Knee Exam
 

Assessment of Gait

 
 
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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
 
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