Ankle Exam
 

Assessment of Gait

 
 
Bookmark

Overview

  • Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.
  • Gait involves many different systems - vision, proprioception, upper motor neurons, lower motor neurons, basal ganglia, cerebellum and higher planning centres. Full neurological assessment is required to correlate gait disturbances.
    • How to Assess

    • Ask the patient to walk ~5m and return to their starting point.
    • Look For

    • Posture - position of the head, shoulders and spine.
    • Symmetry - symmetrical rise and fall of the shoulders, hips, knees and feet.
    • Rhythm - natural movement through the stance and swing phases.
    • Coordination - steadiness of the gait and amount of sway. Dyscoordination may indicate an ataxic or spastic gait.
    • Foot separation - wide-based or narrow-based. A wide base  is used to compensate for poor coordination.
    • Stride length - the distance between heel placements of one foot over one gait cycle.
    • Cadence - the number of steps per minute.
    • Causes of Abnormal Gait

    • Pain - inflammation, infection, malignancy, trauma
    • Weakness - muscular, neuromuscular or neurological
    • Deformity - arthritis, surgery, shortening post fracture, congenital malformations
    • Instability - peripheral neuropathy, cerebellar or brainstem pathology

Antalgic Gait

  • The presence of an antalgic gait indicates injury or other pathology causing pain on weightbearing.
    • Look For

    • A painful gait, with quick stance on the affected lower limb.

Ataxic Gait

  • An ataxic gait occurs with cerebellar lesions or with loss of proprioception.
    • Look For

    • An unsteady, staggering, wide-based gait.

Apraxic Gait

  • An apraxic gait is common with frontal lobe pathology.
    • Look For

    • A wide-based gait with short, shuffling steps.

Trendelenburg Gait

  • The Trendelenburg gait is indicative of proximal myopathy.
    • Look For

    • Dropping of the affected side during the stance phase and the unaffected side during the swing phase.

Spastic Gait

  • Spastic gait may occur with cerebral palsy or hemiplegia.
    • Look For

    • A poorly coordinated gait with short steps and jerky movement.

Festinating Gait

  • Festinating gait may be caused by Parkinson's disease or other causes of parkinsonism.
    • Look For

    • Quick, shuffling steps with the torso held rigid.

Short Leg Gait

  • A short leg gait may occur in the context of any condition in which one leg is shorter than the other.
    • Look For

    • Dipping of the affected leg.
    • Causes of Short Leg Gait

    • Congenital short leg
    • Fracture
    • Joint disease
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Want more info like this?
  • Your electronic clinical medicine handbook
  • Guides to help pass your exams
  • Tools every medical student needs
  • Quick diagrams to have the answers, fast
  • Quizzes to test your knowledge
Explore
   
 
 

Read More...

 Allen RH, Gross MT. Toe Flexors Strength and Passive Extension Range of Motion of the First Metatarsophalangeal Joint in Individuals with Plantar Fasciitis. Journal of Orthopaedic & Sports Physical Therapy. 2003; 33: 468-478. Davis H, Blundell C. Clinical examination of the foot and ankle. Orthopaedics and Trauma. 2011; 25(4): 287-292.
Dix-Peek SI. An approach to the assessment of cavus deformity. SA Orthopaedic Journal. 2008 Sep;7(3):54-8.
 Douglas J, Kelly M, Blachut P. Clarification of the Simmonds-Thompson Test for Rupture of the Achilles Tendon. Canadian Journal of Surgery. 2009 Jun; 52(3): 40-41. Douglas J, Kelly M, Blachut P. Clarification of the Simmonds-Thompson test for rupture of the achilles tendon. J Can Chir. 2009; 52(2): E40-E41. Hecht PJ. Hallux Valgus. The Medical Clinics of North America. 2014 Mar; 98(2): 227-232. Heron JR. Neurological Syndromes Associated with Pes Cavus. Proceedings of the Royal Society of Medicine. 1969 Mar; 62: 270-271. Jacobs B. Toe walking, flat feet and bow legs, in-toeing and out-toeing. Paediatrics and Child Health. 2010 May; 20(5): 221-224. Jhadav V, Mahajan P, Mhaske C. Nail Pitting and Onycholysis. Indian Journal of Dermatology, Venereology and Leprology. 2009; 75(6): 631-633. Piazza S, Ricci G, Ienco EC, Carlesi C, Volpi L, Siciliano G, Mancuso M. Pes cavus and hereditary neuropathies: when a relationship should be suspected. Journal of Orthopaedics and Traumatology. 2010 Dec 1;11(4):195-201. Redmond AC, Crosbiec J, Ouvrier RA. Development and eValidation of a Novel Rating system for Scoring Standing Foot Posutre: the Foot Posture Index. Clinical Biomechanics. 21(1): 89-98. Roche A, Hunter L, Pocock N, Brown D. Physical examination of the foot and ankle by orthopaedic and accident and emergency clinicians. Injury, Int. J. Care Injured. 2009; 40: 136–138. Scher RK. Toenail Disorders. Clinics in Dermatology. 1983; 1(1): 114-124. Schwieterman B, Haas D, Columber K, Kunpp D, Cook C. Diagnostic accuracy of physical examination tests of the ankle / foot complex: a systematic review. Int J Sports Phys Ther. Aug 2013; 8(4): 416–426. Scott BW, Al Chalabi A. How the Simmonds-Thompson Test Works. J Bone Joint Surg Br. 1992 Mar; 74B(2): 314-315. Shirzad K. Lesser Toes Deformities. Journal of the American Academy of Orthopaedic Surgeons. 2011 Aug; 19(8): 505-514. Singh D, Bentley G, Trevino SG. Callosities, Corns and Calluses. British Medical Journal. 1996 Jun; 312(7043): 1403. Solis G, Hennessy MS, Saxby TS. Pes Cavus: a Review. Foot and Ankle Surgery. 2000; 6: 145-153. Talusan PG, Milewski MD, Reach JS. Fifth Toe Deformities: Overlapping and Underlapping Toe. Foot Ankle Spec. 2013 Apr; 6(2): 145-149. Torpy J, Burke A. Thrombophlebitis. JAMA. 2011 Apr; 305(13): 1372. Yeagerman SE, Cross MB, Positano R, Doyle S. Evaluation and Treatment of Symptomatic Pes Planus. Current Opinion in Paediatrics. 2011 Feb; 23(1): 60-67.
Feedback