Original Editor - Lucinda hampton
Top Contributors - Nupur Smit Shah, Lucinda hampton, Mei Toone, Kim Jackson, Olajumoke Ogunleye, Lilian Ashraf, Cindy John-Chu, Rucha Gadgil and Aminat AboladeEdited April 2022 - by Mei Toone as part of the Arkansas Colleges of Health Education School of Physical Therapy Musculoskeletal 1 Project
Introduction[edit | edit source]
A gait deviation is an abnormality in the gait cycle that can affect the trunk, hip, knee, or ankle joint. Gait deviations can stem from increased age and/or certain pathologies. These pathologies can be musculoskeletal or neurological in nature. The etiology can be determined through lab work, clinical presentation, and diagnostic testing. Furthermore, this entity can be subdivided into episodic and chronic deviations. Gait deviations can have a tremendous impact on patient's quality of life, morbidity, and mortality.
The variety of gait deviations calls for different treatments.
Etiology[edit | edit source]
The causes of gait deviations include neurological conditions (e.g. sensory or motor impairments), orthopedic problems (e.g. osteoarthritis and skeletal deformities) and medical conditions (e.g. heart failure, respiratory insufficiency, peripheral arterial occlusive disease and obesity).
- In older age, gait deviations typically have several causes, which may include impaired proprioceptive function in polyneuropathy, poor vision, frontal gait disorder associated with vascular encephalopathy and osteoarthritis of the hips or knees.
- If a gait disorder has an acute onset, cerebrovascular, spinal and neuromuscular causes should be considered, as should adverse drug effects and psychiatric deviations.
Some common causes are:
- A degenerative disease (such as arthritis)
- An inner ear disorder
- Foot conditions
- A neurologic condition like Parkinsonism.
- Something as simple as ill-fitting shoes
Epidemiology[edit | edit source]
Studies have demonstrated that gait deviations occur as an individual age; these deviations stemming from neurological and non-neurological causes. Studies have shown that while 85% of individuals 60-year-old have a normal gait, by the time they reach the age of 85, only 20% maintains normal gait. Gait deviations are not commonly seen in the younger population unless they stem from a developmental or musculoskeletal etiology.
Physiological Basis of Gait[edit | edit source]
For normal gait many all of the following functions and systems are required to be intact: locomotor function (for initiating and sustaining rhythmic gait), balance, postural reflexes, sensory function and sensorimotor integration, motor control, the musculoskeletal apparatus and cardiopulmonary functions. Afferent nerves from the visual, vestibular and proprioceptive systems provide essential information on the position of the body and its parts. Efferent system comprises descending pathways including the pyramidal tract, peripheral nerves, neuromuscular end plate and muscles.
The gait cycle is divided into a stance and swing phase. The stance phase constitutes approximately 60 % of the gait cycle and is subdivided into initial contact, loading response, mid-stance, terminal stance and pre-swing. The swing phase constitutes 40% and is subdivided into initial swing (toe-off), mid-swing (tibia vertical) and terminal swing, terminated by the heel striking the ground. Both feet are on the ground at the beginning and end of the stance phase, these two double support periods lasts for approximately 10–12 % of the gait cycle.
Pathological Gait Deviations[edit | edit source]
Pathological gait deviations can be caused by decreases in joint pathology, ROM, muscular strength, balance, and proprioception or a combination of them all. They can cause varying compensations at the trunk, hip, knee, or ankle joint, and can be musculoskeletal or neurological in nature.
Musculoskeletal[edit | edit source]
Antalgic gait. Antalgic gait is due to pain in the lower extremities that results in a limp that is associated with a shortened stance phase relative to the swing phase. This gait deviation, asymmetry, can be caused by issues that originate in the trunk, hip, knee, or ankle.
Leg Length Discrepancies. Leg length discrepancies can either be structural of functional. This can cause pelvic drop, decreased hip, knee, and ankle plantarflexion. To compensate, the patient may use vaulting or toe-walking.
Trendelenburg Gait. Trendelenburg gait occurs when the gluteus medius is weak. Gluteus medius weakness can be the result of dysfunctions or diagnoses related to back pain or lumbopelvic pain, chronic hip dysfunctions, or lumbopelvic surgery. The weakness of the involved side causes a contralateral pelvic hip drop during swing phase. This contralateral hip drop might cause the quadratus lumborum, on the stance leg, to bring the pelvis back in neutral.
Posterior Lurch Gait. Posterior lurch gait is when the trunk leans posteriorly with a hyperextended hip, especially during the loading response due to a weak gluteus maximus.Hence it is also known as gluteus maximus gait.
Circumduction of the Hip. Circumduction of the hip during swing phase occurs for several reasons including weak hip flexors, contralateral hip dysfunction, or leg length discrepancy. This is a combination of hip hiking, forward rotation of the pelvis, and abduction of the hip. Hip flexor weakness is caused by L2-L3 nerve compression or possibly upper motor neuron lesion.
Neurological[edit | edit source]
Spastic hemiparetic gait. It is characterized by unilateral leg extension and circumduction, in which the paretic leg performs a lateral motion (circumduction ) during the swing phase. This is also known as circumductory gait.
Spastic diplegic gait (scissors gait). It is characterized by bilateral leg extension and adduction, the legs appear to be stiff. When spasticity in the adductors is marked it results in a scissoring gait where the legs cross in the scissors-like pattern.
Steppage gait. In this gait, the patient must lift the leg higher than usual and the patient is unable to stand or walk on their heel. It is caused by weakness in the ankle dorsiflexors. This gait is also known as a slapping gait.
Waddling gait (myopathic gait). In waddling gait weakness in the gluteus medius muscles leads the hip on the swinging side to drop during gait, in an attempt to counteract, the patient bends the trunk towards the other side, resulting in the gait to appear waddling.
Parkinsonism gait. The gait is slow with a short step length and a narrow base. The feet are lifted less high than normal resulting in shuffling. Patients with parkinsonism can develop a Freezing gait in which there is blockage of movement during turning or when approaching obstacles or narrow passages such as doors. This gait is also known as festinating gait.
Cerebellar ataxic gait. The gait is broad based, insecure and lacks coordination. Leg movements and step length are irregular and variable.
Senosory Ataxic gait. In this gait the patient’s proprioception is disturbed resulting the gait to appear broad-based and insecure. The patient uses visual control to compensate for the disturbed proprioception.
Hyperkinetic gait. this gait is seen in basal ganglia deviations including chorea, dystonia and Wilson's disease.
Examination[edit | edit source]
The gait should be observed from all sides, while the patient walks a distance of at least several meters without obstacles and preferably without shoes. Normal walking appears to be rhythmical, flowing, and effortless, with freely swinging legs and with an upright body posture. Normal walking is accompanied by movements of the head, the trunk and the arms.
The parameters that should be clinically examined include step length, stride length, step width, rhythm, speed, posture, swinging of arms and legs and the duration and type of contact with the floor.
A general neurological examination should follow evaluation of gait.
The examination is advised to be done most of the patient’s clothes removed to detect any orthopedic abnormalities such as asymmetries or postural abnormalities. 
Treatment[edit | edit source]
It depends on the cause. Assistive devices such as canes and walkers may help in some cases in which balance is a problem.
- Physical therapy: may be appropriate in other cases to improve balance, strength and flexibility. You should also receive instruction in fall prevention.
- Maintaining proper foot alignment may require in-shoe splints or leg braces. A shoe lift may help in cases of an unequal leg length.
- Medicines are available to treat arthritis, Parkinson’s disease and multiple sclerosis.
- Surgery or prostheses may be recommended, such as hip and knee replacement for persons with osteoarthritis
See also comprehensive links in Resources below
Differential Diagnosis[edit | edit source]
There are numerous etiologies that could lead to gait deviations. The following potential causes should be ruled out and to come up with a final diagnosis.
Neurologic: Parkinson, dementia, delirium, stroke, cerebellar dysfunction, multiple sclerosis, amyotrophic lateral sclerosis
Metabolic: Diabetes mellitus, encephalopathy, obesity, vitamin B12 deficiency, uremia
Psychiatric: Substance abuse, depression, anxiety, malingering
Prognosis[edit | edit source]
The prognosis depends on the aetiology. Metabolic etiologies of gait deviations have a relatively good prognosis. If the metabolic disorder is addressed the patient mostly recovers without lasting symptoms. While neurologic conditions often have a poor prognosis, some neurologic conditions have no cure and must be treated symptomatically. 
Resources[edit | edit source]
- Gait and Lower Limb Observation of Paediatrics - (GALLOP)
- Gait deviations in amputees
- Gait Training in Stroke
- Gait: Antalgic
- Gait Re-education in Parkinson's
- Gait Re-education in Multiple Sclerosis(MS)
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Vazquez-Galliano J, Kimawi I, Chang L. Biomechanic of Gait and Treatment of Abnormal Gait Patterns.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Ataullah AHM, De Jesus O. Gait Disturbances. [Updated 2021 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan Available:https://www.ncbi.nlm.nih.gov/books/NBK560610/#!po=60.7143 (accessed 21.7.2021)
- ↑ 3.0 3.1 3.2 3.3 Wien Klin Wochenschr. 2017; 129(3): 81–95.Gait disorders in adults and the elderly Published online 2016 Oct Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318488/#!po=20.3125 (accessed 21.7.2021)
- ↑ 1.Dr. Prodigious. 3. Antalgic Gait – AOS Normal & Abnormal Gaits. Available from: https://www.youtube.com/watch?v=SpnWhrKPNAA
- ↑ 1.Alexandra Kopelovich. Gait Deviations: at Ankle & Foot. Available from: https://youtu.be/nekqkxLeGOw?t=35
- ↑ Shah K, Solan M, Dawe E. The gait cycle and its variations with disease and injury. Orthopaedics and Trauma. 2020 Jun 1;34(3):153-60.
- ↑ Dutton M, Dutton's Orthopaedic Examination, Evaluation, and Intervention. 5th ed. New York: McGraw Hill; c2020.
- ↑ Alexandra Kopelovich. Gait Deviations: Hip, Pelvis, Trunk. Available from: https://www.youtube.com/watch?v=N_zt5fC6SOE&t=229s
- ↑ 1.Kenzothiazepine. Trendelenburg Gait. Available from: https://www.youtube.com/watch?v=ZUPQp5oxXj8
- ↑ 1.Rebecca Haug. Lurch Gait Pattern. Available from: https://www.youtube.com/watch?v=krm2Fm26S54&t=8s
- ↑ 1.Alexandra Kopelovich. Gait Deviations: Hip, Pelvis, Trunk. Available from: https://www.youtube.com/watch?v=N_zt5fC6SOE&t=229s
- ↑ Mission Gait. Hemiplegic Gait - Case Study 13. Available from: https://www.youtube.com/watch?v=ihz74Zv6D84 [last accessed 16/8/2021]
- ↑ prohealthsys. Assessment - Gait - Parkinsonian Gait Demonstration. Available from:https://www.youtube.com/watch?v=yhj1PktNA1c [last accessed 16/8/2021]
- ↑ Cleveland Clinic Gait disorders Available:https://my.clevelandclinic.org/health/symptoms/21092-gait-disorders (accessed 21.7.2021)