Pathologic Gait

Question 1

Waddling gait cause & presentation

Answer 1

Bilateral hip abductor weakness (gluteus medius)

Lateral and posterior trunk lean towards stance limb

Question 2

Trendelenburg gait cause & presentation

Answer 2

Hip abductor weakness (gluteus medius/minimus, superior gluteal nerve)

Uncompensated - pelvic drops toward contralateral limb (stance limb affected)
Compensated - trunk lean toward affected stance limb to maintain CoG over BOS

Question 3

Antalgic gait cause & presentation

Answer 3

Pain

Shortened stance phase of affected limb, limp

Question 4

Ataxic gait cause & presentation

Answer 4

Cerebellum injury, sensory deficits, disturbed proprioception, extrapyramidal CP

Unsteady/uncoordinated, wide BOS, exaggerated movements, inconsistent, use of visual cues

Question 5

Hyperkinetic (choreiform) gait cause & presentation

Answer 5

CP - damage to extrapyramidal tract, athetosis, dystonia, Huntington’s

Irregular, jerky, involuntary movements in all extremities

Question 6

Diplegic gait cause & presentation

Answer 6

CP - damage to pyramidal tract

Bilateral leg extension and adduction, scissoring w/tight or spastic hip adductors

Question 7

Quadriplegic gait cause & presentation

Answer 7

CP - damage to pyramidal tract

Spasticity in all extremities, narrow base/scissor from adductor tightness, dragging legs and toes

Question 8

Hemiplegic gait cause & presentation

Answer 8

CVA or CP

Unilateral weakness or spasticity on affected side
Hip/knee extension, ankle PF, IR
Arm IR, elbow flexed, thumb in palm
Circumduction

Question 9

Lurch gait cause & presentation

Answer 9

Hip extensor weakness (gluteus maximus, inferior gluteal nerve)

Backward trunk lurch through stance phase (esp. LR) to push hip into more stable extended position

Question 10

Dropfoot cause & presentation

Answer 10

Weak or paralyzed DF - damage to common peroneal nerve

PF in swing phase without heel strike; audible slap from lack of eccentric DF at heel strike

Question 11

Festinating gait cause & presentation (Parkinsonian)

Answer 11

Parkinson’s disease, other basal ganglia disorders

Bradykinesia, tremor, and rigidity
Small, shuffling steps
Difficulty initiating steps, turning
Festination - involuntary inclination to increase cadence

Question 12

Leg length discrepancy cause & presentation

Answer 12

Functional or structural causes

Vaulting, circumduction, pelvic drop

Question 13

Circumduction motions & possible causes

Answer 13

Hip hiking, forward pelvic rotation, hip abduction

Weak hip flexors (L2-L3 nerves)
LLD’cy (functional or structural)

Question 14

Steppage gait cause & presentation

Answer 14

Weak/paralyzed DF (common peroneal nerve)

Excessive knee and hip flexion
Unable to stand or walk on heel

Question 15

Crouch gait presentation & possible causes

Answer 15

Hip flexion, knee flexion, ankle dorsiflexion

Due to weak PF (eg. spina bifida)

Due to spastic hamstrings, knee flexion contracture, etc. (eg. spastic CP) - likely also have excessive pronation

Question 16

Excessive pronation presentation

Answer 16

WB: HF valgus, MF collapse, FF abduction
(eversion, dorsiflexion, and abduction)

NWB: FF varus

Question 17

Excessive supination

Answer 17

WB: HF varus, MF elevated, FF adduction
(inversion, plantarflexion, and adduction)

NWB: FF valgus

Question 18

CMT presentation

Answer 18

Pes cavus, drop foot, hammer toes

Question 19

Knee hyperextension (genu recurvatum) possible causes

Answer 19

Weak quads (L4 femoral nerve), PF contracture, Polio

Question 20

Normal thigh and shank inclination through stance

Answer 20

IC: thigh and shank are reclined
Toe off: thigh reclined, shank vertical
MS: thigh vertical, shank inclined (10-12˚)
TS: thigh and shank are inclined

Question 21

Effect of abnormal thigh and shank inclinations in stance

Answer 21

Changes GRF vector causing compensation at various joints to maintain CoM over BOS