Gait: Antalgic

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Introduction[edit | edit source]

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Antalgic gait is one of the most common forms of altered gait. It refers to an abnormal pattern of walking secondary to pain that ultimately causes a limp, whereby the stance phase is shortened relative to the swing phase. In a normal, healthy person, gait is a cyclical and symmetric process. However, when an abnormality is present in one of the joints, muscles, or bones of the complex system that regulates gait, this process is disrupted. Finding the source of this disruption is essential to accurate diagnosis and effective treatment.[1]

  • At one point in life most people will likely have had an antalgic gait as the result of a eg. trip, fall, or a stubbed toe. The limp isn’t usually permanent and probably not given much thought.
  • There are more serious conditions, eg injury, neoplasms and arthritis, that can cause pain and result in an antalgic gait. In most cases, these conditions can improve with treatment.[2]

Etiology/Epidemiology[edit | edit source]

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The etiology of an antalgic gait usually relates to a disorder of the lower back or lower extremity. It can be caused by traumatic, infectious, inflammatory, vascular, or neoplastic processes. This adaptive alteration of gait avoids placing undue pressure on painful areas and attempts to minimize the recruitment of muscle and joint groups that may be affected by the above processes.

  • Older Persons: The likelihood of experiencing a gait disorder from any cause increases with age, affecting more than 60% of patients greater than 80 years old. It is a common complaint of patients presenting to the emergency department and to primary care offices.[1]
  • Paediatrics: Some causes of pediatric antalgic gait have an age-wise predilection. The common causes in adolescents and teenagers include slipped capital femoral epiphysis (SCFE) and osteoid osteoma, whereas the causes in younger children include Legg-Calve-Perthes disease (LCP) and transient synovitis. ).[3]

Management[edit | edit source]

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Management of an antalgic gait is aimed at identifying and treating the underlying cause of pain with referral to the appropriate specialist.

  • Inflammatory conditions should be treated with non-steroidal anti-inflammatories and appropriate primary care or rheumatology follow-up. Physical therapy can also be helpful in the management of long-term conditions such as sciatica, degenerative disc disease, and lumbar radiculopathy. Orthotics may be indicated to help with deformities related to chronic diseases, such as rheumatoid arthritis. Encouraging weight loss may also help decrease stress on the joints of the back and lower extremities.
  • Infectious causes of antalgic gait can be medical emergencies and require prompt diagnosis with emergent orthopedic consultation and/or admission for joint aspiration, intravenous antibiotics, and possible surgery.
  • Neoplastic causes require oncology input and possibly neurosurgical consultation and follow-up[1]
  • Injury (Sprains and fractures may need to be immobilized and splinted with appropriate orthopedic/physiotherapy follow-up. Crutches or a walking boot may be provided for additional support. Ice and elevation of the affected extremity, as well as a course of non-steroidal anti-inflammatory medication, may be recommended.)
    • sports
    • car accident
    • work accident
  • Joint or leg deformity
    • partial dislocation of a joint
    • bone malalignment after healing from a fracture
    • rickets, caused by a vitamin D deficiency
  • Back issues eg sciatica, discitis.[2]

Complications[edit | edit source]

The most serious complication of an antalgic gait is the potential for missed pathology, such as septic arthritis, osteosarcoma (xray image R), or severe vascular disease, which can be life or limb-threatening. It is important to do a thorough evaluation of these conditions and not assume that an antalgic gait is always related to a minor injury.[1]

A high index of suspicion for serious etiologies in children with an antalgic gait, combined with a thorough history and physical examination, will help improve outcomes in children.[3]

Physiotherapy[edit | edit source]

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While the cause of pain is being determined and addressed, physiotherapy may help to normalize gait as much as possible. Physiotherapy techniques may include:

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Auerbach N, Tadi P. Antalgic Gait in Adults. [Updated 2021 Jul 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan Available:https://www.ncbi.nlm.nih.gov/books/NBK559243/ (accessed 20.7.2021)
  2. 2.0 2.1 Healthline Antalgic gait Available: https://www.healthline.com/health/antalgic-gait#takeaway (accessed 20.7.2021)
  3. 3.0 3.1 Vezzetti R, Bordoni B. Antalgic Gait In Children. [Updated 2021 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan- Available: https://www.ncbi.nlm.nih.gov/books/NBK535385/ (accessed 20.7.2021)