PHYSIOTHERAPY • REHABILITATION EDUCATION

Gait Abnormalities: Types, Assessment and Physiotherapy Management

Rehab Lectures | Physiotherapy & Rehabilitation Education

1. Introduction

Walking, also called gait, is a coordinated activity that requires muscle strength, joint mobility, balance, sensation, and proper nervous system function. A gait abnormality is a change in the normal pattern of walking. It may affect walking speed, step length, symmetry, foot clearance, balance, or turning. Gait abnormalities can occur due to neurological disorders, muscle weakness, joint pain, injuries, sensory problems, or changes associated with ageing. Physiotherapists assess gait abnormalities to identify functional limitations, improve walking safety, and develop appropriate rehabilitation.

2. What Is Normal Gait?

Normal gait is a coordinated sequence of movements that allows a person to move forward while maintaining balance and minimising unnecessary energy expenditure. One complete gait cycle begins when one foot contacts the ground and ends when that same foot contacts the ground again.

Stance phase — approximately 60% of the cycle: The foot remains in contact with the ground. Its functions are to accept body weight, support the body, and move the body forward. It includes initial contact, loading response, midstance, terminal stance, and pre-swing.

Swing phase — approximately 40% of the cycle: The foot moves forward without contact with the ground. Its main function is to advance the leg and prepare it for the next step. It includes initial swing, midswing, and terminal swing. These percentages are approximate and vary with walking speed and individual characteristics.

3. Causes of Gait Abnormalities

Neurological causes: stroke, Parkinson’s disease, cerebral palsy, multiple sclerosis, spinal cord disorders, peripheral nerve injuries, and foot drop due to nerve dysfunction.

Musculoskeletal causes: osteoarthritis, hip or knee pain, muscle weakness, joint stiffness, fractures and orthopaedic injuries, and leg-length discrepancy.

Sensory and balance-related causes: peripheral neuropathy, reduced proprioception, vestibular disorders, and visual impairment.

Other contributors: fear of falling, pain and fatigue, inappropriate footwear, medication effects, and poorly fitted walking aids.

The same gait pattern can have several different causes. Assessment is essential before treatment is selected.

4. Common Types of Gait Abnormalities

A. Antalgic gait

Definition: A protective walking pattern used to reduce pain during weight-bearing.

Common causes: hip osteoarthritis, knee osteoarthritis, ankle sprain, foot pain, fractures, or other painful injuries.

Features: reduced time spent standing on the painful leg, shortened stance phase on the affected side, uneven step timing, and reduced walking speed.

Management: assess the source and severity of pain; modify aggravating activities; restore comfortable joint mobility when appropriate; introduce strengthening and functional exercises according to the diagnosis; and progress weight-bearing as medically appropriate.

Clinical point: A new painful gait after trauma, particularly with inability to bear weight, requires prompt medical assessment.

B. Trendelenburg gait

Definition: Associated with inadequate control of the pelvis during single-leg support, often due to weakness or dysfunction of the hip abductor mechanism.

Causes: hip abductor weakness, hip joint disorders, superior gluteal nerve dysfunction, and certain postoperative hip conditions.

Features: the pelvis may drop on the side opposite the supporting leg; the person may lean the trunk toward the supporting leg; single-leg balance may be reduced.

Management: hip abductor strengthening, supported single-leg weight-bearing practice, pelvic control exercises, step-up and functional movement training, and gait/walking-aid assessment when indicated. Adjust exercises to pain, surgical precautions, and safe pelvic control.

C. Steppage gait

Definition: The person lifts the knee and hip more than usual to clear the foot during swing.

Causes: foot drop, common fibular (peroneal) nerve injury, L5 nerve-root dysfunction, peripheral neuropathy, and certain neurological disorders.

Features: excessive hip and knee flexion during swing, reduced ankle dorsiflexion, difficulty clearing the toes, and increased risk of tripping.

Management: assess ankle dorsiflexor strength and neurological function; strengthen where appropriate; practise safe gait and foot-clearance strategies; consider an ankle-foot orthosis (AFO) when clinically appropriate; assess footwear and fall risk; and refer for medical evaluation. New foot drop requires prompt assessment.

D. Spastic gait

Definition: A walking abnormality associated with increased muscle tone and impaired selective motor control, commonly following upper motor neuron pathway damage.

Causes: stroke, cerebral palsy, multiple sclerosis, and spinal cord injury.

Features: limb stiffness, reduced knee flexion during swing, difficulty clearing the foot, abnormal muscle activation, and reduced walking speed/balance. Circumduction may occur when the leg moves outward in an arc to clear the foot.

Management: task-specific gait training, strengthening weak muscles, stepping and weight-transfer practice, range-of-motion exercises when indicated, balance and functional mobility training, orthotic assessment, and medical collaboration when spasticity limits function. Focus on functional goals; muscle tone may sometimes assist standing or transfers.

E. Parkinsonian gait

Definition: A walking pattern commonly associated with Parkinson’s disease.

Features: short shuffling steps, reduced arm swing, stooped posture in some individuals, difficulty initiating walking, reduced turning efficiency, freezing of gait in some situations, and festination (steps become progressively quicker and may shorten).

Management: practice larger purposeful steps; use visual or rhythmic auditory cues when helpful; practise safe turning; provide balance and strength training; perform functional gait training; and educate about freezing triggers and fall prevention. Medication timing, fatigue, and symptom fluctuations may affect walking performance.

F. Waddling gait

Definition: Side-to-side movement of the trunk and pelvis during walking.

Possible causes: bilateral hip abductor weakness, certain muscular dystrophies, proximal muscle weakness, and some hip disorders.

Features: side-to-side trunk movement, difficulty maintaining pelvic stability, and possible difficulty climbing stairs or rising from a chair.

Management: assess proximal muscle strength and hip function; provide graded strengthening; train pelvic control and functional mobility; avoid excessive fatigue in progressive muscle weakness; and refer for medical evaluation when the cause is unknown or progressive.

G. Ataxic gait

Definition: Walking characterised by impaired coordination and unsteadiness.

Possible causes: cerebellar disorders, some neurological diseases, sensory pathway dysfunction, and certain medication or toxic effects.

Features: irregular step length, variable foot placement, often a wider base of support, and difficulty with balance and turning.

Management: assess coordination, balance, and walking safety; provide supported balance and gait training; practise controlled stepping and functional activities; assess need for a walking aid; and refer for medical assessment if onset is new or unexplained. Sudden-onset ataxia may indicate a neurological emergency.

H. Scissoring gait

Definition: Excessive inward movement of the thighs, causing the legs to cross or approach each other during walking.

Causes: spastic cerebral palsy and other upper motor neuron disorders.

Features: increased hip adduction, legs crossing during stepping, difficulty with foot placement, and reduced walking stability.

Management: task-specific gait practice, strengthening and motor-control training, functional balance exercises, and assessment of footwear/orthoses when appropriate. Multidisciplinary management may be needed.

I. Sensory ataxic gait

Definition: Occurs when reduced sensory information, especially proprioception, interferes with awareness of limb position.

Causes: peripheral neuropathy, posterior column disorders, and certain neurological diseases.

Features: reduced awareness of foot position, heavy or stamping steps in some individuals, greater instability when visual feedback is reduced, and difficulty walking in low light.

Management: assess sensation and balance; train safe foot placement and controlled stepping; improve environmental lighting; consider an appropriate walking aid; and use suitable support and supervision. Removing visual support should not be an unsupervised exercise for someone with significant sensory loss.

5. Clinical Gait Assessment

Subjective assessment: ask about onset and duration, sudden or gradual progression, pain, stiffness, weakness, numbness, previous falls, dizziness, medical and surgical history, medications, walking aids/orthoses, difficulty with stairs/transfers/daily activities, and patient goals.

Observation: observe from the front, side, and back when safe. Assess posture and trunk position, base of support, step length and cadence, walking speed, stance/swing symmetry, arm swing, foot clearance, knee/hip movement, pelvic control, turning, and compensatory movements.

Physical examination: assess muscle strength, joint range of motion, muscle tone, sensation and proprioception, coordination, static and dynamic balance, pain/swelling, foot and ankle function, and transfers as relevant.

Common outcome measures:

• 10-Metre Walk Test: measures walking speed over a defined distance.
• Timed Up and Go (TUG): assesses standing, walking, turning, and sitting.
• Berg Balance Scale: measures performance on functional balance tasks.
• Functional Gait Assessment (FGA): evaluates walking under conditions such as changing speed, turning the head, and stepping over obstacles.
• Six-Minute Walk Test: measures distance walked over six minutes and may assess walking endurance.

Choose tests according to ability and safety. Use consistent procedures to compare results over time.

6. Physiotherapy Treatment Principles

A. Strengthening exercises: sit-to-stand, supported heel raises, knee extension, hip abduction, and appropriate step-ups. Exercise selection and dosage depend on diagnosis, pain, fatigue, and function.

B. Balance training: supported weight shifting, standing balance, controlled reaching, stepping in different directions, safe turning, and functional balance tasks. Provide support and supervision when fall risk is high.

C. Gait retraining: target the specific problem, such as increasing step length when steps are abnormally short, improving foot clearance in foot drop, improving pelvic control in Trendelenburg gait, practising safe turns in Parkinsonian gait, or improving weight transfer and limb advancement after stroke. Treatment must reflect the underlying impairment and patient goals.

D. Task-specific training: practise walking from a chair to a doorway, turning to sit down, walking on appropriate outdoor surfaces, negotiating steps with a handrail, and safe transfers. Progress from simpler to more challenging tasks as control improves.

E. Assistive devices and orthoses: a cane, walker, ankle-foot orthosis, or other prescribed orthosis may help. The device must be appropriately fitted, and the patient should be trained in safe use.

10. Role of the Physiotherapist

Physiotherapists help identify movement impairments, improve functional walking, reduce preventable fall risks, and support independence. Their role includes clinical gait and functional assessment, exercise prescription, task-specific gait retraining, balance and mobility training, assistive-device assessment, patient/caregiver education, monitoring progress and safety, and referral when medical or neurological investigation is needed.

11. Conclusion

Gait abnormalities can result from neurological, musculoskeletal, sensory, or other medical conditions. Recognising the walking pattern can guide assessment, but the pattern alone does not confirm the underlying diagnosis. Effective physiotherapy management combines clinical reasoning, individualised exercise, gait retraining, balance practice, and appropriate assistive strategies. Early recognition of red flags and timely referral are essential for patient safety.

Educational disclaimer: This article is intended for educational purposes and does not replace an individual clinical assessment, medical diagnosis, or personalised rehabilitation programme.