Cock gait (steppage) is observed in pathologies accompanied by a violation of the dorsiflexion of the foot: polyneuropathies, poliomyelitis, Guillain-Barré syndrome, multiple sclerosis, compression or mechanical damage to the peroneal nerve. The cause of the violation is established according to the survey, physical examination, neurological examination, ultrasound of the nerve, neurophysiological studies, and other methods. Treatment of cock's gait includes NSAIDs, cholinesterase inhibitors, immunomodulators, immunosuppressants, hormonal drugs.
Due to paresis of the muscles that carry out the dorsiflexion of the foot, when the leg is raised, the toe of the foot sags. In order not to cling to the ground with the toe, the patient strongly bends the leg at the knee joint, lifts it up and throws it forward, and then sharply lowers it. The foot rests on the toes, then on the outer edge, and lastly on the heel. The cock's gait (steppage) got its name because of its external resemblance to the step of a rooster and the special trot of a horse in equestrian sport.
Along with the cock's gait, this pathology is characterized by the impossibility or difficulty of standing and walking on the heels, raising the outer edge of the sole. Sensitivity disturbances are detected on the back of the foot and in the lower part of the leg. The muscles of the anterolateral surface of the lower leg and the rear of the foot atrophy over time, so the diseased leg looks thinner in the lower leg, with sunken interosseous spaces on the foot. Neuropathy is caused by:
A frequent provoking factor of neuropathy with the development of steppage is nerve compression in the area of the foot or head of the fibula due to prolonged exposure to a forced position in certain professions. In addition, nerve compression is sometimes observed during immobilization. A rare cause of neuropathy is a tumor in the area where the nerve passes.
With polyneuropathies, not one leg is affected, but both, weakness of the hands is revealed. Steppage is not observed in all patients; it develops with significant weakness of the muscles of the peroneal group. The severity of motor, sensory and autonomic disorders varies. A feature of many polyneuropathies is the asymmetry of the cock's gait and other motor disorders with the symmetry of autonomic and sensory symptoms. Given the etiology, the following multiple nerve lesions are distinguished:
In addition, polyneuropathies develop in acute and chronic intoxications. The most common example of toxic nerve injury is alcoholic polyneuropathy. Multiple nerve damage is detected in some infectious diseases, sometimes found during pregnancy.
neuropathy
The disease often debuts with weakness in the legs; in some patients, a cock's gait is formed even in the early stages of the disease. Subsequently, the severity of the steppage varies depending on the phase of the disease. Possible numbness and paresthesia in different parts of the body, optic neuritis, dizziness, dysfunction of the pelvic organs. Then the central place in the clinical picture of MS is occupied by paresis and cerebellar disorders.
Cock gait occurs with spinal and mixed forms of poliomyelitis, develops on the 3rd-6th day of illness, is not an obligatory symptom. In most cases, steppage is one-sided, combined with paresis and paralysis of other muscle groups. In the outcome, complete or partial disappearance of symptoms is possible. In some patients, the cock's gait and other abnormalities persist throughout life.
Guillain-Barré syndrome manifests with sensory impairment and muscle weakness in the lower extremities. The result of muscle weakness is a cock's gait. Manifestations progress rapidly, neurological disorders spread to the upper limbs. The severity of symptoms ranges from mild muscle weakness to complete tetraparesis. Respiratory failure occurs in 30% of patients.
The neurologist is engaged in determining the cause of the formation of the steppage. At the initial stage, the specialist finds out complaints, collects an anamnesis, examines the dynamics of the onset and development of symptoms. Then the doctor assesses the general condition of the patient. A special examination of a patient with signs of a cock's gait includes the following diagnostic techniques:
Neurological examination
The scheme of drug treatment of diseases accompanied by the development of a cock's gait may include drugs of the following groups:
With secondary lesions, treatment of the underlying pathology is necessary. With progressive generalized neurological disorders, resuscitation measures are performed, mechanical ventilation. Drug therapy with steppage is supplemented with non-drug methods. Apply exercise therapy, massage, manual therapy. Electromyostimulation, paraffin treatment, electrophoresis are prescribed. Patients are referred for magnetic therapy, amplipulse therapy, ultraphonophoresis.
The tactics of surgical intervention is determined by the cause of the steppage and the consequences of the underlying disease. With neuropathies, a suture or plastic surgery of the nerve is performed, neurolysis or decompression of the nerve trunk is performed. Patients with secondary deformities of the musculoskeletal system may be shown surgical interventions to eliminate contractures, arthrolysis, arthrodesis in a functionally advantageous position. Movement of tendons, tenodesis, various types of osteotomy are possible.