What is steppage gait?

Steppage gait, sometimes referred to as neuropathic gait or foot drop gait, is characterized by exaggerated lifting of the thigh while walking. Patients adopt this high-stepping pattern to clear the toes during the swing phase. Without this, the toes would drag along the ground. To avoid tripping, patients often flex the hip and knee excessively or externally rotate the leg.

In steppage gait, the ipsilateral hip and knee are flexed high enough to allow the toes to clear the ground during the swing phase. This gait is directly caused by complete paralysis of the foot and ankle dorsiflexors. If the patient has foot drop, they must adopt a steppage gait; otherwise, they risk tripping and falling forward.

The dorsiflexors of the ankle and foot are supplied by the peroneal nerve, a branch of the sciatic nerve.

The sciatic nerve originates in the lower back, passes through the buttock, and continues into the lower limb. In the distal thigh, just above the knee, the sciatic nerve divides into two branches: the tibial nerve and the common peroneal nerve. The common peroneal nerve then courses around the fibular neck and divides into superficial and deep peroneal branches.

The deep peroneal nerve innervates the tibialis anterior muscle, the primary muscle responsible for ankle dorsiflexion.

Causes of foot drop include:
L4–L5 disc herniation, where the herniated disc compresses the L5 nerve root.
Lumbosacral plexus injury.
Sciatic nerve injury, particularly the common peroneal division, which may be damaged during fracture-dislocation of the hip.
Knee dislocation, where both the common peroneal nerve and popliteal artery must be assessed.
Established compartment syndrome, where foot drop is a late finding. Ischemia lasting more than six to eight hours may result in irreversible muscle damage.
Fasciotomy should be performed early. While four hours of ischemia may be tolerated, by eight hours the injury is often permanent.
Thanks to Nathan Elkins for his assistance.

Quizzes
Slap gait occurs due to weakness of which muscle group?
A) Plantar flexors
B) Hip abductors
C) Ankle dorsiflexors
D) Quadriceps
Answer: C) Ankle dorsiflexors
Explanation: Weak dorsiflexors fail to control heel strike, causing the forefoot to slap the ground.

Steppage gait is also commonly referred to as:
A) Antalgic gait
B) Trendelenburg gait
C) Neuropathic gait
D) Spastic gait
Answer: C) Neuropathic gait
Explanation: Steppage gait is synonymous with neuropathic gait or foot drop gait.

Which nerve supplies the ankle dorsiflexors?
A) Tibial nerve
B) Deep peroneal nerve
C) Superficial peroneal nerve
D) Femoral nerve
Answer: B) Deep peroneal nerve
Explanation: The deep peroneal nerve innervates tibialis anterior, the primary dorsiflexor.

The common peroneal nerve most commonly gets injured at:
A) Inguinal ligament
B) Fibular neck
C) Popliteal fossa
D) Anterior ankle
Answer: B) Fibular neck
Explanation: The nerve winds around the fibular neck, a vulnerable site for injury
In slap gait, the abnormality is usually diagnosed by:
A) MRI
B) EMG
C) Hearing the foot strike
D) X-ray
Answer: C) Hearing the foot strike
Explanation: The audible “slap” during walking suggests dorsiflexor weakness.

Foot drop due to compartment syndrome occurs because of:
A) Venous thrombosis
B) Chronic arthritis
C) Ischemic muscle necrosis
D) Ligament rupture
Answer: C) Ischemic muscle necrosis
Explanation: Prolonged ischemia leads to irreversible damage of dorsiflexors.

Which muscle is primarily responsible for ankle dorsiflexion?
A) Gastrocnemius
B) Tibialis anterior
C) Soleus
D) Peroneus longus
Answer: B) Tibialis anterior
Explanation: Tibialis anterior is the main dorsiflexor of the ankle.

A patient with foot drop may compensate during swing phase by:
A) Plantarflexing the foot
B) Flexing the hip and knee excessively
C) Extending the hip
D) Adducting the thigh
Answer: B) Flexing the hip and knee excessively
Explanation: This exaggerated movement helps clear the toes.

In knee dislocation, assessment should include
Answer: Popliteal artery and common peroneal nerve
Explanation: Both structures are at high risk in knee dislocation.