Abnormal gait

This man's gait is incredibly abnormal.

For gait examination, visit the GALS page.

Definition

Essentially, there are certain things that compose a normal gait:

• symmetry
• 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.

Epidemiology

Gait problems are common. Usually, the cause is musculoskeletal but in more serious cases, it is due to a neurological cause.

Clinical and Associated Features

Like the Maginot Line, this is an abnormal gate. This type of gate/gait is not considered here as carpentry is not a specialty in medicine. PUNTASTIC!

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
  • Rigidity,
  • Akinesia
  • 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.

Differential Diagnosis

Basically, it's either musculoskeletal or neurological.

Musculoskeletal

Any abnormality in the back, hip, knee, ankle, foot or lower limb, in general including fractures. It can also cause the antalgic gait mentioned above.

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).

Investigations

• Musculoskeletal - will need X-rays and potentially MRI is serious enough.
• Neurological -