Gait - Patterns of sensory loss

Gait

Spastic gait: This is a sign of upper motor neurone disease. The gait is stiff, one or both legs are kept extended. If unilateral, the leg is swung out to the side to move it forwards (circumduction). If bilateral, the pelvis has to alternately tilt and the gait often becomes scissor-like. The patient can stand on tip-toe, but often not on their heels.

Foot-drop: This is caused by weakness of ankle dor-siflexion, usually a feature of a lower motor neurone disease such as a peripheral neuropathy. The knee is lifted high and as the ankle cannot dorsiflex, the foot tends to slap on the ground. If bilateral, it is called a high-stepping gait.

Ataxic: This is the typical gait of a person with cerebellar disease. The gait is broad-based, and there may be a tendency to veer to the side of the lesion in unilateral disease. Even if mildly affected the patient is unable to walk heeltoe in a straight line.

Parkinsonian: There is hesitancy, that is slowness in initiating movement, and turning. The steps are small and shuffling, and the patient tends to be flexed or stooped. ‘Festination’ is the hurrying steps which appear to be the only way the patient can remain upright. In the upper limbs, there is reduced arm swing, and increased tremor may be apparent. In Parkinson’s disease, this pattern tends to be asymmetrical, whereas it is symmetrical in other causes of parkinsonism.

Waddling gait: Proximal muscle weakness such as occurs in myopathies leads to difficulty in rising to an erect position and then the pelvis tends to drop on the side of the lifted leg.

Antalgic gait: Pain around the joints or within the muscles may give rise to abnormalities in gait (the classical limp).