EpistemisMarch in steppe or steppage
Specialty: Neurology.
Why it occurs
- Mononeuropathy of the common peroneal nerve (entrapment in the head of the fibula due to external compression)
- Active L5 compressive radiculopathy (L4-L5 foraminal disc herniation)
- Charcot-Marie-Tooth motor peripheral polyneuropathy (hereditary neuropathy)
- Amyotrophic Lateral Sclerosis (pseudopolio presentation or distal debut in the lower limbs)
- Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
Initial workup
Physical examination evaluating active dorsiflexion of the foot against resistance; electroneuromyogram (ENMG) of the lower limbs to locate the site of injury (fibular head block vs L5 root denervation); MRI of the lumbosacral spine if root involvement is suspected; High-resolution ultrasound of the common peroneal nerve.
red flags
Steppe gait of bilateral onset and rapidly progressive (days) associated with loss of proximal strength in the lower limbs and global abolition of deep reflexes, compatible with a variant of Guillain-Barré syndrome, or associated with unbearable lumbar pain and sphincter incontinence.
Standard management
- Pregabalin (75-300 mg/day) or Gabapentin if associated with neuropathic pain due to entrapment or radiculopathy
- Use of ankle and foot orthosis (AFO / Rancho splint or anti-equinus) to stabilize gait and prevent falls
- Physiotherapy to strengthen the anterior tibial and interosseous muscles.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3