Médecine et chirurgie du pied


Importance of Ultrasound-Guided Electromyography of the Posterior Tibial Muscle in the Etiological Diagnosis of Steppage Gate Volume 37, issue 4, Décembre 2021


The differential diagnosis between an L5 root lesion and a fibular neuropathy in steppage gait is challenging but can be facilitated by clinic and electric exploration of the posterior tibial muscle. However, several studies have shown that needle placement is not as accurate as might be expected in specific muscles, even in the hands of an experienced electromyographer, and that accuracy can be enhanced by the use of ultrasound guidance, particularly for deep and thin anatomic elements. We report herein two cases of steppage gait in two men aged 55 and 66. The first had L5 root impairment (with involvement of the posterior tibialis muscle confirmed by ultrasound guided electromyography) related to a recurrence of his L5 discal hernia. The second had suspected peroneal nerve impairment as he had steppage gait with a normal posterior tibial muscle electromyography. This was confirmed by an ultrasound exploration that showed an intra-neural mucoid cyst of the peroneal nerve. This clearly demonstrates the contribution of ultrasound guidance of needle electromyographic detection of the posterior tibialis muscle in the etiological diagnosis of steppage gait.