Gait pattern | Characteristics of gait | Common causes | Further evaluation |
Weakness with spasticity (UMN) | The toes do not adequately clear the ground because the hip flexors are weak, and the toes scuff with each step. The strategy of circumduction at the hip helps with toe clearance. With bilateral spasticity, the gait is narrow based and scissoring. The toes scrape the floor with each step. | - Compressive myelopathy due to degenerative joint disease, trauma, osteoporotic/compression fractures
- Intrinsic spinal cord disease (hereditary, vascular, neoplastic)
- Central lesions affecting descending motor pathways
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Weakness with foot drop (LMN) | The foot drags, scuffs, or catches with walking. In some patients, a compensatory high-stepping gait develops, making use of hip flexor strength to allow foot clearance. | - Lumbar radiculopathy
- Lumbar spinal stenosis
- Sensorimotor neuropathies
- Mononeuropathies
- Motor neuron disease
| - Lumbosacral spine MRI
- EMG/NCS
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Myopathic gait | Waddling gait and abnormal pelvic tilt with each step because of limb girdle weakness. | - Myopathies (eg, drug-induced, inclusion body myositis, endocrinopathies)
- Sarcopenia and deconditioning
- Myasthenia gravis
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Parkinsonian (extrapyramidal) gait | Narrow-based gait with reduced stride length; the feet barely clear the floor. Posture is stooped and arm swing reduced when walking. The forward center of gravity causes increasingly faster, short steps (hurrying or "festinating"). Turning is by small steps rather than pivoting. | - Parkinson disease
- Multiple system atrophy
- Dementia with Lewy bodies
- Vascular dementia
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Frontal (apraxic) gait | Gait may appear cautious or "magnetic." There is difficulty initiating or maintaining walking. There may be inappropriate or counterproductive postural responses, short shuffling steps, disequilibrium, and start and turn hesitation. | - NPH
- Small vessel disease/vascular dementia affecting bifrontal white matter
- Neurodegenerative dementias
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Sensory ataxia | Classically, gait is high stepping and stamping, and may be slightly wide based. Stride length is normal or a little reduced. The gait deteriorates markedly in the dark. | - Sensory neuronopathy
- Vitamin B12 deficiency
- Compressive myelopathy
- Paraneoplastic disorder
| - Spine MRI
- Vitamin B12 level
- EMG/NCS
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Cerebellar ataxia | The gait may appear to be stumbling, lurching, staggering, reeling, drunken, or slow, with reduced step length and a wide base. Associated features can include other signs of cerebellar dysfunction, including scanning and slow speech, finger-nose and heel-shin dysmetria, and dyssynergia. | - Stroke
- Tumor
- Vitamin deficiencies
- Drug toxicity
- Alcohol
- Hereditary and neurodegenerative ataxias
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Vestibular gait | Deviation on walking to the side of the affected ear. The gait varies from an occasional stumble to frank veering. The legs are slightly spread, and stride length is slightly reduced. Stamping on the spot with eyes closed demonstrates veering (Unterberger test). Often associated with nystagmus. | - Benign paroxysmal positional vertigo
- Vestibular neuritis
- Meniere disease
- Brainstem or cerebellar stroke
| - Brain MRI with fine cuts through internal auditory canals
- Sensorineural vestibular testing
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Functional gait disorder | Walking is bizarre and does not conform to any of the usual patterns. There may be excessive slowness and stiffness, or maintenance of postural control on a narrow base with flailing arms and excessive trunk sway. | | - Clinical diagnosis
- Brain/spine imaging when atypical
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