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Essentially, there are certain things that compose a normal gait:
- arm swing
- body position (should be upright, not stooped forward)
- stride length
- heel-on, toe-off (your heel touches the floor first. Then your toe pushes you off)
- stability turning
If these things are not all present. the patient (or you) has an abnormal gait. You need to buy them a new one.
Epidemiologymusculoskeletal but in more serious cases, it is due to a neurological cause.
Clinical and Associated Features
There are essentially, lots of different types of abnormal gait and each points to a different pathological condition. The following are descriptions for different types of gait
- Cerebellar - think drunk people. Wide base/reeling on a narrow base; patient falls to side of lesion; feet raised excessively and placed down carefully. The cerebellum deals with fine control.
- High-stepping - this is foot-drop. Remember the "heel-on, toe-off" from above? It's the opposite. Your foot doesn't dorsiflex before touching the ground. In order to not trip over, you need to lift it really high. It dangles (hence "foot-drop") and lands toes-first.
- Parkinsonian - this type of gait has a lot of specific features but the mains ones are: TRAPS-
- Resting tremor
- Stooping posture.
- Shuffling gait
- Sensory Ataxic - broad base, bangs feet down clumsily (may have foot-drop), looks at feet throughout gait cycle. Positive Romberg's sign.
- Scissor - typical of cerebral palsy. Walking on tip-toes (plantar flexed feet), flexed kneed, adducted and internally rotated hip, ridigity, excessive adduction in leg swing and contractures in all spastic muscles.
- Waddling - broad-base; duck-like waddle; pelvis tilts away from lifted leg; forward curvature of lumbar spine; and marked body swing.
- Antalgic - patient leans on affected side taking rapid, heavy step. The step on the unaffected side is slower. Usually caused by hip OA.
Basically, it's either musculoskeletal or neurological.
- Cerebellar - any lesion of the cerebellum. There are a whole heap of causes but these are the most important.: CVA, alcohol, tumour, MS.
- High-stepping - local: common peroneal nerve palsy, sciatic nerve palsy, distal myopathy; spine: L4,5 root lesion; generalised: peripheral neuropathy (alcohol, diabetes), motor neurone disease.
- Parkinsonian - mainly idiopathic parkinson's disease. There are other causes but they are rare.
- Sensory ataxia - generalised: peripheral neuropathy; spinal cord: cervical spondylosis, MS, B12/folate deficiency, and bizarrely syphillis (though that's pretty rare, if amusing.
- Scissor - cerebral palsy
- Waddling - CDH, proximal myopathy, being overweight and being pregnant (which is kind of the same).