What Are Gait Abnormalities?

Gait is defined as one’s pattern of walking. An abnormal gait occurs when a person is unable to walk in the usual way. This may happen due to injuries, underlying conditions, or problems with the legs and feet. Abnormal gait can include dragging of toes when walking, taking high steps or feeling off balance when walking. Certain gait abnormalities are temporary, while others require lifelong management.

Overview

Gait is used to describe a person's manner of walking. Abnormal gait includes a person’s inability to walk the usual way because of a change to the normal walking pattern. Any variations from the usual gait or walking pattern are referred to as gait abnormalities. These variations can occur due to injuries or underlying conditions. Age, personality, and mood can have a significant impact on how someone walks. Gait and balance issues are significantly more common in older people; 1 in 10 people between the ages of 60 and 69 and more than 6 in 10 people over the age of 80 have irregularities in their gait.¹ 

Children are less likely to develop a gait abnormality, except in cases of an accident or underlying health issues. Gait abnormalities can significantly lower a person's quality of life and limit their ability to live independently.² Additionally, balance and gait issues may lead to falls, which are the most typical reasons for serious injuries in older populations. Strength, coordination, and sensation are all contributing factors that allow a person to walk with a normal gait. An irregular gait can occur when one or more of these systems are not functioning properly. Examples of gait abnormalities include:

• Limping
• Dragging toes
• Shuffling feet
• Short steps
• Weight-bearing
• Trouble with coordination

Types of abnormal gait

Gait abnormalities are divided based on various factors:

Antalgic gait

An antalgic gait is an abnormality which develops because of pain. It is the most common type of gait abnormality. This abnormality occurs as a result of the person not taking steps with the affected leg to reduce pressure and avoid pain. This results in a limping appearance with slow short steps, usually because of a reduced range of movement or an inability to put your full weight on the leg because of pain. Antalgic gait can be seen after trauma, osteoarthritis, or pelvic girdle pain.

Propulsive gait (also known as Parkinsonian gait or Festinating Gait)

Propulsive gait happens when a person walks with their head and neck bent forward with a stooping posture. It may appear as though they are tightly maintaining a slouched posture. In order to keep their centre of gravity constant, the steps taken are typically short and swift. This type of gait is seen in patients diagnosed with Parkinson’s disease.

Scissors gait

A person with a scissors gait typically walks with their legs bent inward. With this type of gait abnormality, a person’s knees and thighs cross and may hit each other while walking. The crisscross motion resembles a scissor-like pattern. The steps taken may be slow and small. Patients who have been diagnosed with spastic cerebral palsy frequently exhibit this gait abnormality. 

Spastic gait (also known as hemiplegic gait)

With a spastic gait, a person walks with stiffness in their leg. It is seen when a person walks with a narrow base while dragging both legs and scraping the toes. The stiff leg drags or swings in a semi-circular manner as it is lifted to walk. This gait is seen among patients diagnosed with cerebral palsy, multiple sclerosis or hemiplegia.

Steppage gait (also known as neuropathic gait or Equine Gait)

This type of gait causes high stepping, where the hip is lifted higher than normal during walking so that the foot does not drag on the floor. the foot may appear floppy as it drops due to weakness of foot dorsiflexion movement (raising the foot upwards towards the shin) causing the toes usually point down and scrape the ground. Muscle atrophy, nerve injury or neuropathic disorders (such as those associated with uncontrolled diabetes) can cause a steppage gait.

Waddling gait (myopathic gait or Trendelenburg gait)

A waddling gait causes an exaggeration in the movement of the upper body, which creates a duck-like walk. It occurs due to weakness of the hip abductor muscles. A person with a waddling gait moves from side to side when walking, taking short steps as well as swinging the body.

Crouching gait

With a crouching gait, the ankles, knees and hips flex, giving the impression that the person is leaning over. This type of gait is common in patients who have cerebral palsy.

Ataxic gait

This gait is described as a wide-based gait with clumsy and staggering movements. It causes irregular steps that affect the ability to walk in a straight line when walking heel to toe. While standing still, the body may be unsteady and swagger back and forth and from side to side. This type of gait occurs with cerebellar disease. 

Shuffling gait

A shuffling walk consists of walking without lifting the feet completely off the ground. This causes the feet to drag. A shuffling gait can be seen in a person who is unsteady or has a condition that makes it difficult for them to lift their feet off the ground when walking.

Lurching gait

People with paralysis or weakening of the gluteus muscles may have a lurching gait. These are the muscles in the hips and butt area. It causes a slow and long stride in which the upper body is pulled either forward or backward to relieve pressure on the injured leg.

Magnetic gait

Magnetic gait abnormality is associated with the inability to lift the feet off the floor. The feet appear stuck to the ground. There is a decrease in mobility and an increased risk of falls. This type of gait is commonly seen in a condition called normal pressure hydrocephalus.

Causes of abnormal gait

Nerve impairment, bone conditions (such as osteoarthritis and bone deformities), and other medical diseases (such as heart failure, respiratory failure, peripheral artery occlusive disease and obesity) can all contribute to gait disorders. The most common causes of gait abnormalities include: 

• Injuries to the legs or feet
• Joint conditions such as arthritis
• Infections in the soft tissue of the legs
• Birth-defects
• Infections in the inner ear which can affect balance
• Conditions affecting the nervous system such as cerebral palsy or stroke

Other possible causes include:

Neurological diseases

Any condition affecting the nerves in the body can affect the gait. There are several diseases that can attack the nervous system resulting in an abnormal gait. Parkinson's, Huntington's, and normal pressure hydrocephalus are just a few examples of such conditions.

Vitamin deficiency

Common vitamin deficiencies that can result in abnormal gait include folate, vitamin B12, vitamin E and copper deficiency. It has been proven that a deficiency in these vitamins causes neurological dysfunctions that make normal giat difficult.

Electrolyte imbalance

Electrolyte disorders like hyponatremia, hypokalaemia, and hypomagnesemia might affect gait. Maintaining adequate musculoskeletal function, which directly affects normal walking, requires electrolyte balance.

Psychiatric

Gait problems have also been linked to psychiatric disorders such as anxiety and depression.

Signs and symptoms of abnormal gait

Signs and symptoms of gait abnormalities depend on the cause and type of gait abnormality. Some of the symptoms that can be seen are:

• Pain while walking 
• Back pain
• Dragging or shuffling of feet
• Imbalance
• Muscle or joint stiffness
• Waddling

Management and treatment for abnormal gait

The first step in treating gait abnormalities is identifying the underlying cause. The cause of gait and balance abnormalities is what determines the appropriate treatment. Physiotherapy and medicine are two possible treatments. The treatment plan is based on the location and intensity of a patient's symptoms. Treating the underlying cause, such as injuries, often improves the gait. The risk of falling is decreased after physiotherapy and is often helpful for both short- and long-term gait abnormalities.

Nutritional deficiencies can be treated with lifestyle changes, while vitamin deficiencies can be treated with supplements. To make sure therapeutic vitamin levels are reached in these patients, routine laboratory testing must be continued. Neurologic causes of gait disturbances can be treated with medications to provide symptomatic relief. Gait training, the use of assistive devices, and fall prevention strategies are all beneficial to improve gait. Elderly people can enhance their regular and maximum gait speed with the help of muscle strengthening, coordination and resistance training exercises.

Diagnosis

Diagnosis happens based on gait analysis. A clinical assessment of muscles and joints is carried out by a physiotherapist and is followed by gait analysis. The gait analysis consists of walking up and down a lab several times; movement data is recorded by motion capture cameras and gait is observed. The whole process can take one to three hours.

Clinical assessment includes the following:³

• Standing
• Posture
• Stance (narrow or wide)
• Initiation
• Walking
• Step length
• Speed
• Arm swing
• Freezing
• Turning
• Tandem gait 
• Romberg's test
• Blind walk
• Backwards walking
• Fast turning
• Heels walking
• Toes walking
• Running (if able to perform) 

Complications

The complications of gait abnormalities could include:

• Pain
• Increased risks of falls due to imbalance
• Weakness of muscles

Risk factors

Risk factors for developing gait abnormalities include:

• Age more than 60 years
• History of conditions affecting movements, joints, bones, muscles, brain or spinal cord
• History of injury

FAQs

How can I prevent abnormal gait?

There is not much a person can do to stop an abnormal gait caused on by a medical condition or genetics. However, people can take precautions to avoid accidents that result in gait abnormalities. Taking safety precautions and wearing protective gear can help avoid injuries. 

How common is abnormal gait?

The prevalence of gait and balance disorders markedly increases with age, from around 10% between the ages of 60 and 69 years to more than 60 % in those over 80 years.¹

When should I see a doctor?

You should consult a doctor if you have difficulty walking and are experiencing symptoms such as limping and imbalance.

Summary

Gait and posture are both essential for a person's quality of life. A normal gait leads to functional independence. Age, personality, mood, and sociocultural influences all impact a person's walk pattern. The prognosis of gait abnormalities depends on the cause. Deficiencies and injuries that can be healed have a relatively good prognosis. However, many neurologic conditions are incurable and can only be managed symptomatically. Neurologic problems frequently get worse over time, making treatment ineffective.