Abnormal gait
Gait is another word for the walking pattern. An abnormal gait is when a person’s walk is different from what would be classed as ‘normal’. A person with an abnormal gait will have a distinctive change in their pattern of walking.
Normal gait
Normal gait is a ‘normal’ walking pattern. Heel strike to heel strike or one stride length is known as a gait cycle.
The gait cycle consists of a stance phase and a swing phase.
Stance phase
There are three stages in the stance phase.
- Initial contact
- Loading response
- Mid Stance
- Terminal stance
- Pre- swing
Swing phase
This stage occurs after heel off. For a successful swing phase to occur three stages must take place.
- Pre swing
- Mid swing
- Terminal swing
Common reasons for an abnormal gait
Several common reasons cause a person to have an abnormal gait these includes,
Fracture
Neurological
Pain
Muscle weakness
Stiffness
Joint problems
Age-related changes
Leg length discrepancy
Common Types of abnormal gait patterns
Different pathological gaits can be categorized based on the symptoms or appearance of an individual’s walk.
️Neuropathic gait (steppage gait)
Seen in patients with foot drop (weakness of foot dorsiflexion), the cause of this gait is due to an attempt to lift the leg high enough during walking so that the foot does not drag on the floor.
If unilateral, causes include peroneal nerve palsy and L5 radiculopathy. If bilateral, causes include amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease and other peripheral neuropathies including those associated with uncontrolled diabetes.
️Myopathic gait
Hip girdle muscles are responsible for keeping the pelvis level when walking. If you have weakness on one side, this will lead to a drop in the pelvis on the contralateral side of the pelvis while walking (Trendelenburg sign).
With bilateral weakness, you will have to droop the pelvis on both sides during walking leading to waddling. This gait is seen in a patient with myopathies, such as muscular dystrophy.
️Hemiplegic gait
The patient stands with unilateral weakness on the affected side, arm flexed, adducted, and internally rotated. The leg on the same side is in extension with plantar flexion of the foot and toes. When walking, the patient will hold his or her arm to one side and drags his or her affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop) and extensor hypertonia in the lower limb. This is most commonly seen in stroke.
️Diplegic gait
Patients have involvement on both sides with spasticity in lower extremities worse than upper extremities. The patient walks with an abnormally narrow base, dragging both legs and scraping the toes.
This gait is seen in bilateral periventricular lesions, such as those seen in cerebral palsy. There is also characteristic extreme tightness of hip adductors which can cause legs to cross the midline referred to as a scissors gait.
️Ataxic gait (cerebellar)
Most commonly seen in cerebellar disease, this gait is described as clumsy, staggering movements with a wide-based gait. While standing still, the patient's body may swagger back and forth and from side to side, known as titubation. Patients will not be able to walk from heel to toe or in a straight line.
️Parkinsonism gait
In this gait, the patient will have rigidity and bradykinesia. He or she will be stooped with the head and neck forward, with flexion at the knees. The whole upper extremity is also in flexion with the fingers usually extended.
The patient walks with slow little steps. The patient may also have difficulty initiating steps. The patient may show an involuntary inclination to take accelerating steps. This gait is seen in Parkinson's disease or any other condition causing parkinsonism, such as side effects from drugs.
️Choreiform gait (hyperkinetic gait)
This gait is seen with certain basal ganglia disorders including Sydenham's chorea, Huntington's Disease, and other forms of chorea, athetosis, or dystonia. The patient will display irregular, jerky, involuntary movements in all extremities. Walking may accentuate their baseline movement disorder.
️Sensory Ataxic gait
As our feet touch the ground, we receive proprioceptive information to tell us their location. The sensory ataxic gait occurs when there is a loss of this proprioceptive input. To know when the feet land and their location, the patient will slam the foot hard onto the ground to sense it. A key to this gait involves its exacerbation when patients cannot see their feet (i.e. in the dark). This gait is also sometimes referred to as a stomping gait since patients may lift their legs very high to hit the ground hard.
This gait can be seen in disorders of the dorsal columns (B12 deficiency or tabes dorsalis) or diseases affecting the peripheral nerves (uncontrolled diabetes). In its severe form, this gait can cause ataxia that resembles the cerebellar ataxic gait.
Sehani Ravindi
References
https://www.physio.co.uk/what-we-treat/neurological/symptoms/walking-problems/abnormal-gait.php
https://stanfordmedicine25.stanford.edu/the25/gait.html
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