Gait abnormalities

Question 1

Name general possible causes for gait abnormalities.

Answer 1

• nerve lesions
• joint instability
• joint immobility
• pain

Question 2

What is the medical term for a limp?

Answer 2

antalgic gait

Question 3

What causes an antalgic gait?

Answer 3

i) painful leg/joint

ii) stiffness or reduced mobility of a joint

Question 4

Describe the mechanism of an antalgic gait.

Answer 4

Uneven due to:

1. shorter stance phase of affected leg (to reduce its weight bearing time)
2. lack body weight shift to affected leg
3. shorter swing phase of unaffected leg (in order to take over weight again)

Question 5

In what hand should patients with an antalgic gait hold a walking stick?

Answer 5

opposite hand (allows shifting of body weight onto stick)

Question 6

What causes a hemiplegic gait?

Answer 6

hemi-brain injury, e.g.

• stroke
• cerebral palsy
• trauma

Question 7

Describe the mechanism of a hemiplegic gait.

Answer 7

Problem with 1 lower limb.

1. flexed upper limb (stronger flexors)
2. extended lower limb as extensors overwhelm flexors… causes foot plantarflexion and so lengthened limb…
3. … circumduction of affected leg in order to clear toes of floor and place affected leg in midline
4. short step of unaffected leg

Question 8

What causes a diplegic gait?

Answer 8

Neuromuscular disorders, e.g.

- cerebral palsy

Question 9

Describe the mechanism of a diplegic gait.

Answer 9

1. hypertonia in legs, hips and pelvis causes flexion of these areas
2. scissoring due to tight muscle groups - psoas, adductors, hamstrings and calves - knees and thighs hit/cross-over
3. ankle plantarflexion - walk on tip toes so forefoot = initial contact

Question 10

What is foot drop? What type of gait does it cause?

Answer 10

Foot drop = inability to dorsiflex ankle so toes hand down during swing phase.

Causes high steppage gait.

Question 11

What causes a high steppage gait?

Answer 11

Can be CNS or PNS problem

• neuromucular disorders
• sciatica (CNS)
• common peroneal nerve palsy (affects tibialis anterior)

Question 12

Describe the mechanism of a high steppage gait.

Answer 12

1. toes hang down during swing phase - risk of tripping so excessive hip flexion of affected limb
2. foot slap

Question 13

Suggest a possible treatment for foot drop.

Answer 13

splint to control plantarflexion

Question 14

What causes a parkinsonian gait?

Answer 14

neurological disease - Parkinson’s

Question 15

Describe the mechanism of a parkinsonian gait.

Answer 15

1. shuffling/short step
2. no arm swing
3. forward flexed - shift forward of centre of gravity
4. festinant - rapid, almost falling due to shift in C of G

Question 16

What causes a Trendelenberg gait?

Answer 16

i) lesion of superior gluteal nerve (and consequent muscle paralysis)
ii) hip instability (as in congenital dislocation of the hip)

Question 17

Describe the mechanism of a Trendelenberg gait.

Answer 17

• Tilting of pelvis during standing and walking.
• Caused by weakness of abductor muscles of lower limb, gluteus medius and gluteus minimus.

If bilateral weakness, causes waddling.