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Lower Limb Neuro
Lower Limb Neuro
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.
Assessment of Gait
- 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.
- 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
- The presence of an antalgic gait indicates injury or other pathology causing pain on weightbearing.
- A painful gait, with quick stance on the affected lower limb.
- An ataxic gait occurs with cerebellar lesions or with loss of proprioception.
- An unsteady, staggering, wide-based gait.
- An apraxic gait is common with frontal lobe pathology.
- A wide-based gait with short, shuffling steps.
- The Trendelenburg gait is indicative of proximal myopathy.
- Dropping of the affected side during the stance phase and the unaffected side during the swing phase.
- Spastic gait may occur with cerebral palsy or hemiplegia.
- A poorly coordinated gait with short steps and jerky movement.
- Festinating gait may be caused by Parkinson's disease or other causes of parkinsonism.
- 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.
- Dipping of the affected leg.
Causes of Short Leg Gait
- Congenital short leg
- Joint disease
Last updated on December 1st, 2019
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