11/13/24, 7\:04 PM Guide | Gait abnormalities

Gait abnormalities

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Normal gait cycle

The gait cycle has six phases\:
1. Heel-strike\: initial contact of the heel with the
2. Foot
3. Mid-stance\: the weight is aligned and balanced on this leg.
4. Heel-o
5. Toe-o
6. Swing\: the foot swings forward and comes back into contact with the
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Gait cycle

Hemiplegic gait

A hemiplegic gait is typically caused by a lesion in the central nervous system (e.g. stroke) which results in unilateral
weakness and spasticity.
Patients with hemiplegia exhibit spastic
Due to the extension of the lower limb (
have to circumduct their leg to prevent their foot from dragging on the ground.
Associated clinical features
Clinical features which may be associated with a hemiplegic gait include\:
Increased tone with clasp-knife spasticity
Hyperre
Upgoing plantars (i.e. positive Babinski)
Reduced power
Sensory de
Causes
Unilateral cerebral lesion\:
Stroke
Space-occupying lesion
Trauma
Multiple sclerosis
Hemisection of the spinal cord\:
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Trauma

Diplegic gait

A diplegic gait (a.k.a scissoring gait) may be caused by a lesion in the central nervous system (e.g. stroke, or complete
transection of the spinal cord).
Clinical
limbs compared to the upper limbs.
The hips and knees are
The knees are forced together due to spasticity in the adductor muscles resulting in leg overlap when walking (a.k.a.
scissoring).
In an attempt to overcome this adduction, the patient circumducts both legs during the swing phase.
The upper limb may have
guard' or 'mid-guard' position). They also typically lack the swinging movements present in a normal gait.
Associated clinical features
Clinical features which may be associated with a diplegic gait include\:
Increased tone with clasp-knife spasticity
Hyperre
Upgoing plantars (i.e. positive Babinski)
Reduced power
Sensory de
with normal sensation) correlates with the level of spinal cord pathology
Wasting and fasciculations (consider motor neuron disease)
Causes
Spinal cord lesion (sensation usually a
Prolapsed intervertebral disc
Spinal spondylosis
Spinal tumour
Transverse myelitis
Spinal infarct
Syringomyelia
Hereditary spastic paraparesis
Bilateral brain lesion\:
Cerebral palsy
Multiple sclerosis
Bilateral brain infarcts
Midline tumour (e.g. paraspinal meningioma)
Motor neuron disease\: associated with lower motor neuron
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Parkinsonian gait

A Parkinsonian gait (a.k.a. festinant gait) is caused by rigidity and bradykinesia as a result of the loss of dopaminergic neurons
in the basal ganglia.
Features of a Parkinsonian gait include\:
Initiation\: typically slow to start walking due to failure of gait ignition and hesitancy.
Step length\: reduced stride length with short steps is common (shu
the patient attempts to retain balance (known as festinant gait).
Arm swing\: reduced arm swing on or both sides (often an early feature of Parkinson's disease).
Posture\:
Tremor\: resting tremor can be observed when the patient is distracted by walking.
Turning\: impaired balance on turning or hesitancy is common due to postural instability.
Associated clinical features
Clinical features which may be associated with a Parkinsonian gait include\:
Tremor
Rigidity
Bradykinesia
Hypomimia
Causes
Features of the Parkinsonian gait are observed in both idiopathic Parkinson’s disease and other Parkinsonian disorders.
Idiopathic Parkinson’s disease usually has most features of the gait described above and the classic triad of tremor,
rigidity and bradykinesia.
Other Parkinsonian disorders may only have a few of the gait features, may not have all features of the triad, and may be
associated with other
Examples of disorders with Parkinsonian features include\:
Vascular Parkinson’s disease
Dementia with Lewy bodies
Parkinson’s plus syndromes (e.g. multisystem atrophy and progressive supranuclear palsy)
Drug-induced Parkinsonism (e.g. antipsychotics, antiemetics)
Dementia pugilistica

Ataxic gait

An ataxic gait is typically broad-based and associated with midline cerebellar disease (e.g. alcoholic cerebellar
degeneration), vestibular disease (e.g. labyrinthitis) or loss of proprioception (known as sensory ataxia).
Features of an ataxic gait include\:
Stance\: a broad-based ataxic gait is typically associated with midline cerebellar pathology (e.g. a lesion in multiple sclerosis
or degeneration of the cerebellar vermis secondary to chronic alcohol excess).
Stability\: a staggering, slow and unsteady gait is typical of cerebellar pathology. In unilateral cerebellar disease, patients will
veer towards the side of the lesion.
Turning\: patients with cerebellar disease will
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Associated clinical features
The presence of an ataxic gait may be the result of cerebellar, vestibular or sensory impairment.
Clinical features associated with cerebellar ataxia\:
Nystagmus
Ataxic dysarthria
Dysmetria
Intention tremor
Dysdiadokokinesia
Clinical features associated with sensory ataxia\:
Positive Romberg’s sign
Impaired proprioception
Impaired vibration sensation
Absence of other cerebellar signs (e.g. dysmetria, nystagmus, dysarthria)
Clinical features associated with vestibular ataxia\:
Vertigo
Nausea
Vomiting
Causes
Cerebellar ataxia\:
Cerebellar stroke (ischaemic or haemorrhagic)
Space-occupying lesion
Multiple sclerosis
Alcoholism
B12 de
Drugs (e.g. phenytoin, carbamazepine, barbiturates, lithium)
Genetic disease (e.g. Frederich’s ataxia, spinocerebellar ataxia)
Paraneoplastic disease
Sensory ataxia\:
Peripheral neuropathy (e.g. diabetes mellitus)
Vestibular ataxia\:
Labyrinthitis
Meniere's disease
Acoustic neuroma

Neuropathic gait

Neuropathic gait (a.k.a. high-steppage gait) is caused by weakness of the muscles in the distal limb (typically the dorsi
of the foot) as a result of damage to the peripheral nerves providing motor innervation.
Weakness of the dorsi
To prevent the toes from dragging on the
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Associated clinical features
Clinical features which may be associated with a neuropathic gait include\:
Peripheral vascular disease
Peripheral sensory impairment
Distal muscle weakness
Reduced or absent re
Causes
Foot drop is caused by weakness of the muscles of ankle dorsi
peroneal nerve (L4, L5 and S1 nerve root).
Foot drop may therefore be caused by\:
Isolated common peroneal nerve palsy (e.g. secondary to trauma or compression)
L5 radiculopathy (e.g. disc prolapse)
Generalized polyneuropathy involving multiple nerves (e.g. diabetic neuropathy, motor neurone disease, Charcot-Marie
Tooth disease)

Myopathic gait

A myopathic gait (a.k.a. waddling gait or Trendelenburg gait) occurs due to weakness of the hip abductors resulting in a
waddling appearance.
Hip abductor weakness results in an inability to stabilize the pelvis during the stance phase. As a result, the pelvis tilts
downwards towards the unsupported side during the swing phase of the gait cycle.
The body compensates to prevent the swinging foot from dragging by\:
Laterally
characteristic ‘waddling’ appearance)
Circumducting the leg
Associated clinical features
Clinical features which may be associated with a myopathic gait include\:
Di
Di
Positive Trendelenburg's sign; when the patient stands on one leg, the pelvis drops towards the contralateral side
Causes
Systemic disease\:
Hyperthyroidism
Hypothyroidism
Cushing’s syndrome
Acromegaly
Polymyalgia rheumatica
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Polymyositis
Dermatomyositis
Muscular dystrophies\:
Duchenne’s muscular dystrophy
Becker’s muscular dystrophy
Myotonic dystrophy

Choreiform gait

A choreiform gait (a.k.a. hyperkinetic gait) presents with involuntary movements such as\:
Oro-facial dyskinesia (grimacing or lip-smacking)
Choreic movements of the upper and lower limbs (writhing, dance like semi-purposeful movements)
The involuntary movements are usually present at rest, however, walking can accentuate the movements.
Causes
Basal ganglia disease\:
Huntington’s disease
Sydenham’s chorea
Cerebral palsy (choreiform type)
Wilson’s disease
Dopaminergic medications (e.g. Parkinson’s medications)

Antalgic gait

An antalgic gait is an abnormal gait pattern which develops as a result of pain. Typically the stance phase is reduced on the
a
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