Alternate Names: Gait/walking abnormalities

Considerations: The pattern of how a person walks is called the gait. Many different types of gait abnormalities are produced unconsciously. Most, but not all, are due to some physical malfunction.

Some gait abnormalities are so characteristic that they have been given descriptive names:

• Propulsive gait (characterized by a stooped, rigid posture, with the head and neck bent forward)
• Scissors gait (characterized by legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement)
• Spastic gait (characterized by a stiff, foot-dragging walk caused by one-sided, long-term, muscle contraction)
• Steppage gait (characterized by foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking)
• Waddling gait (characterized by a distinctive duck-like walk that may appear in childhood or later in life)

• Vestibular (the inner ear is responsible for maintaining balance; damage results in vertigo)
• Central nervous system (diseases of the brain that cause muscular problems resulting in gait disturbance such as multiple sclerosis and cerebral palsy)
• Spinal cord abnormalities (disease, trauma, degeneration)
• Peripheral nerve diseases (nerves from the spinal cord to the muscles may be damaged by disease or trauma and result in gait abnormalities)
• Degenerative muscle diseases (muscular dystrophy, myotonic dystrophy, myositis)
• Neurodegenerative illnesses (Parkinson's disease)
• Skeletal abnormalities and disease
• Arthritis
• Skin conditions (plantar warts, bunions, ingrown toenails, ulcers)
• Toxic reactions (alcohol, drugs, toxins)

Common Causes: ABNORMAL GAIT IN GENERAL

• Trauma
• Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin ulcer, swelling, spasms)
• Chondromalacia patellae
• Fracture
• Hemophilia
• Immunization (soreness in the leg or buttocks)
• Legs that are different lengths
• Myositis
• Tight or uncomfortable shoes
• Shin splints
• Infection
• Tendinitis
• Torsion of the testis
• Conversion disorder (a psychological disorder)

• Propulsive gait:
  • Carbon monoxide poisoning
  • Manganese poisoning
  • Parkinson’s disease
  • Drugs including phenothiazines, haloperidol, thiothixene, loxapine, metoclopramide, and metyrosine (usually drug effects are temporary)
• Scissors gait:
  • Cerebrovascular accident (stroke)
  • Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)
  • Liver failure (hepatic failure)
  • Multiple sclerosis
  • Pernicious anemia
  • Spinal cord trauma
  • Spinal cord tumor
  • Syphilitic meningomyelitis
  • Syringomyelia
  • Cerebral palsy
• Spastic gait:
  • Brain abscess
  • Brain tumor
  • Cerebrovascular accident (stroke)
  • Head trauma
  • Multiple sclerosis
• Steppage gait:
  • Guillain-Barre syndrome
  • Herniated lumbar disk
  • Multiple sclerosis
  • Peroneal muscle atrophy
  • Peroneal nerve trauma
  • Poliomyelitis
  • Polyneuropathy
  • Spinal cord trauma
• Waddling gait:
  • Congenital hip dysplasia
  • Muscular dystrophy
  • Spinal muscle atrophy

Home Care: Treatment of the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals.

For an abnormal gait that occurs with conversion disorder, psychiatric counseling as well as comfort and love from family members is strongly recommended.

For a propulsive gait:

• Encourage the person to be as self-reliant and independent as possible.
• Allow plenty of time for daily activities, especially walking. People with this problem are susceptible to falls because of poor balance and an unconscious effort to always catch up.
• Provide walking assistance for safety reasons, especially on uneven ground.
• Consult a physical therapist about exercise therapy and walking retraining.

• Loss of skin sensation is often associated with scissors gait, so skin care should be provided in order to avoid skin breakdown and ulcers.
• Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate.

• Both active and passive exercises are encouraged.
• Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate.
• Use of a cane or a walker is recommended for those with poor balance.

• Adequate rest is encouraged. Fatigue can often cause affected people to stub their toes and fall.
• Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate.

• Follow the prescribed therapy.

Call If:

If there is any sign of uncontrollable and unexplained gait abnormalities, call your health care provider.

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting the problems with walking in detail may include:

• Time pattern
  • When did this problem with walking begin?
  • Did it occur suddenly or gradually?
  • Has it become worse over time?
• Quality (type of gait disturbance)
  • Scissors gait (flexed hips and knees; legs cross each other)
  • Steppage gait (foot drop; toes scrape ground)Sspastic gait (stiff, foot-dragging walk)
  • Propulsive gait (stooped, rigid posture; head, neck bent forward)
• Other symptoms
  • Is there pain?
  • If there is pain, is it in the muscles, joints, spine, or other location?
  • Is there a fever?
  • Is there testicular pain?
  • Does there appear to be muscle atrophy (wasting)?
  • Is there any paralysis?
  • Are there any muscle spasms?
  • Are there joint deformities (contractures)?
  • Has there been a recent infection?
• Medications
  • What medications are being taken?
• Injury history
  • Have there been any recent or past leg injuries?
  • If there was a leg injury, what type? Was it a broken bone, dislocation, or burn?
  • Has the person had any head injuries, especially one that resulted in a coma?
  • Has the person had any spinal injuries or nerve injuries?
• Illness history
  • Are there any known blood vessel problems?
  • Are there any known Illnesses such as polio, meningitis, myositis, tumors, or stroke?
  • Have there been any recent infections, including abscesses?
  • Does the person have hemophilia?
  • Has the person been exposed to carbon monoxide?
• Treatments
  • Have there been any recent immunizations?
  • Has there been a recent surgery?
  • Has there been any chemotherapy or radiation therapy?
• Self and family history
  • Are there any known birth defects, such as spina bifida, myelomeningocele, or hip dysplasia?
  • Is there a history of cerebral palsy or muscular dystrophy?
  • Has anyone in the family had multiple sclerosis?
  • Has the affected person had any growth abnormalities?
  • Are the legs different lengths?
  • Is there a known problem with scoliosis?