Stanford Medicine 25

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Gait Abnormalities
There are eight basic pathological gaits that can be
attributed to neurological conditions: hemiplegic,
spastic diplegic, neuropathic, myopathic,
Parkinsonian, choreiform, ataxic (cerebellar) and
sensory. Observation of these gait are an important
aspect of diagnosis that may provide information
about several musculoskeletal and neurological
conditions.

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Stanford Medicine 25 Gaits

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Stanford Medicine 25 Gaits
Hemiplegic Gait
Diplegic Gait
Neuropathic Gait
Myopathic Gait
Choreiform Gait
Ataxic Gait
Parkinsonian Gait
Sensory Gait

Hemiplegic Gait
The patient stands with unilateral weakness on the affected side, arm flexed, adducted and internally
rotated. Leg on same side is in extension with plantar flexion of the foot and toes. When walking, the
patient will hold his or her arm to one side and drags his or her affected leg in a semicircle
(circumduction) due to weakness of distal muscles (foot drop) and extensor hypertonia in lower limb.
This is most commonly seen in stroke. With mild hemiparesis, loss of normal arm swing and slight
circumduction may be the only abnormalities.

Diplegic Gait
(Spastic Gait)

Patients have involvement on both sides with spasticity in lower extremities worse than upper
extremities. The patient walks with an abnormally narrow base, dragging both legs and scraping the
toes. This gait is seen in bilateral periventricular lesions, such as those seen in cerebral palsy. There is
also characteristic extreme tightness of hip adductors which can cause legs to cross the midline
referred to as a scissors gait. In countries with adequate medical care, patients with cerebral palsy
may have hip adductor release surgery to minimize scissoring.

Neuropathic Gait
(Steppage Gait, Equine Gait)

Seen in patients with foot drop (weakness of foot dorsiflexion), the cause of this gait is due to an
attempt to lift the leg high enough during walking so that the foot does not drag on the floor. If
unilateral, causes include peroneal nerve palsy and L5 radiculopathy. If bilateral, causes include
amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease and other peripheral neuropathies
including those associated with uncontrolled diabetes.

Myopathic Gait
(Waddling Gait)
Hip girdle muscles are responsible for keeping the pelvis level when walking. If you have weakness on
one side, this will lead to a drop in the pelvis on the contralateral side of the pelvis while walking
(Trendelenburg sign). With bilateral weakness, you will have dropping of the pelvis on both sides
during walking leading to waddling. This gait is seen in patient with myopathies, such as muscular
dystrophy.

Choreiform Gait
(Hyperkinetic Gait)

This gait is seen with certain basal ganglia disorders including Sydenham's chorea, Huntington's
Disease and other forms of chorea, athetosis or dystonia. The patient will display irregular, jerky,
involuntary movements in all extremities. Walking may accentuate their baseline movement disorder.

Ataxic Gait
(Cerebellar)

Most commonly seen in cerebellar disease, this gait is described as clumsy, staggering movements
with a wide-based gait. While standing still, the patient's body may swagger back and forth and from
side to side, known as titubation. Patients will not be able to walk from heel to toe or in a straight line.
The gait of acute alcohol intoxication will resemble the gait of cerebellar disease. Patients with more
truncal instability are more likely to have midline cerebellar disease at the vermis.

Parkinsonian Gait
(Festinating Gait, Propulsive Gait)

In this gait, the patient will have rigidity and bradykinesia. He or she will be stooped with the head
and neck forward, with flexion at the knees. The whole upper extremity is also in flexion with the
fingers usually extended. The patient walks with slow little steps known at marche a petits pas (walk
of little steps). Patient may also have difficulty initiating steps. The patient may show an involuntary
inclination to take accelerating steps, known as festination. This gait is seen in Parkinson's disease or
any other condition causing parkinsonism, such as side effects from drugs.

Sensory Gait
As our feet touch the ground, we receive propioreceptive information to tell us their location. The
sensory ataxic gait occurs when there is loss of this propioreceptive input. In an effort to know when
the feet land and their location, the patient will slam the foot hard onto the ground in order to sense
it. A key to this gait involves its exacerbation when patients cannot see their feet (i.e. in the dark). This
gait is also sometimes referred to as a stomping gait since patients may lift their legs very high to hit
the ground hard. This gait can be seen in disorders of the dorsal columns (B12 deficiency or tabes
dorsalis) or in diseases affecting the peripheral nerves (uncontrolled diabetes). In its severe form, this
gait can cause an ataxia that resembles the cerebellar ataxic gait.


Key Learning Points

Review the following eight gaits and be able to observe the unique characteristics of each.

Related to Gait Abnormalities

Internal Capsule Stroke

Involuntary Movements

The Stanford Medicine 25

Ankle Brachial Index

Ankle and Foot Exam

Ascites & Venous Patterns

Bedside Ultrasound

Breast Exam

Cardiac Second Sounds

Carpal Tunnel Exam

Cerebellar Exam

Deep Tendon Reflexes

Dermatology Exam: Acne vs. Rosacea

Dermatology Exam: Learning the Language

Dermatology Exam: Nevi (Mole) Exam

Fundoscopic Exam (Ophthalmoscopy)

Gait Abnormalities

Hand Exam

Hip Region Exam

Internal Capsule Stroke

Involuntary Movements and Tremor Diagnosis: Types, Causes, and Examples

Knee Exam

Liver Exam
Low Back Exam

Lymph Node Exam

Neck Vein Exam

Pelvic Exam

Precordial Movements in the Cardiac Exam

Pulmonary Exam: Percussion & Inspection

Pupillary Responses

Pulsus Paradoxus and Blood Pressure Measurement Techniques

Rectal Exam

Spleen Exam

Tarsal Tunnel Exam

Thyroid Exam

Tongue Exam

Liver Disease, Head to Foot

Visit the 25

Shoulder Exam Tutorial

Parkinson's Disease Exam

Diastolic Murmurs Exam

Dermatology Exam: Nevi (Mole) Exam

The Stanford Medicine 25

Ascites & Venous Patterns

BP & Pulsus Paradoxus

Bedside Ultrasound

Cardiac Second Sounds

Cerebellar Exam

Deep Tendon Reflexes

Examination of the Spleen

Fundoscopic Exam

Gait Abnormalities

Internal Capsule Stroke

Involuntary Movements

Knee Exam

Liver Disease, Head to Foot

Lymph Node Exam

Neck Veins & Wave Forms

Precordial Movements

Pulmonary Exam: Percussion & Inspection

Pupillary Responses

Rectal Exam

Shoulder Exam

The Hand in Diagnosis

The Tongue in Diagnosis

Thyroid Exam

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