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Ab Gait

Trendelenburg Sign

Pathologic gait patterns can be broadly divided into either neuromuscular or musculoskeletal etiologies. Gait deviations may result from structural abnormalities of a bone, joint, or soft tissue. Other causes of pathologic gait include neuromuscular and myopathic conditions. [1]

Common Musculoskeletal causes [2]Edit

  • no Hip pathology
  • Knee pathology
  • Foot and ankle pathology
  • Leg length discrepancy

Common neurologic causes [3]Edit

  • Cerebrovascular conditions
  • Central nervous system conditions
  • Cerebellar conditions

Common motor weakness causes [4]Edit

  • Hip extensor weakness
  • Hip flexor weakness
  • Quadriceps weakness
  • Ankle dorsiflexor weakness
  • Triceps surae weakness


Antalgic GaitEdit

Antalgic Gait00:33

Antalgic Gait

CausesEdit

  • Pain in limb

CharacteristicsEdit

A limping gait, indicative of pain upon weight bearing. The stance phase is significantly shortened relative to the swing phase to minimize closed chain loading and reduce pain. [5]

Ataxic GaitEdit

Abnormal Gait Exam Ataxic Gait Demonstration01:19

Abnormal Gait Exam Ataxic Gait Demonstration

CausesEdit

  • Injury to the cerebellum
  • Sensory deficits in lower limb

Characteristics

An unsteady, uncoordinated walk with a broad standing base. Movements appear exaggerated, leg placement is variable and reproducibility is lost.  [6]

Choreiform (Hyperkinetic) GaitEdit

Abnormal Gait Exam Choreiform Gait Demonstration01:02

Abnormal Gait Exam Choreiform Gait Demonstration

Causes [7]Edit

  • Sydenham's chorea
  • Huntington's disease
  • Athetosis
  • Dystonia

CharacteristicsEdit

Irregular, jerky, and involuntary movements occur in all extremities. Walking may accentuate  the baseline movement disorder. [8]


Diplegic GaitEdit

Abnormal Gait Exam Diplegic Gait Demonstration01:24

Abnormal Gait Exam Diplegic Gait Demonstration

CausesEdit

  • Cerebral Palsy

CharacteristicsEdit

Bilateral involvement and spasticity in all extremities. Patient will walk with an abnormally narrow base, dragging both legs and scraping the toes. Adductor tightness may cause legs to scissor. [9]


Drop FootEdit

Foot drop00:16

Foot drop

CausesEdit

  • Weak dorsiflexors
  • Paralyzed dorsiflexors
  • Damaged common fibular nerve

CharacteristicsEdit

Gait in which the forefoot cannot be actively raised. The advancing leg is lifted high in order to clear the toes and in some cases the foot may audibly slap the ground due to lack of eccentric dorsiflexion. [10]


Gluteus Maximus (Lurch) GaitEdit

Gluteus Maximus Lurch Inferior Gluteal Nerve01:25

Gluteus Maximus Lurch Inferior Gluteal Nerve

CausesEdit

  • Hip extensor weakness[11]

CharacteristicsEdit

A backward trunk lurch persists throughout stance phase to maintain center of mass behind the hip axis, locking the hip in extension. The hamstring muscles may compensate in some cases. [12]


Gluteus Medius (Trendelenburg) GaitEdit

Abnormal Gait Exam Myopathic Gait Demonstration01:37

Abnormal Gait Exam Myopathic Gait Demonstration

CausesEdit

  • Hip abductor weakness [13]

CharacteristicsEdit

  • If uncompensated, during stance phase on the affected side there is a drop in the pelvis on the unaffected side greater than the normal 5 degrees (Trendelenburg sign). There is also a lateral protrusion of the affected hip. [14]
  • If compensated, there is a lateral trunk lurch over the affected hip during stance phase. This maintains the center of gravity over the hip, reducing the muscle force required to stabilize the trunk and pelvis. [15]

Hemiplegic GaitEdit

Abnormal Gait Exam Hemiplegic Gait Demonstration01:11

Abnormal Gait Exam Hemiplegic Gait Demonstration

CausesEdit

  • Cerebrovascular accident [16]

CharacteristicsEdit

Patient has unilateral weakness on affected side, with leg in extension and foot plantarflexed. During swing phase, affected limb circumducts to clear ground due to foot drop and extensor hypertonia in the lower limb. [17]

Parkinsonian (Festinating) GaitEdit

Abnormal Gait Exam Parkinsonian Gait Demonstration01:14

Abnormal Gait Exam Parkinsonian Gait Demonstration

CausesEdit

  • Parkinson's Disease
  • Other disorders of the basal ganglia [18]

CharacteristicsEdit

Patient presents observable bradykinesia, tremor, and rigidity. [19] Gait consists of many small, shuffling steps also known as marche a petis pas. There may be difficulty initiating steps and once moving there may be an involuntary inclination to increase cadence, which is known as festination. [20]

ReferencesEdit

  1. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  2. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  3. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  4. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  5. http://en.wikipedia.org/wiki/Antalgic_gait
  6. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  7. http://stanfordmedicine25.stanford.edu/the25/gait.html
  8. http://stanfordmedicine25.stanford.edu/the25/gait.html
  9. http://stanfordmedicine25.stanford.edu/the25/gait.html
  10. http://en.wikipedia.org/wiki/Foot_drop
  11. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  12. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  13. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  14. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  15. http://www.rehab.research.va.gov/mono/gait/malanga.pdf
  16. http://stanfordmedicine25.stanford.edu/the25/gait.html
  17. http://stanfordmedicine25.stanford.edu/the25/gait.html
  18. http://en.wikipedia.org/wiki/Hypokinesia
  19. http://en.wikipedia.org/wiki/Bradykinesia#Bradykinesia
  20. http://stanfordmedicine25.stanford.edu/the25/gait.html

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