Comprehensive clinical gait analysis covering the normal gait cycle, identification of pathological gait patterns, and systematic assessment for orthopaedic and neurological conditions.
Gait observation is often the first and most revealing part of a lower limb examination. Examiners expect you to systematically describe the gait cycle, identify common abnormal patterns (antalgic, Trendelenburg, foot drop), and correlate findings with underlying pathology. Always observe gait BEFORE proceeding to focused examination.
High-Yield Exam Summary
Environment Requirements:
Consent Script: "I'd like to watch you walk. Please walk at your normal pace to the end of the room and back. Then I'll ask you to do some additional walking tests."
Equipment:
One gait cycle = Heel strike to next heel strike of same foot
STANCE PHASE (60% of cycle):
SWING PHASE (40% of cycle):
Key Parameters:
Determinants of Gait (Saunders): Six mechanisms that minimize vertical and lateral displacement of the center of mass, making gait energy-efficient:
Observe:
| gait | description | mechanism | causes |
|---|---|---|---|
| Antalgic | Short stance phase on affected side | Reduces time weight-bearing on painful limb | OA, fracture, infection, any painful lower limb condition |
| Stiff Leg | Leg held in extension, circumduction | Avoids painful/impossible knee/hip flexion | Knee arthritis, hip arthritis, fusion |
| Foot Avoidance | Abnormal foot placement | Avoids pressure on painful area | Plantar fasciitis, metatarsalgia, ulcer |
| gait | description | mechanism | causes |
|---|---|---|---|
| Trendelenburg | Pelvis drops on swing side | Hip abductor weakness (gluteus medius) | Hip OA, post-THR, L5 palsy, DDH, polio |
| Compensated Trendelenburg | Trunk shifts OVER affected hip | Moves center of mass over affected hip | Same as Trendelenburg |
| Foot Drop (Steppage) | High stepping, foot slaps | Weak ankle dorsiflexion, compensatory hip/knee flexion | L5 palsy, common peroneal palsy, HSMN |
| Gluteus Maximus Lurch | Trunk thrown backward at heel strike | Weak hip extension | Muscular dystrophy, polio |
| Quadriceps Weakness | Hand on thigh, knee hyperextension | Prevents knee collapse | Femoral nerve injury, muscular dystrophy |
| gait | description | mechanism | causes |
|---|---|---|---|
| Hemiplegic | Circumduction, arm held flexed | Spasticity, weakness, loss of selectivity | Stroke, TBI |
| Diplegic (Scissoring) | Crouched, internally rotated, adducted hips | Bilateral spasticity (adductors, hamstrings) | Cerebral palsy |
| Ataxic (Cerebellar) | Wide-based, lurching, irregular | Impaired coordination | Cerebellar lesion, alcohol, MS |
| Sensory Ataxic | Stamping, wide-based, worse with eyes closed | Proprioceptive loss | Peripheral neuropathy, posterior column lesion |
| Parkinsonian | Shuffling, festinating, reduced arm swing | Rigidity, bradykinesia | Parkinson's disease |
| Waddling | Side-to-side trunk sway | Bilateral hip abductor weakness | Muscular dystrophy, bilateral hip disease |
| gait | description | mechanism | causes |
|---|---|---|---|
| Short Leg | Pelvic dip, vaulting on long side | Compensate for leg length discrepancy | LLD from any cause |
| Varus Thrust | Lateral thrust of knee into varus | Lateral compartment collapse or ligament insufficiency | Medial compartment OA, lateral ligament laxity |
| Valgus Thrust | Medial thrust of knee into valgus | Medial compartment collapse or ligament insufficiency | Lateral compartment OA, medial ligament laxity |
| Recurvatum | Knee hyperextension in stance | Quadriceps weakness or compensation | Polio, stroke, quadriceps weakness |
Test ankle dorsiflexors (L4,5 - tibialis anterior)
Unable to walk on heels, foot drops
L5 weakness, common peroneal nerve palsy, foot drop
Ability to detect true positives
Ability to exclude false positives
Test ankle plantarflexors (S1,2 - gastrocnemius/soleus)
Unable to rise or maintain position on toes
S1 weakness, Achilles rupture, gastrocnemius weakness
Ability to detect true positives
Ability to exclude false positives
Test balance and cerebellar function
Unable to maintain balance, veering to one side
Cerebellar dysfunction, vestibular dysfunction, sensory ataxia
Ability to detect true positives
Ability to exclude false positives
Test hip abductor function (Trendelenburg)
Pelvis drops on unsupported (swing) side
Hip abductor weakness (gluteus medius dysfunction)
Ability to detect true positives
Ability to exclude false positives
Differentiate sensory from cerebellar ataxia
Able to balance with eyes open but falls/sways with eyes closed
Sensory (proprioceptive) ataxia - relies on vision for balance
Ability to detect true positives
Ability to exclude false positives
Hemiplegic CP (Winters Classification):
Diplegic CP (Common Patterns):
Always state to the examiner:
"To complete my gait assessment, I would like to:
"65-year-old woman walks into clinic with obvious limp."
| condition | gait | observation | confirmWith |
|---|---|---|---|
| Hip OA | Antalgic + Trendelenburg | Short stance, trunk shift, reduced ROM | Hip examination, X-ray |
| Knee OA | Antalgic + varus/valgus thrust | Stiff, thrust on loading | Knee examination, X-ray |
| Common Peroneal Palsy | High-stepping (foot drop) | Foot slaps at heel strike, circumduction | Neurological exam, nerve conduction |
| L5 Radiculopathy | Subtle foot drop + Trendelenburg | Weak dorsiflexion and hip abduction | Lumbar spine exam, MRI |
| Leg Length Discrepancy | Pelvic obliquity, vaulting | Asymmetric stance, short side dips | Leg length measurement, block test |
| Age | Milestone |
|---|---|
| 12-15 months | Independent walking begins |
| 2 years | Running, heel-toe pattern emerging |
| 3 years | Heel strike present, arm swing developing |
| 7 years | Adult gait pattern mature |
Normal Variants (Physiological):
Pathological (Require Investigation):
High-Yield Exam Summary