Gait Disorders: Identifying and Managing Gait Patterns

Normal Gait involves a coordinated and balanced movement of the limbs. Gait, in physiotherapy, refers to the complex pattern of human locomotion or walking. It encompasses the coordinated movement of various body parts, including the legs, pelvis, trunk, and upper extremities. Assessment of a patient's gait is done to identify abnormalities, deviations, or dysfunctions in their walking pattern, which may result from musculoskeletal, neurological, or other health-related conditions.

By understanding and addressing these gait abnormalities, physiotherapists aim to improve mobility, reduce pain, enhance functional capacity, and promote the overall well-being of their patients.

 

Assessment of Gait

Patient History: Begin by taking a detailed patient history. Inquire about the patient's medical history, any recent injuries or surgeries, current medications, and their chief complaints regarding gait issues.

Observation: As the patient walks, keen observation is essential. Take note of their posture, balance, stride length, and any deviations from a normal gait pattern. Pay attention to the following aspects:

• Posture
• Balance
• Step Length
• Foot Clearance - insufficient clearance may indicate a risk of tripping or falling.
• Arm Swing
• Range of Motion
• Strength and Muscle Testing - quadriceps, hamstrings, calf muscles, and hip abductors.
• Palpation - the source of pain or discomfort, such as the lower back, hips, knees, and ankles. Identify any areas of tenderness or muscle tightness.
• Footwear Assessment

 

Functional Tests

• Timed Up and Go (TUG) Test:

The TUG test measures the time it takes for a person to stand up from a chair, walk three meters, turn around, return to the chair, and sit down. It assesses mobility, balance, and gait speed.

• 6-Minute Walk Test:

This test measures how far a person can walk in six minutes. It provides information about walking endurance and overall functional capacity.

• Four-Square Step Test (FSST):

The FSST assesses dynamic balance and stepping ability. It involves stepping forward, backward, and sideways over four canes arranged in a square shape.

• Dynamic Gait Index (DGI):

DGI is a series of eight tasks that assess a person's ability to perform various dynamic activities while walking, including stepping over obstacles and changing directions.

• Functional Reach Test:

This test evaluates a person's ability to reach forward while maintaining their balance, which is important for functional mobility.

• Single-Leg Stance Test:

This assesses a person's ability to balance on one leg and is relevant for identifying balance deficits that can affect gait.

• Stair Climbing Test:

Assessing a person's ability to ascend and descend stairs can reveal specific gait abnormalities and balance issues related to stair navigation.

• Figure-of-Eight Walk Test:

This test involves walking around a figure-eight pattern on the floor, which assesses a person's ability to change direction and navigate curves while walking.

• Berg Balance Scale:

While not exclusively a gait test, the Berg Balance Scale evaluates balance and stability during various tasks, which are closely related to gait function.

• Functional Gait Assessment (FGA):

The FGA is a comprehensive test that includes tasks such as walking with head turns, stepping over obstacles, and walking with eyes closed to assess gait stability and dynamic balance.

     I.           These functional tests are valuable for physiotherapists to assess gait and mobility in individuals, especially those with balance impairments, neurological conditions, or musculoskeletal issues. The choice of test may depend on the specific clinical context and the goals of the assessment.

 

Antalgic Gait

Antalgic gait is a walking pattern that is adopted by individuals as a protective response to pain or discomfort during weight-bearing activities.

It is characterized by:

• shortened stance phase
• noticeable limp or an altered gait pattern
• reduction in stride length
• quick shift of weight from the affected limb to the unaffected limb
• an altered foot placement to minimize pressure on the painful area

 

Common Causes:

Musculoskeletal Injuries

• Fractures
• Sprains and Strains - ankle sprains or hamstring strains
• Tendonitis - like Achilles tendonitis
• Muscle Tears - quadriceps or calf muscles

Joint Conditions

• Osteoarthritis
• Rheumatoid Arthritis

Neurological Conditions

• Sciatica
• Herniated Disc
• Peripheral neuropathies

Infections

• Osteomyelitis
• Septic Arthritis

Gait Abnormalities

• Leg Length Discrepancy
• Foot Deformities - bunions, claw toes

Post-Surgery or Post-Trauma

• Joint replacement or ligament repair
• Trauma - accidents or falls

Inflammatory Conditions

• Bursitis
• Tendinopathy

Nerve Compression

• Pinched Nerve - lumbar radiculopathy

Other Medical Conditions

• Vascular Issues - like peripheral artery disease
• Metabolic Disorders -  gout, which can cause joint pain
• Autoimmune Diseases

Identifying the specific cause of antalgic gait is crucial for developing an effective treatment plan. 

 

Trendelenburg Gait

Trendelenburg gait, also known as a Trendelenburg sign or Trendelenburg limp, is an abnormal gait pattern characterized by an abnormal side-to-side movement of the pelvis during walking. This condition is typically caused by weakness or dysfunction in the muscles that stabilize the pelvis, particularly the hip abductor muscles.

 Causes of Trendelenburg gait include

• Hip Abductor Weakness - such as the gluteus medius and gluteus minimus
• Hip Fractures - involving the neck of the femur
• Hip Dysplasia - affect the alignment and stability of the hip joint
• Hip Osteoarthritis - can result in pain and decreased function of the hip joint, leading to compensatory gait abnormalities
• Nerve Injuries - nerves that innervate the hip abductor muscles can cause weakness or paralysis, injuries include damage to the superior gluteal nerve
• Polio - Post-polio syndrome can cause progressive muscle weakness, including the hip abductors
• Muscular Dystrophy of hip abductors
• Hip Joint Infections - cause pain, inflammation, and muscle weakness
• Congenital Hip Dislocation

 

Spastic Gait

Spastic gait refers to a type of abnormal walking pattern characterized by increased muscle tone and stiffness in the muscles, which results from a condition known as spasticity. Spasticity is a neurological condition where there is an involuntary and sustained contraction of muscles. This increased muscle tone makes it difficult for the affected individual to control their leg movements, leading to a distinct gait pattern as following:

• Stiffness - results in reduced joint flexibility and resistance to movement
• Scissoring -crossing of the legs as the individual walks
• Toe-Walking - tend to walk on their toes, with limited or no heel-to-toe contact with the ground
• Reduced Range of Motion - restrict the range of motion at the hip, knee, and ankle joints
• Lack of Coordination - have difficulty controlling the timing and sequence of their steps
• Hip Hiking or Circumduction
• Uneven Step Length
• Difficulty with Weight Shifting

Causes of Spastic Gait

• Cerebral Palsy
• Stroke
• Multiple Sclerosis
• Spinal Cord Injury
• Hereditary Spastic Paraplegia
• Brain or Spinal Tumors
• Brain Infections - like encephalitis or meningitis
• Traumatic Brain Injury (TBI)
• Neurodegenerative Disorders - amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS)
• Vitamin Deficiencies
• Metabolic Disorders - Wilson's disease or adrenoleukodystrophy
• Inflammatory Conditions - such as transverse myelitis, which causes inflammation of the spinal cord

 

Ataxic Gait

Ataxic gait is a type of abnormal walking pattern characterized by uncoordinated and unstable movements. It is often associated with damage or dysfunction in the cerebellum, which is responsible for coordinating and controlling movements. 

Causes of Ataxic Gait

• Cerebellar Disorders - such as cerebellar degeneration, cerebellar atrophy, or cerebellar stroke
• Multiple Sclerosis - can affect the central nervous system, leading to ataxia and an ataxic gait
• Brain Tumors - especially in the posterior fossa where the cerebellum is located
• Alcohol or Drug Intoxication - substances that affect the cerebellum, can lead to temporary ataxia
• Head Trauma - Traumatic brain injuries (TBIs)
• Hereditary Ataxias - such as Friedreich's ataxia and spinocerebellar ataxia
• Toxic or Metabolic Causes - including vitamin B12 deficiency can lead to ataxic gait
• Infections - such as encephalitis or cerebellitis, can result in ataxia
• Autoimmune Diseases - like gluten ataxia, associated with celiac disease
• Certain Medications - like certain anti-seizure drugs

 

Steppage Gait

Steppage gait, also known as equinus gait, is an abnormal walking pattern characterized by excessive lifting of the foot and toes, often causing the toes to drag on the ground or the foot to slap down during the swing phase of walking. 

Causes of Steppage Gait

• Peripheral Neuropathy - such as diabetic neuropathy, can result in muscle weakness and difficulty lifting the foot while walking
• Peroneal Nerve Palsy - it is responsible for dorsiflexion (lifting the foot)
• Charcot-Marie-Tooth Disease - hereditary neurological disorder affects the peripheral nerves, leading to muscle weakness and muscle wasting
• Spinal Cord Lesions or Injuries - especially in the lumbar or lumbosacral region, can affect the nerves controlling foot dorsiflexion
• Muscular Dystrophy
• Motor Neuron Diseases - amyotrophic lateral sclerosis (ALS) can result in muscle weakness and gait abnormalities
• Foot Drop
• Inflammatory Neuropathies - like Guillain-Barré syndrome can affect peripheral nerves and lead to muscle weakness, including dorsiflexor muscles
• Injuries – to the peroneal nerve or the muscles involved in dorsiflexion due to accidents, falls, or other injuries
• Stroke - that affects the brain's motor areas or the corticospinal tracts
• Tumors or Masses - either within the spinal cord, peripheral nerves, or in the vicinity of these structures

 

Waddling Gait

Waddling gait is characterized by a walking pattern where the person's hips sway from side to side with each step, is often associated with certain underlying conditions that affect the muscles, joints, or structure of the pelvis and lower extremities. 

Causes of a Waddling Gait

• Muscular Dystrophy
• Congenital Hip Dysplasia
• Pelvic Girdle Muscle Weakness
• Osteoarthritis
• Hip Dysplasia in Adulthood
• Myopathies - such as myotonic dystrophy, can lead to muscle weakness and an abnormal gait
• Pelvic Fractures or Trauma
• Ligamentous Instability
• Neurological Conditions
• Pregnancy - pregnant women may develop a temporary waddling gait due to changes in posture and the body's center of gravity
• Obesity - can affect the mechanics of walking, leading to a waddling gait in some cases

 

Festinating Gait

A festinating gait is a type of abnormal walking pattern characterized by a shuffling, forward-leaning, and progressively accelerating gait. It is often associated with specific medical conditions, particularly neurological and movement disorders. 

Causes of Festinating Gait

• Parkinson's Disease - it can lead to shuffling steps and difficulty initiating and stopping walking
• Parkinsonism - conditions that mimic the symptoms of Parkinson's disease, such as multiple system atrophy (MSA) or progressive supranuclear palsy (PSP), can also result in festinating gait
• Medication Side Effects - used to treat neurological and psychiatric conditions can cause movement abnormalities
• Normal Pressure Hydrocephalus (NPH) - characterized by an abnormal buildup of cerebrospinal fluid in the brain's ventricles, it can lead to gait disturbances
• Cerebral Small Vessel Disease - involves damage to the small blood vessels in the brain and can result in gait disturbances
• Stroke
• Huntington's Disease
• Tremor or dystonia
• Musculoskeletal Problems - issues like arthritis, muscle weakness, or joint problems
• Psychogenic Gait Disorders
• Frontotemporal Dementia - can cause motor symptoms, including festinating gait
• Autoimmune Encephalitis – occurs rarely and can affect the brain and result in gait abnormalities, including festination

Tandem Gait

A tandem gait is a specific walking pattern that involves walking in a straight line with one foot placed directly in front of the other, as if walking on a tightrope. It is often used as a clinical test to assess balance and coordination. The ability to perform a tandem gait can be affected by various factors, and its impairment can be indicative of an underlying issue. 

Causes of Tandem Gait

• Neurological Disorders - include multiple sclerosis, cerebellar ataxia, Parkinson's disease, and other movement disorders
• Peripheral Neuropathy - such as diabetic neuropathy or alcohol-related neuropathy, can result in an impaired tandem gait
• Vestibular Disorders
• Musculoskeletal Issues
• Medication Side Effects - those affecting the central nervous system, may cause dizziness, drowsiness, or impair balance and coordination
• Alcohol or Drug Intoxication - impair motor skills and coordination, including the ability to walk in a straight line with a tandem gait
• Infections - affecting the inner ear or the central nervous system can disrupt balance and coordination
• Stroke
• Head Injuries - traumatic brain injuries or head injuries that affect the brain and its control over
• Aging - age-related changes can affect balance and coordination
• Psychological Factors - such as anxiety or fear, can affect balance and coordination, potentially making it difficult to perform a tandem gait

Physiotherapy Treatment