Pathologic Gait Patterns

Trendelenburg Sign

Pathologic gait patterns can be broadly divided into either neuromuscular or musculoskeletal etiologies. Gait deviations may result from structural abnormalities of a bone, joint, or soft tissue. Other causes of pathologic gait include neuromuscular and myopathic conditions. 

Common Musculoskeletal causes

• Knee pathology
• Foot and ankle pathology
• Leg length discrepancy

Common neurologic causes

• Cerebrovascular conditions
• Central nervous system conditions
• Cerebellar conditions

Common motor weakness causes

• Hip extensor weakness
• Hip flexor weakness
• Quadriceps weakness
• Ankle dorsiflexor weakness
• Triceps surae weakness

Antalgic Gait

Causes

• Pain in limb

Characteristics

A limping gait, indicative of pain upon weight bearing. The stance phase is significantly shortened relative to the swing phase to minimize closed chain loading and reduce pain.

Ataxic Gait

Abnormal Gait Exam Ataxic Gait Demonstration

Causes

• Injury to the cerebellum
• Sensory deficits in lower limb

Characteristics

An unsteady, uncoordinated walk with a broad standing base. Movements appear exaggerated, leg placement is variable and reproducibility is lost.  

Choreiform (Hyperkinetic) Gait

Abnormal Gait Exam Choreiform Gait Demonstration

Causes

• Sydenham's chorea
• Huntington's disease
• Athetosis
• Dystonia

Characteristics

Irregular, jerky, and involuntary movements occur in all extremities. Walking may accentuate  the baseline movement disorder. 

Diplegic Gait

Abnormal Gait Exam Diplegic Gait Demonstration

Causes

• Cerebral Palsy

Characteristics

Bilateral involvement and spasticity in all extremities. Patient will walk with an abnormally narrow base, dragging both legs and scraping the toes. Adductor tightness may cause legs to scissor.

Drop Foot

Foot drop

Causes

• Weak dorsiflexors
• Paralyzed dorsiflexors
• Damaged common fibular nerve

Characteristics

Gait in which the forefoot cannot be actively raised. The advancing leg is lifted high in order to clear the toes and in some cases the foot may audibly slap the ground due to lack of eccentric dorsiflexion. 

Gluteus Maximus (Lurch) Gait

Gluteus Maximus Lurch Inferior Gluteal Nerve

Causes

• Hip extensor weakness

Characteristics

A backward trunk lurch persists throughout stance phase to maintain center of mass behind the hip axis, locking the hip in extension. The hamstring muscles may compensate in some cases.

Trendelenburg Gait

Abnormal Gait Exam Myopathic Gait Demonstration

Causes

• Hip abductor weakness

Characteristics

• If uncompensated, during stance phase on the affected side there is a drop in the pelvis on the unaffected side greater than the normal 5 degrees (Trendelenburg sign). There is also a lateral protrusion of the affected hip.
• If compensated, there is a lateral trunk lurch over the affected hip during stance phase. This maintains the center of gravity over the hip, reducing the muscle force required to stabilize the trunk and pelvis.

Hemiplegic Gait

Abnormal Gait Exam Hemiplegic Gait Demonstration

Causes

• Cerebrovascular accident

Characteristics

Patient has unilateral weakness on affected side, with leg in extension and foot plantarflexed. During swing phase, affected limb circumducts to clear ground due to foot drop and extensor hypertonia in the lower limb. 

Parkinsonian (Festinating) Gait

Abnormal Gait Exam Parkinsonian Gait Demonstration

Causes

• Parkinson's Disease
• Other disorders of the basal ganglia

Characteristics

Patient presents observable bradykinesia, tremor, and rigidity.  Gait consists of many small, shuffling steps also known as marche a petis pas. There may be difficulty initiating steps and once moving there may be an involuntary inclination to increase cadence, which is known as festination.