Abnormal Gait

By: Dr Sneha Bhalala

• Gait deviations can occur for three reasons.
1st , they may occur because of pathology or
injury in the specific joint.
2nd they may occur as a compensations for injury
or pathology in other joints on the same or
ipsilateral side.
3rd , they may occur as compensations for injury
or pathology on the opposite or contralateral
limb.
1) Antalgic gait/ painful gait:
• It is self protective and is the result of injury to
the pelvis, hip, knee, ankle or foot.
• The stance phase on the affected leg is shorter
than that on the non affected leg, because the
patient attempts to remove weight from the
affected leg as quickly as possible; therefore ,
the amount of time on each leg should be noted.
• The swing phase of the uninvolved leg is

decreased. The result is a shorter step length

on the uninvolved side, decreased walking

velocity, and decreased cadence.

• Painful region is often supported by one

hand.
2) Arthrogenic (stiff hip or knee ) gait:
• The arthrogenic gait results from stiffness, laxity ,
or deformity, and it may be painful or pain free.
• If the knee or hip is fused or the knee has recently
been removed from a cylinder cast, the pelvis
must be elevated by exaggerated plantar flexion of
the opposite ankle and circumduction of stiff leg
( circumducted gait)to provide toe clearance.
• The patient with this gait lifts the entire leg

higher than normal to clear the ground

because of a stiff hip or knee.

• When the stiff limb is bearing weight , the gait

length is usually smaller.

3) Ataxic gait:
• If the patient has poor sensation or lacks
muscle coordination, there is a tendency
toward poor balance and a broad base.
• The gait of a person with cerebellar ataxia
includes a lurch , and all movements are
exaggerated.
• The feet of an individual with sensory ataxia

slap the ground because they cannot be felt.

The patient also watches the feet while walking.

The resulting gait is irregular, jerky and

weaving.
4) Contracture gait:
• Joints of the lower limb may exhibit contracture if
immobilization has been prolonged or pathology
to the joint has not been properly cared for.
• Hip flexion contracture often results in increased
lumbar lordosis and extension of the trunk
combined with knee flexion to get the floor on the
ground.
• With a knee flexion contracture, the patient
demonstrates excessive ankle dorsiflexion
from late swing phase to early stance phase
on the uninvolved leg and early heel rise on
the involved side in terminal stance.
• Plantar flexion contracture at the ankle results
in knee hyperextension and forward bending
of the trunk with hip flexion.
• Heel rise on the affected leg also occurs
earlier.
5) Equinus gait (Toe walking):
• This childhood gait is seen with talipes
equinovarus (club foot). Weight bearing is
primarily on the dorsolateral or lateral edge
of the foot, depending on the degree of
deformity.
• The weight bearing phase on the affected limb

is decreased, and a limp is present.

• The pelvis and femur are laterally rotated to

partially compensate for tibial and foot medial

rotation.
6) Gluteus Maximus gait:
• If the gluteus maximus muscle, is weak, the
patient thrusts the thorax posteriorly at initial
contact(heel strike) to maintain hip extension
of the stance leg.
• The resulting gait involves a characteristic
backward lurch of the trunk.
7) Gluteus medius ( Trendelenburg’s ) gait:
• If the hip abductor muscle are weak, the
stabilizing effect of these muscles during
stance phase is lost, and the patient exhibits
an excessive lateral list in which the thorax is
thrust laterally to keep the center of gravity
over the stance leg.
• A positive Trendelenburg’s sign is also
exhibited( contralateral side droops because
the ipsilateral hip abductors do not stabilize or
prevent the droop).
• If there is bilateral weakness of the gluteus
medius muscles, the gait shows side to side
movement , resulting in a wobbling gait or ‘
chorus girl swing.’
• This gait may also be seen in patients with

congenital dislocation of the hip and coxa

vara.
8) Hemiplegic or Hemiparetic gait:

• The patient with hemiplegic gait swings the

paraplegic leg outward and ahead in a

circumduction or pushes it ahead.

• This is sometimes referred to as a neurogenic

or flaccid gait.
9) Parkinsonian gait:
• The neck, trunk, and knees of a patient with
parkinsonian gait are flexed.
• The gait is characterized by shuffling or short
rapid steps at a times. The arms are held
stiffly and do not have their normal
associative movement.
10) Plantar Flexor Gait:
• If the plantar flexor muscles are unable to
perform their function, ankle and knee
stability are greatly affected.
• Loss of the plantar flexors results in decrease
or absence of push off. The stance phase is
less, and there is a shorter step length on the
unaffected side.
11) Scissors gait:

• The gait is the result of spastic paralysis of the

hip adductor muscles, which causes the knees

to be drawn together so that the legs can be

swung forward only with great effort.

• This is seen in spastic paraplegics and may be
referred to as a neurogenic or spastic gait.
PELVIC TILT
• The patient must be suitably undressed. For
the sacroiliac joints to be observed properly,
the patient is often required to be nude from
the midchest to the toes.
• The pelvic portion along with the hip and the vertebral

column makes the normal sinusoidal curve in the gait cycle,

these pelvic movement are together called as ‘’PELVIC TILT.’’

• Normally, some degree pelvic movements occur in our gait

cycle, but if it increases beyond a certain then it may be

called as ABNORMAL PELVIC TILT. Pelvic tilt may be of

following :
1. Anterior pelvic tilt
2. Posterior pelvic tilt
3. Lateral pelvic tilt
4. Pelvic drop
5. Pelvic rotation
 Anterior – Posterior Pelvic tilt:
• Anterior – posterior pelvic tilt occurs in the
saggital plane and coronal axis.
• It can be measured by following ways:
a. Lumbosacral Angle-
 The angle made by the line parallel to the
ground and the line along the base of the
sacrum is normally 30 degree.
 If it is increased, it is said to anterior pelvic
tilt and if decreased then called posterior
pelvic tilt.
 b. Pelvic inclinometer:

 One arm of pelvic inclinometer placed over the

pubic symphysis and another over PSIS.

 In normal pelvic tilt it is 30 degree, a change in

it will be called as anterior – posterior pelvic

tilt.
c. Draw a vertical line from ASIS to down.
Normally this line touches the PUBIC SYMPHISIS
, alternation in which is said to be ANTERIOR OR
POSTERIOR PELVIC TILT.
 ANTERIOR PELVIC TILT:

• Here ASIS moves anteriorly and inferiorly , PUBIC

SYMPHISIS moves posteriorly and closure to the
femoral head.
• Alignment of ASIS is horizontal with PSIS and in
vertical with PUBIC symphysis is distorted. Sacral
angle increases and lumbar lordosis and thoracic
kyphosis also increases.
• Muscle responsible for ANTERIOR PELVIC TILT
are hip flexors and SPINAL EXTENSOR whereas
muscles which oppose ANTERIOR PELVIC TILT
are abdominus and hip extensors.
• Weakness of abdominus and hip extensors &
contraction of hip flexors and spinal extensors
will result into ANTERIOR PELVIC TILT.
 POSTERIOR PELVIC TILT:

• Here ASIS moves posteriorly and superiorly, pubic

symphysis moves anteriorly and away from femoral
head.
• Sacral angle decreases and lumbar lordosis also
decreases. The muscles responsible POSTERIOR
PELVIC TILT are hip extensors and abdominus
whereas muscles responsible to prevent POSTERIOR
PELVIC TILT are hip flexors and spinal extensors.
• Contraction of hip extensors and spinal flexors
or weakness of hip flexors and spinal extensors
would result in ABNORMAL POSTERIOR PELVIC
TILT.
 LATERAL PELVIC TILT:

• It occurs in the frontal plane and around the

ANTERIOR- POSTERIOR AXIS. In normal

standing position, both the ASIS are aligned in

an horizontal line. If any change occurs in this

alignment then it is said to be lateral pelvic tilt.

• It may occur during both bilateral as well as
unilateral stance.
 Hip Hiking:

• In normal person, hip hiking occurs while

clearing the foot from the ground.
• Also it is helpful when the patient walk with a
long plaster cast or brace.
• This is also needed for pressure relieve during
prolong sitting. During hiking ASIS moves upwards
and medially, spine goes for same side flexion and
hip goes for abduction on the hiking side.
• Hiking occurs due to contraction of quadratus
lumborum and spinal side flexors. Hip abductor,
gluteus medius of other side also contract in a
reverse action and help in hip hiking.
 PELVIC DROP:

• Here ASIS moves inferiorly and medially,

spine goes for opposite side flexion and hip
goes for adduction on the dropping side.
• Pelvic dropping occurs mainly due to hip
abductor, gluteal medius weakness of
opposite side.
• When it is unilateral , the gait produce is
called TRENDLENBURG’S GAIT. Both the sides
hip abductors paralysis leads to waddling type
of gait, otherwise also called as DUCK
WALKING.
 PELVIC ROTATION:

• It occurs in the transverse plane & along the vertical axis.

Pelvic rotation occurs when the swinging leg moves forward and

backward on the stance leg.

• In normal walking , the forward motion in the right leg results in

right side pelvic forward rotation, left side upper limb swings

forward and the stance or weight bearing goes for medial

rotation.
• In case of backward motion of right leg, there
occurs posterior rotation of pelvis on right side,
right upper limb swings forward and the stance
or weight bearing limb goes for lateral rotation.
• During normal walking, ant. tilt, post. tilt,
lateral tilt and pelvic rotation which help to
propel the body forward.
• This tilts alter the body segment, during
normal walking, make the walking pattern
easier and convenient and reduce the strain in
weight transmission.
• If any pathological disturbance occurs, then
there will be marked and visible tilts seen. This
pathological tilts or drops can be cured by
regular strengthening and stretching program.
Thank you……