II. Physiology

  1. Gait has 2 phases (walk cycle)
    1. Stance Phase (foot in contact with ground)
      1. Sub-phase 1: Initial double-limb support (20%)
      2. Sub-phase 2: Subsequent single-limb stance (60%)
      3. Sub-phase 3: Return to double-limb support (20%)
    2. Swing Phase (foot in air)
      1. Each foot is in the air 40% of the time of the walk cycle
  2. Age-related changes
    1. Mature gait is established by age 3 years, and is adult-like by age 7 years
    2. With age comes increased walk velocity, step length and duration of single-limb stance

III. Exam: Joint Specific Exams

IV. Exam: Leg Neurologic Exam

  1. Strength
    1. Hip Extension (L5 and S1)
    2. Hip flexors (L2-3, Iliopsoas Muscle, femoral nerve)
    3. Knee Extension (L3-4, Quadriceps Muscle)
    4. Knee Flexion (S1, Sciatic nerve)
    5. Ankle dorsiflexion (L4, tibialis anterior Muscle, deep peroneal nerve)
    6. Great toe extension and foot dorsiflexion (L5)
    7. Ankle plantar flexion (S1, Gastrocnemius and Soleus Muscles, tibial nerve)
  2. Deep Tendon Reflexes
    1. Patellar Reflex (L2-4, Knee Jerk)
    2. Medial Hamstring Reflex (L5)
    3. Achilles Reflex (S1, Ankle Jerk)
  3. Standing and Walking
    1. Patient stands unassisted
    2. Romberg Test
    3. Walk Cycle
      1. Observe patient walking across a room or down a hall and back
      2. Observe balance
      3. Observe swinging of the arms
      4. Observe movement of the legs
      5. Observe turning (typically smooth)
    4. Heel Walking (L4 and L5, ankle dorsiflexion)
      1. Weak dorsiflexion may suggest Upper Motor Neuron Deficit
      2. Also consider distal Muscle Weakness
    5. Toe Walking (L5 and S1, ankle plantar flexion)
      1. Consider distal Muscle Weakness
    6. Tandem Walking (heel-to-Toe Walk)
      1. Patient walks heal to toe in as straight line
      2. Observe for Ataxia (may otherwise be subtle)
  4. Other Testing
    1. Get Up and Go Test
      1. See Gait and Balance Evaluation in the Elderly
      2. Patient gets up from chair unassisted and walks
      3. Observe for ability to rise from chair without upper body force from arm rest
    2. Hip Abduction while standing
      1. May perform if patient able to balance on one leg (L5 and gluteus medius)
    3. Hop in place on one foot at a time
      1. Consider in able patient to test for Muscle Weakness and position sense
      2. May be abnormal in motor weakness, loss of proprioception or cerebellar disorders
    4. Shallow knee bend with one leg at a time
      1. Patient may need light support of elbow
      2. Consider weak hip extensors or knee extensors

V. Types: Abnormal

  1. See Nonantalgic Gait in Children
  2. Antalgic Gait
    1. Limited joint range of motion with an inability to bear full weight on affected extremity
    2. Stance phase duration shortens to compensate pain in the affected leg
    3. Results in limp with slow and short steps
    4. Causes: Joint Pain due to Degenerative Joint Disease or injury, Stress Fractures, Septic Arthritis
  3. Cautious Gait
    1. Careful gait, slow and wide based with abducted arms, similar to that of walking on ice
    2. Causes: Prior falls, deconditioning, sensory deficit (e.g. low sight)
  4. Cerebellar Gait
    1. Staggering, wide-based gait
    2. Associated cerebellar signs (Dysarthria, dysmetria, Intention Tremor, Nystagmus, Positive Romberg test)
    3. Causes: Vitamin B12 Deficiency, Multiple Sclerosis, Cerebellar CVA, Thiamine deficiency
  5. Choreic Gait
    1. Wide-based gait, with slow leg raising and simultaneous knee flexion
    2. Associated with similar Choreoathetosis involving upper extremities
    3. Causes: Huntington's Chorea, Levodopa-induced Dyskinesia
  6. Dystonic Gait
    1. Hyperflexed hips with dragging of foot, exacerbated by walking
  7. Frontal Gait (Gait Apraxia)
    1. Hesitation on starting to walk and on turning
    2. Causes: Dementia, Frontal Lobe degeneration, Normal Pressure Hydrocephalus
  8. Hemiparetic Gait
    1. Weak and spastic limb extended and circumducted
    2. Associated with Hemiparesis, hyperreflexia
    3. Causes: CVA with Hemiparesis
  9. Paraparetic Gait
    1. Stiff, scissor-like walk with leg adduction and extension
    2. Associated with bilateral leg weakness, hyper-reflexia, spasticity
    3. Causes: Spinal cord lesion, bilateral Cerebral Hemisphere abnormalities
  10. Parkinsonian Gait
    1. Shuffling gait with short steps
    2. Causes: Parkinsonism
  11. Pelvic Rotational Wink
    1. Pelvis rotates >40 degrees in axial plane towards the affected hip
    2. Maladaptive gait allows for terminal hip extension on walking
    3. Causes: Intraarticular hip disorder, hip flexure contracture
  12. Psychogenic Gait
    1. Bizarre, non-physiologic, lurching gait
    2. Associated with normal Neurologic Exam (especially with distraction)
    3. Causes: Somatoform Disorder, Malingering
  13. Sensory Ataxia Gait
    1. Unstead gait, worse with impaired Vision or at night
    2. Associated with decreased distal Sensation, Positive Romberg test
    3. Causes: Dorsal column dysfunction, Vitamin B12 Deficiency, Diabetic Neuropathy
  14. Steppage Gait
    1. Hyper-flexed hips and knees on ambulation compensating for foot-drop
    2. Associated with distal leg atrophy and loss of Achilles Reflex
    3. Causes: Distal motor Neuropathy
  15. Trendelenburg Gait
    1. See Trendelenburg Gait
    2. Causes: Abductor weakness (esp. Gluteus Medius) or Intrinsic Hip Pathoplogy
  16. Vestibular Ataxia Gait
    1. Unsteady gait with a falling to one side
    2. Causes: See Vertigo, Ataxia
  17. Waddling Gait
    1. Swaying, symmetric, wide-based gait with Toe Walking
    2. Associated with proximal Muscle Weakness in lower extremities
    3. Causes: Muscular Dystrophy, Pregnancy, Athletes, Osteitis Pubis

VI. References

  1. Zawora in Arenson (2009) Reichel's Care of the Elderly, 6th ed, Cambridge University Presss, p. 143

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Gait (C0016928)

Definition (NCI) A pattern or manner of running, walking, or moving on foot.
Definition (CSP) manner of running, walking, or moving on foot; applicable to humans or animals.
Definition (MSH) Manner or style of walking.
Concepts Finding (T033)
MSH D005684
SnomedCT 63448001, 271705001
LNC LP100865-7, LP30516-6, MTHU015039, MTHU035898
English Gait, Gaits, Gait, function, gaits, gait, gaits types, gait types, Gait type (observable entity), Gait type, Gait, function (observable entity), Manner of walking, Gait, NOS, Manner of walking, NOS, Gait (function)
Swedish Gång
Czech chůze (způsob)
Finnish Kävelytyyli
Croatian HOD
Polish Chód
Norwegian Gangart, Gange, Ganglag
Spanish manera de caminar, marcha (entidad observable), marcha (función), marcha, tipo de marcha (entidad observable), tipo de marcha, Marcha
French Démarche
German Gang
Italian Andatura
Dutch Gang
Portuguese Marcha

Ontology: Antalgic gait (C0231685)

Concepts Finding (T033)
SnomedCT 67141003
Dutch antalgic gait (gewijzigde manier van lopen)
French Démarche antalgique
German Schmerzschongang
Italian Andatura antalgica
Portuguese Marcha antálgica
Spanish Marcha antálgica, cojera antálgica, marcha antálgica (hallazgo), marcha antálgica
Japanese 鎮痛歩行, チンツウホコウ
English antalgic gait (physical finding), antalgic gait, antalgic limp, Antalgic gait, Antalgic limp, Antalgic gait (finding)
Czech Antalgická chůze
Hungarian Antalgiás járás

Ontology: Cerebellar Gait Ataxia (C0231691)

Concepts Finding (T033)
MSH D020234
SnomedCT 69021004
Czech mozečková chůze
French Démarche cérébelleuse, Démarche de l'ataxie cérébelleuse
German Zerebellarer Gang
English Ataxia, Cerebellar Gait, Ataxias, Cerebellar Gait, Cerebellar Gait Ataxias, Gait Ataxia, Cerebellar, Gait Ataxias, Cerebellar, Cerebellar Gait, Cerebellar Gaits, Gait, Cerebellar, Gaits, Cerebellar, Cerebellar gait ataxia, cerebellar gait, cerebellar gait ataxia, Cerebellar gait, Swaying gait, Cerebellar gait (finding), Cerebellar Gait Ataxia
Norwegian Cerebellær gange, Cerebellar gangataksi, Cerebellar gange, Cerebellær gangataksi
Spanish marcha cerebelosa (hallazgo), marcha cerebelosa, marcha del ebrio, Marcha Cerebelosa
Dutch Cerebellaire gang
Portuguese Marcha Cerebelar

Ontology: Waddling gait (C0231712)

Concepts Sign or Symptom (T184)
MSH D020233
SnomedCT 11130005, 271706000
English Gait Waddling, 'Waddling' gait, waddling gait (physical finding), waddling gait (symptom), waddling gait, Trendelenburg gait, Waddling gait, Gait, Duck, Dystrophic gait, Dystrophic gait (finding), Waddling gait (finding), Duck gait, Dystrophic gait (finding) [Ambiguous], Duck Gait
Dutch waggelende looppas
German Watschelgang
Italian Andatura ondeggiante
Portuguese Marcha bamboleante
Spanish Marcha de pato, marcha anadeante, marcha de pato (concepto no activo), marcha de pato (hallazgo), marcha de pato, marcha de ánade (hallazgo), marcha de ánade, marcha distrófica
Japanese あひる歩行, アヒルホコウ
French Démarche en canard, Démarche dandinante
Czech Kolébavá chůze, kachní chůze
Hungarian Totyogó járás
Norwegian Andegange

Ontology: Vestibular ataxic gait (C0427156)

Concepts Finding (T033)
SnomedCT 250032008
English Vestibular ataxic gait, Vestibular ataxic gait (finding)
Spanish marcha de ataxia vestibular (hallazgo), marcha de ataxia vestibular

Ontology: Choreic gait (C0427162)

Concepts Finding (T033)
SnomedCT 250040002
English Choreic gait, Choreic gait (finding)
Spanish marcha coreica (hallazgo), marcha coreica

Ontology: Dystonic gait (C0427163)

Concepts Finding (T033)
SnomedCT 250042005
English Dystonic gait, Dystonic gait (finding)
Spanish marcha distónica (hallazgo), marcha distónica

Ontology: Cautious gait (C0427165)

Concepts Finding (T033)
SnomedCT 250044006
English gait elderly, elderly gait, Cautious gait, Elderly gait, Senile gait, Cautious gait (finding)
Spanish marcha cautelosa (hallazgo), marcha cautelosa

Ontology: Gait abnormality (C0575081)

Definition (NCI_CTCAE) A disorder characterized by walking difficulties.
Definition (NCI) A finding referring to walking difficulties.
Concepts Finding (T033)
ICD9 781.2
SnomedCT 206817004, 206823009, 22325002, 158195007, 158200003
LNC LA17293-4
English GAIT ABNORMAL, GAIT DISORDER, GAIT DISTURBANCE, Gait abnormality NOS, [D]Gait abnormality (context-dependent category), [D]Gait abnormality NOS (context-dependent category), [D]Gait abnormality, [D]Gait abnormality NOS, Gait difficulties, Gait abnormalities, gait abnormality, gait abnormality as symptom, disturbance of gait (diagnosis), abnormality of walk as symptom, disturbance of gait, gait abnormality (symptom), Gait disturbances, Gait Disturbance, Gait problem, Abnormal gait, Abnormal gait (finding), Gait problem (finding), Abnormal;gait, gait disorder, gait disturbance, abnormal gaits, abnormality of gait, Problem;gait, gait abnormal, gait problems, gait disturbances, abnormalities gait, abnormal gait, difficulties gait, disorders gait, Gait Abnormalities, [D]Gait abnormality NOS (situation), [D]Gait abnormality (situation), Gait abnormal, Gait disorders, Gait-abnormal, Gait difficulty, Gait abnormality, Gait abnormality, NOS, Abnormal gait, NOS, Abnormality of gait, Gait abnormal NOS, Disorder gait, Gait disorder, Gait disturbance, gait problem
Italian Alterazione dell'andatura, Disturbi dell'andatura, Andatura anormale, Disturbo dell'andatura, Andatura anormale, NAS
Dutch loop abnormaal, stoornis lopen, afwijking gang, loop abnormaal NAO, loopstoornissen, loopstoornis
French Trouble de la démarche, Démarche anormale, Anomalie de la démarche, Démarche anormale SAI, ALTERATION DE LA DEMARCHE, ANOMALIE DE LA DEMARCHE, TROUBLES DE LA DEMARCHE, Troubles de la marche, Troubles de la démarche
German Gang anomal, Gang anomal NNB, Anomalie des Gangs, Stoerung des Gangs, anomaler Gang, GANG ANOMAL, GANG VERAENDERT, GANGSTOERUNG, Gangstoerungen, Gangstoerung
Portuguese Marcha anormal, Alteração da marcha, Anomalia da marcha NE, Anomalia da marcha, ALTERACAO DA MARCHA, MARCHA ANORMAL, Perturbações da marcha, Perturbação da marcha
Spanish Anormalidad de la marcha, Marcha anormal NEOM, Trastorno de la marcha, Marcha anormal, [D]anomalía de la marcha (categoría dependiente del contexto), [D]anomalías de la marc ha, SAI (categoría dependiente del contexto), MARCHA ANORMAL, MARCHA, ALTERACION, MARCHA, TRASTORNO, [D]anomalía de la marcha (situación), [D]alteración de la marcha, [D]anomalías de la marc ha, SAI, [D]anomalías de la marc ha, SAI (situación), [D]anomalía de la marcha, anomalía de marcha, marcha anormal (hallazgo), marcha anormal, Alteraciones de la marcha, Alteración de la marcha
Japanese 歩行障害, 歩行異常, 歩行異常NOS, 異常歩行, ホコウイジョウ, ホコウイジョウNOS, ホコウショウガイ, イジョウホコウ
Czech Poruchy chůze, Abnormální chůze, Potíže s chůzí, Abnormální chůze NOS, Porucha chůze, Abnormality chůze
Hungarian Kóros járásmód, Járási rendellenesség, Járáseltérés, Kóros járás k.m.n., Járás-zavar, Járás zavarok, Járászavar, Kóros járás

Ontology: Gait, Frontal (C0751831)

Concepts Finding (T033)
MSH D020233
SnomedCT 250054005
French Trouble de la marche d'origine frontale
English Frontal Gait, Frontal gait disorder, Frontal gait disorder (finding), Gait, Frontal
Norwegian Gange, frontal, Frontal gange
Spanish trastorno frontal de la marcha (hallazgo), trastorno frontal de la marcha

Ontology: Gait Ataxia, Sensory (C0751836)

Concepts Finding (T033)
MSH D020234
SnomedCT 250029005
French Démarche de l'ataxie sensitive, Démarche talonnante
English Ataxia, Sensory Gait, Ataxias, Sensory Gait, Gait Ataxias, Sensory, Sensory Gait Ataxia, Sensory Gait Ataxias, Sensory ataxic gait, Sensory ataxic gait (finding), Gait Ataxia, Sensory
Norwegian Sensorisk gangataksi
Spanish marcha de ataxia sensitiva (hallazgo), marcha de ataxia sensitiva

Ontology: Tandem gait test (C1142033)

Concepts Diagnostic Procedure (T060)
SnomedCT 401209001
Italian Test dell'andatura a tandem
Japanese つぎ足歩行検査, ツギアシホコウケンサ
English tandem gait test, tandem gait test (physical finding), Tandem gait test, Tandem gait test (procedure)
Czech Test chůze po rovné čáře s kladením nohy těsně před nohu
Hungarian Tandem testtartás vizsgálat
Spanish prueba de la marcha en tándem (procedimiento), prueba de la marcha en tándem, Prueba de la marcha dedo-talón
Portuguese Teste da marcha em tandem
Dutch tandem gait test
French Test de la démarche en tandem
German Strichgang

Ontology: Gait Apraxia (C1510417)

Definition (MSH) Impaired ambulation not attributed to sensory impairment or motor weakness. FRONTAL LOBE disorders; BASAL GANGLIA DISEASES (e.g., PARKINSONIAN DISORDERS); DEMENTIA, MULTI-INFARCT; ALZHEIMER DISEASE; and other conditions may be associated with gait apraxia.
Concepts Disease or Syndrome (T047)
MSH D020235
SnomedCT 30767006
Swedish Gångoförmåga
English Gait Apraxia, Apraxia of gait, Apraxia of Gait, Apraxias, Gait, Gait Apraxias, Dyspraxia of Gait, Gait Dyspraxia, Gait Dyspraxias, Gait Apraxia [Disease/Finding], apraxic gait, gait apraxia, apraxia of gait, Apraxia, Gait, Gait apraxia, Apraxic gait, Gait apraxia (finding)
Czech apraxie chůze, dyspraxie chůze, Apraxie chůze
Finnish Kävelyapraksia
Italian Disprassia dell'andatura, Aprassia dell'andatura
Japanese 歩行失行症, ブルーンズの歩行失調, 歩行失行, ホコウシッコウ, 失行-歩行, 失行症-歩行
Dutch loop apraxie, Apraxie van de gang, Apraxie, gang-, Dyspraxie van de gang, Gangapraxie
Spanish Apraxia de la marcha, apraxia de la marcha (hallazgo), apraxia de la marcha, Apraxia de la Marcha, Dispraxia de la Marcha
Portuguese Apraxia da marcha, Apraxia da Marcha, Dispraxia da Marcha
German Gangapraxie, Apraktischer Gang, Gang-Apraxie, Gang-Dyspraxie
French Apraxie de la démarche, Marche apraxique, Démarche apraxique, Apraxie de la marche
Polish Chód z cechami apraksji
Hungarian Járás apraxia
Norwegian Manglende evne til å gå

Ontology: Slow paraparetic gait (C1838198)

Concepts Finding (T033)
English Slow paraparetic gait

Ontology: hemiparetic gait (C2030420)

Concepts Finding (T033)
English hemiparetic gait, hemiparetic gait (physical finding)

Ontology: examination of gait and stance (C2228444)

Concepts Diagnostic Procedure (T060)
English examination of gait and stance, examination of gait and stance (physical finding), gait and stance

Ontology: Gait - parkinsons (C3176211)

Concepts Clinical Attribute (T201)
LNC LP120683-0, MTHU039710
English Gait - parkinsons