GAIT

ABNORMALITIES
AASHISH NEPAL
MPT1ST YEAR
NARAYANA HRUDAYALAYA INSTITUTE OF PHYSIOTHERAPY
CAUSES OF ABNORMAL GAIT

• Focal weakness
Example: dorsiflexion weakness
• Joint contractures and skeletal deformities
Example: tight heel cord
• Pain
Example: hip osteoarthritis
• Neurological conditions

Examples: stroke, Parkinson disease, CP

TRENDELENBURG GAIT

• The drop of the contralateral iliac crest (i.e., hip adduction) during early to mid stance is
normally controlled by an eccentric activation of the hip abductor muscles of the stance
limb. Inadequate abduction torque from these muscles often leads to excessive frontal
plane motion during stance.
• Cause: weak hip abductors, loss of pelvis stabilization
• Uncompensated: contralateral pelvis drops during stance
• Compensated: lateral trunk lean over stance leg to keep COG over stance leg
 ANTALGIC GAIT

• Self protective gait as a result of injury to the pelvis, hip, knee, ankle or foot. To avoid pain weight is put on the affected
leg for as short a time as possible, resulting in a limp.
• Stance phase of the affected leg is shorter than that on the non-affected leg,
• The swing phase of the uninvolved leg is decreased.
• The result is a shorter step length on the uninvolved side, decreased walking velocity, and decreased cadence.
• Patient lifts and lowers foot in a fixed ankle position to reduce load on the affected leg
• In case of a painful hip, the patient also shifts the body weight over the painful hip such that the shift decreases the pull
of the abductor muscles.
• This decreases the pressure on the femoral head from more than two times the body weight to approximately body
weight, owing to vertical instead of angular placement of the load over the hip.
GLUTEUS MAXIMUS GAIT

• Muscle involved: G Max (primary hip extensor)

• The patient thrusts the thorax at heel strike to maintain extension of the stance leg.
• Resulting in a characteristic backward lurch of the trunk.
GENU RECURVATUM

• Excessive knee extension in stance

Causes:
– Weak, short, or spastic quadriceps
– Compensated hamstring weakness
– Plantar-flexor spasticity
– Achilles tendon contracture
Treatment:
• Manage plantar-flexor tone, bracing, stretching,
• Quadriceps strengthening
STEPPAGE GAIT

• Steppage gait refers to a manner of walking in which the patient takes unusually high steps.
• The patient takes a high step, throws out the foot, and slams it down on the floor in order to
increase the proprioceptive feedback. The heel may land before the toe, creating an audible
“double tap.”
• The patient watches the feet and keeps the eyes on the floor while walking. With eyes
closed, the feet seem to shoot out, the staggering and unsteadiness are increased, and the
patient may be unable to walk.
• Sensory ataxia is one of the causes of a steppage gait.
DORSIFLEXOR WEAKNESS

• Foot slap seen in mildly to moderately weak muscles creating an effectively longer limb
• Compensation:
 Steppage gait – accentuated hip and knee flexion to clear limb
 Circumduction – swing leg advances in semi-circular pattern
 Hip hiking – pelvis elevates during swing

• Other causes of long limb: plantar-flexor spasticity, equinus deformity, stiff knee, weak
hamstrings
CIRCUMDUCTORY GAIT

• Caused by a lesion interrupting the corticospinal pathways to one half of the body, most commonly stroke.
• Plantar flexion of the foot and toes, either due to foot dorsiflexion weakness or to heel cord shortening,
rendering the lower extremity on the involved side functionally slightly longer than on the normal side.
• When walking, the patient holds the arm tightly to the side, rigid and flexed; extends it with difficulty and
does not swing it in a normal fashion.
• Patient holds the leg stiffly in extension and flexes it with difficulty. Consequently, the patient drags or
shuffles the foot and scrapes the toes. They also may tilt the pelvis upward on the involved side to aid in
lifting the toe off the floor (hip hike) and may swing the entire extremity around in a semicircle from the
hip (circumduction).
SCISSORING GAIT

• Occurs in patients with severe spasticity of the leg: congenital spastic diplegia (Little's
disease, cerebral palsy) and related conditions, multiple sclerosis and cervical spondylosis.
• Characteristic tightness of the hip adductors causing adduction of the thighs, so that the
knees cross, one in front of the other, with each step.
• The patient walks on tiptoes with heel cord shortening and on an abnormally narrow base,
with a stiff shuffling gait, dragging both legs and scraping the toes.
• There may be a marked compensatory sway of the trunk away from the side of the
advancing leg.
 PARKINSONIAN/ FESTINATING GAIT
• Patient is stooped, with head and neck forward and knees flexed; the upper extremities
are flexed at the shoulders, elbows, and wrists, but the fingers are usually extended.
• Gait is usually slow, stiff and shuffling with forward stooping as if the patient is running
to catch up with the COG (festinating).
• The patient eventually shuffles at the same place without proceeding further(freezing).
HYPERKINETIC GAIT

• Seen in certain basal ganglia disorders like Sydenham’s chorea, Huntington’s disease and
other forms of transient or persistent chorea, athetosis or dystonia.
• Patient demonstrates jerky, irregular, involuntary movements in the extremities.
• Walking may accentuate the abnormalities of power and tone appearing grotesque with
dancing or prancing and abundant extraneous movements
MYOPATHIC (WADDLING) GAIT

• Muscles involved: hip girdle muscles, most often due to myopathy, most characteristically due
to muscular dystrophy.
• If the hip flexors are weak there may be a pronounced lordosis. The hip abductor muscles are
vital in stabilizing the pelvis while walking. Trendelenburg's sign is an abnormal drop of the
pelvis on the side of the swing leg due to hip abductor weakness.
• When the weakness is bilateral, there is an exaggerated pelvic swing that results in a waddling
gait. The patient walks with a broad base, with an exaggerated rotation of the pelvis, rolling or
throwing the hips from side to side with every step to shift the weight of the body.
HIP HIKING

• Hip hiking on the side of the swing lower extremity compensates for the inability of the knee
and/or ankle of the lower extremity to sufficiently shorten the limb for clearance of the foot.
• It is described as excessive elevation of the iliac crest on the side of the swing limb. Elevation
results from pelvic-on-femoral abduction of the stance limb.
• Muscles involved: primary abductors of the stance limb, the quadratus lumborum of the swing
limb, and possibly the abdominals and back extensors on the side of the swing limb.
• Example: walking with a knee orthosis, keeping the knee in full extension.
 Gait disorder Characteristics
Hemispastic gait Unilateral extension and circumduction
Paraspastic gait Bilateral extension and adduction, stiff
Ataxic gait Broad base, lack of coordination
Sensory ataxic gait Cautious, worsening without visual input
Cautious gait Broad based, cautious, slow, anxious
Freezing gait Blockage, e. g. on turning
Propulsive gait Centre of gravity in front of body, festination
Astasia Primary impairment of stance/balance
Dystonic gait Abnormal posture of foot/leg
Choreatic gait Irregular, dance-like, broad-based
Steppage gait Weakness of foot extensors
Waddling gait Broad-based, swaying, drop of swinging leg
Antalgic gait Shortened stance phase on affected side
Vertiginous gait Insecure, tendency to fall to one side
Psychogenic gait disorder Bizarre, rarely falls

Pirker W. et. al, 2016