Gait Abnormalities
Common Gait Abnormalities
Hemiplegic dragging of the foot
- Patient cannot lift the leg high enough to clear the floor because of lower extremity weakness.
- Patient produces circumducting gait, instead:
- The abductors of the hip are substituted to tilt the pelvis of the affected side upwards.
High-stepping gait
- Foot is raised high above the ground because of weakness of the anterior tibialis and foot extensors.
- The toe hits the ground first.
- The patient flexes the hip and knee to raise the foot.
- If position sense is severely affected from destruction of the large proprioceptive neurons of the dorsal root ganglia (DRG), the patient is unaware of the position of the feet and the foot and leg may flail side to side, the base is wide, the heel strikes the ground first: sensory ataxia.
- In painless foot drop, worry about ALS
Shuffling gait
Gait ignition failure*: patient has a hard time taking the first step.
- The patient is forward flexed; the carrying angles of the arm are increased in flexion.
- The patient shuffles the feet and slides them in a flat-footed manner.
- Bradykinesia and rigidity are evident with concomitant flexion of the hips and knees.
- As the patient moves, the steps become more rapid (festination) as if the patient is trying to maneuver the body over the center of gravity.
- Lack of associated arm movement is evident and often asymmetrical.
- The patient has difficulty stopping and maintaining position if gently pushed forward (propulsion).
- Patients are unable to easily pass through a doorway and stops with a series of small steps (inability to change motor programs).
- This problem may sometimes be avoided by visual fixation on an object or crack in the floor beyond the doorway.
Note that in multi-infarct states (status lacunaire), the patient has a shuffling small-stepped gait that is irregular and hesitant (“marche a petite pas”).
Magnetic gait
- A small-stepped shuffling gait is seen in normal pressure hydrocephalus (NPH).
- The patient may have gait ignition failure (foot grasp of the floor) OR gait apraxia:
- In gait apraxia, patients will raise and lower the feet in the same place (“egg walking”).
- The patient frequently falls backwards.
Ataxic gait
- A lateral cerebellar hemisphere lesion causes the patient to be unsteady and fall to the ipsilateral side.
- The base is wide, the leg moves irregularly when flexed and extended and the patient sways and rocks to that side.
- If there is bilateral hemispheric cerebellar disease, the patient has a broad-base, rocks
- Ataxia of the trunk is caused by midline vermian lesions.
- When sitting, the patient has lost extensor tone of the paraspinal muscles and titubates
- If the arms are outstretched, the drift is upwards.
- The patient is completely unstable when standing, reels in all directions including backwards and needs support to walk.
- Anterior cerebellar gait: the patient has a stiff-legged extensor posture and tends to lean backwards (“martinette gait”).
Waddling gait
- Muscle disease or any illness that weakens the iliopsoas muscles.
- The patient utilizes the gluteus medius and minimus muscles to lift and rotate the pelvis to compensate for inability to flex the iliopsoas muscle.
- The patient may also utilize upper trunk muscles in this compensation.
Astasia-abasia ("hysterical gait")
- Bizarre, fail to conform to any known pattern of weakness or pathology.
Choreiform gait
- Huntington’s chorea is characterized by a lurching gait that is wide based, reeling from heel to heel with variable steps and associated with vigorous grimace and movements of the hands and wrist.
Adapted from: Robert J. Schwartzman, MD Neurologic Examination (2006) Massachusetts, USA: Blackwell Publishing, with Permission from Dr. Schwartzman