Disorders of gait may be structural or neurological. When assessing gait, it is important to observe the whole patient and not merely the feet. An abnormality of gait that has been present since birth is usually due to a structural cause or cerebral palsy. Discrepancies of length may originate from disorders affecting joint articulation, bone length or from soft-tissue contractures surrounding the joints. Most of the neurological causes of gait abnormalities result from acquired lesions of the central or peripheral nervous systems. Pain is the underlying cause for the antalgic gait and patients will be able to direct you to the site of origin of the pain. Loss of motor function such as paralysis of dorsiflexion of the foot causes the foot drop gait, more extensive paralysis of the arm and leg with the hemiplegic gait may occur with stroke. Paraesthesia, sensory loss or impairment of joint position sense is suggestive of peripheral neuropathy. Patients with sensory apraxia suffer from proprioceptive impairment and have great difficulties walking in the dark when visual cues are lost. A concomitant resting tremor is associated with Parkinson’s disease and an intention tremor results from cerebellar disease. A previous history of trauma to the lower limb is very significant; fractures of the long bones predispose to length abnormalities on healing. Fractures of the fibular neck may disrupt the common peroneal nerve causing foot drop. Frontal lobe contusions may result from severe head injuries. Diabetes, carcinoma and vitamin B deficiencies are associated with peripheral neuropathies. Alcoholism, multiple sclerosis and drugs such as phenytoin are associated with cerebellar impairment. Direct questioning should be undertaken for previous strokes and Parkinson’s disease.
Gait Abnormalities
History
Duration
Associated symptoms
Past medical and drug history
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Basicmedical Key
Fastest Basicmedical Insight Engine
