Funny walks

Watching a patient walk is the one of the most important parts of the neurological examination. Normal gait requires that many systems, including strength, sensation and coordination, function in an integrated fashion.  An abnormal gait can be very distinctive, and indicate neurologic diagnoses:

1.  Foot drop, caused by a lesion of the peroneal nerve, sciatic nerve or L5 nerve root:

2. Bilateral foot drops cause a steppage gait as can been seen in Charcot-Marie-Tooth disease and other peripheral neuropathies:

3. Hemiplegic gait is caused by unilateral spastic weakness on one side, usually from a stroke.  The patient stands with arm flexed, and the leg in extended and foot dragging in a semicircle (circumduction):

4. The scissoring gait is seen when both legs are weak and spastic, usually from a spinal cord injury, multiple sclerosis or amyotorphic lateral sclerosis.  For more information on spasticity, click here:

5. The waddling gait is seen in hip girdle muscle weakness from myopathy. These muscles are responsible for keeping the pelvis level when walking, and when they are weak and the patient stands on one leg to initiate a step, the pelvis drops to the other side. Weakness of these same muscles also causes difficulty getting out of a chair and up off the toilet seat:

6. The ataxic gait is seen in cerebellar disease, and is a clumsy, staggering, wide-based gait. Affected patients have particular difficulty walking from heel to toe in a straight line:

7. The gait in Parkinson’s disease demonstrates a stooped posture, small steps which can accelerate forwards (festination), decreased arm swing, freezing and poor postural reflexes.
Mild (early) Parkinson’s Disease:

More severe (advanced) Parkinson’s Disease:

8. Gait apraxia refers to the loss of ability to properly use the legs for the act of walking that cannot be attributed to deficits in sensory, motor, or cerebellar function, or psychiatric disease. There is particular difficulty in initiating gait and making turns, often with a tendency to freeze, with relative preservation of straight-line gait once initiated:

The “Magnetic” gait, seen in NPH, is characterized by a particular difficulty picking up the feet as if they are stuck to the floor. For more information on NPH, click here:

The apraxic gait of Progressive Supranuclear Palsy, differs from Parkinson’s disease by the early gait involvement and falls, stiff extended posture and lack of tremor:

Gait ignition failure is a form of gait apraxia, where the only deficit is initiating a step, and once initiated gait is relatively normal:

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