Steppage gait ? Or just a runway model ? Take the thinking farther.
Today we have a short blog post for you. You may take the topic simply on the surface or cogitate over it and find some deeper epiphanies from the well of knowledge we have tried to present here on our blog for the past 4+ years.
It is clear that in this video that the model has a consciously driven steppage gait. Meaning, she is lifting her limb/foot via exaggerated hip flexion and knee flexion to clear the foot. This is often seen unilaterally in a foot drop case where the client has a neurologic lesion that for one reason or another has impaired the client’s ability to extend the toes or dorsiflex the ankle sufficiently to clear the foot (so they do not drag toes and trip/fall).
But, why is she doing this steppage gait ? It is highly unlikely that she has bilateral lesions. Sure, she was asked to walk this way by her mentor but again, take it further. Is there a factor making this gait necessary regardless of the coaching ?
Obviously the answer is yes or we wouldn’t be doing a blog post on this topic. She is wearing ridiculously high heels. This is forcing her into an extreme plantarflexed foot and ankle posture. IF she were to swing her leg normally during the swing phase she would drive the foot and ankle into dorsiflexion (a normal gait event) and the long pointed heel would be made more prominent as it was driven forward and downward. This would surely catch on the ground, immediately driving the foot into sudden violent forefoot loading and pitch her into a forward fall. Yes, you have seen this on the run way videos on youtube, and yes we know you laughed too ! You see, when wearing heels this high, one must deploy a certain degree of steppage gait to clear the heel because ankle plantarflexion is fraught with the risk we just discussed above, the heel is too prominent and will catch. How much steppage (knee flexion and hip flexion to clear the foot) is necessary ? Well, to a large degree it depends on how much of a heel is present. If you are wearing a small heeled shoe, lets say 1 inch, then a small steppage is necessary.
None the less, there is a bigger problem lurking and brewing underneath when heels are a regular occurrence. Slowly and gradually the disuse of the anterior compartment muscles (Extensor dig., Ext. hallucis, peroneus tertius, tibialis anterior) will weaken and the posterior compartment will shorten respectively. IF left too long, it will result in tightness (yes, there is a difference between tightness and shortness, one is a neurlogical protective mechanism, the other is a more permanent change.) We have said this many times here and in our videos, much of posterior compartment problems (ie achilles tendonitis, Sever’s, Hagglunds etc) are related to a degree of anterior compartment weakness, skill deficits or endurance challenges. Wearing high heels often will often, but not always, increase this risk.
If you are an athlete, but someone who wears high heels often, you may have to do extra work to keep your anterior compartment competent on several levels. Eccentric strength is just as important as concentric in this region. Remember, many gait problems come on slowly, a slow simmering smoldering fire. And remember this last point about heeled shoes, your forefoot is always being loaded initially in ankle plantarflexion, this is not normal and in time this will have a cost in many people.
One last thing. We are not necessarily talking about dress shoes, although they are a greater culprit. Many running shoes still have accentuated rear foot stack heights where the heel will be many millimeters above the plane of the forefoot. Do not discount these shoes as a possible contributor of your problem, remember, physiological adaptation takes time to express into a biomechanical symptom creating problem, and it may take quite some time to resolve your compensations and adaptations.
PS: drive that “cross over gait” lady. Fools.
Shawn and Ivo
the gait guys
