The term “gait” refers to the manner or way a person walks. Any disruption of the normal, rhythmic manner of walking can be called a gait disturbance. The most common gait disturbance is a limp, but there are many others as well.

Pain is a frequent, though not the only, cause of gait disturbance. When experiencing pain while walking, people tend to compensate by altering their gait (e.g., limping, walking on their toes). Gait disturbances may also cause pain. For example, many gait disturbances put extra weight on one knee. The added stress can result in more pain in that area.

A gait disturbance may be caused by something minor or transient (a stone in a shoe or even pregnancy, for instance) or a serious medical condition, such as fractures, deformities, arthritis or neurological conditions. Leg pain, knee pain, foot pain and back pain are common sources of gait disturbances. In many cases, a gait disturbance may be the first sign of a condition.

A physician evaluating a gait disturbance will obtain the patient’s medical history and perform a physical examination, including a gait assessment. The physician will focus on potential causes of the disturbance and particular factors of the disturbance itself.  

To help determine the potential cause for the gait disturbance, the physician may order diagnostic tests. These tests can include imaging studies, such as x-rays, MRI or bone scan. Other tests may include blood tests that can help diagnose certain medical conditions that could contribute to gait disturbances. 

Treatment includes correcting or healing the underlying cause, such as immobilizing a broken bone. Methods of alleviating pain (e.g., ice, painkillers) and support devices (e.g., crutches) may help the patient function with the gait disturbance. Physical therapy may be used to treat contributing factors, such as muscle weakness or joint instability. The prevention of gait disturbances relies upon treating and preventing the illnesses and injuries that cause disturbances.

Gait disturbances are abnormalities in gait, a person’s manner of walking. A normal gait is rhythmic, smooth and seemingly effortless. Weight is distributed evenly on both sides of the body and stride (distance between footsteps) is even. The heel is the first part of the foot to touch the ground and the first part to be lifted from the ground. Any change in this normal manner of walking (e.g., uneven weight distribution, uneven or erratic stride, abnormal step) is considered to be a gait disturbance.

Many factors, including nonpainful ones, interrupt normal gait. However, pain is a major cause of many gait disturbances. When normal walking involves pain or discomfort, individuals tend to compensate by altering their gait. A limp resulting from pain is the most common gait disturbance.

Abnormal gait can affect joints and cause or worsen existing problems. Stress and weight may be delivered unevenly, weakening a joint. This may worsen the gait disturbance, typically by producing more pain, causing a cycle of problems. Pain causes or worsens a gait disturbance which results in further pain and worsening of the disturbance.

A disturbance in gait may be obvious to any observer but may require a healthcare professional to determine the specific factors. Age may complicate the diagnosis of a gait problem. A child may exaggerate a limp for attention or may attempt to hide it. In the elderly, a certain gait disturbance, referred to as a senile gait, may indicate other difficulties.

It is important for continued or unexplained gait disturbances to be seen by a physician. The longer they are left untreated, the more difficult they may be to correct. They may also indicate a more serious problem that may need medical attention. For instance, limping in a child just learning to walk needs to be seen by a pediatrician as soon as possible because it may be indicate congenital or developmental problems.

For older juveniles and adults, many causes are minor and disappear overnight or within a few days. However, if they continue, a physician may recommend certain types of treatment to avoid placing too much stress on different parts of the body.

There are a great number of different gait disturbances. Some are specifically characteristic of particular conditions, and some may be seen with many problems. Gait disturbances are generally either structural or neurological. However, there may be significant overlap. Types of gait disturbances that may frequently result from either structural or neurological causes include:

• Ataxic gait. A staggering, unsteady and uncoordinated gait typically caused by abnormalities of the nervous system. A variation of this is the tabetic gait, a high-stepping ataxic gait where the feet slap the ground.
  
  
• Toe-walking gait. This is a common gait disturbance in which the patient walks on the toes. A variation on this is the equine gait, which is a high-stepping toe-walking gait.
  
  
• Steppage gait. Commonly seen with foot drop, where the foot appears to hang limp at the ankle. The foot is lifted high so that the toes do not drag on the ground and the toes touch ground first. The hip and knee are typically bent more than normal in order to clear the toes from the ground.

Types of gait disturbances that are typically structural only include:

• Limp. A jerky, uneven gait that may be caused by pain, weakness or deformity. Antalgic gait, a type of limp, is the most common gait disturbance. It is caused by pain and compensates for that pain by keeping weight off of a painful part as much as possible.
  
  
• Spastic gait. A stiff gait where the toes catch and drag, the legs are held together and the hips and knees are kept in a slightly bent position.
  
  
• Hemiplegic gait. This gait is characteristic of paralysis or weakness in one leg and is common after a stroke. The patient swings the paralyzed leg around to bring the foot in front. This gait avoids placing weight on the affected leg.
  
  
• Senile gait. This gait is usually seen in the elderly. It is associated with a stooped posture, with knees and hips bent. Arm swinging is lessened and there is stiffness in turning. Steps are small and broad-based.
  
  
• Waddling gait. The feet are held wide apart and the patient walks somewhat like a duck. This is a common gait disturbance in late pregnancy

Types of gait disturbances that are typically neurological only include:

• Festinating gait. In this gait disturbance, the patient walks on the toes as if being pushed. Steps start slowly and increase in speed. Often, the patient cannot stop until grasping or running into something.
  
  
• Parkinson’s gait. This is a form of festinating gait characteristic of Parkinson’s disease. Steps are short and shuffling, with feet scrapping the ground. They start slow and build up speed. The patient’s upper body is bent forward, head down, and arms, elbows, hips and knees are bent.
  
  
• Magnetic gait. Also called glue-footed gait. The patient seems to have difficulty taking the first step, as though the feet had been glued to the ground. Once the first step is made, subsequent steps are small and shuffling.
  
  
• Double-step gait. In this gait disturbance, alternating steps are made of different length or rate. The stride of one side does not match the other.
  
  
• Helicopod gait. The patient swings one or both feet in a half circle with each step.
  
  
• Scissor gait. In this gait, the legs cross in walking. The left leg moves too far to the right and the right leg moves too far to the left.

The cause of gait disturbances may be minor (e.g., stone in a shoe) or serious (e.g., neurological damage). In a number of cases, a characteristic gait disturbance may be the first sign that a condition presents. Abnormalities or injuries of the nervous system, back, lower limb or abdomen may cause difficulty walking.

Gait disturbances often result from leg pain, knee pain, foot pain or back pain. The location of pain may not reflect the location of the injury or abnormality, so a problem in the hip may cause pain in the knee. Many causes of gait disturbances are structural issues with the bones and/or joints. These issues typically result in a variety of different forms of pain. When this pain occurs with or is made worse by walking, the gait is altered to compensate. In fact, any pain in weight-bearing structures of the body (e.g., feet, legs, knees, hips) may result in compensation by altering the gait. This may range from injuries (e.g., jammed toe, sprained ankle, leg fracture) to medical illnesses and conditions. Such conditions may include:

• Arthritis and other inflammatory or degenerative conditions. These may cause pain and decreased mobility of a joint, causing gait disturbance. Acute and chronic arthritis may affect the hip, knee, ankle, foot or spinal joints and cause a disturbance in gait. Rheumatoid arthritis, infectious arthritis, osteoarthritis, gout and pseudogout are common causes of limp.
  
  Inflammation in structures other than the joints may also result in a gait disturbance. These include inflammation of the fluid sac lubricating the joints (synovitis), muscles (myositis), tendons (tendinitis), bursa (bursitis) or fascia (for example, plantar fasciitis).

Many overuse injuries, such as those sustained in athletics, can disrupt gait, including shin splints, Osgood-Schlatter disease, iliotibial band syndrome, patellofemoral syndrome, patellar tendinopathy, plica syndrome or a damaged Achilles tendon or knee ligament or meniscus.

Degenerative conditions include osteochondroses (degenerative changes in bone formation during periods of rapid growth) and osteonecrosis (lack of blood supply to the bone causes tissue to die).

• Infections. These include discitis, an infection of an intervertebral disc (disc that sits between the vertebrae to cushion them). This may cause severe pain and gait disturbances.  Also, trauma or infection (e.g., osteomyelitis) in the feet, legs or joints can cause a gait disturbance.
  

• Musculoskeletal deformity. An example is tarsal coalition, where fibrous bony connection forms between two or more tarsals (long bones in the foot). This is present at birth but is typically only noticed after the age of 10 years, when the coalitions (connections) ossify (turn into bone). Motion in the foot is limited and pain is produced. The pain worsens with activity (e.g., walking on uneven ground, running) and typically results in a limp. Other examples of deformities include clubfoot, leg-length discrepancy, congenital hip dislocation and scoliosis.
  
  
• Appendicitis. Inflammation of the appendix. In some cases, this may cause acute pain that may irritate a muscle that leads toward the leg. This pain radiating down the leg may cause the patient to limp.
  
  
• Tumors. Tumors, both benign (e.g., osteoid osteoma) and malignant (e.g., leukemia), may cause a variety of gait disturbances.
  
  
• Other conditions that may cause a gait disturbance include:
  
  
• Rheumatic fever
• Serum sickness
• Developmental dysplasia of the hip
• Hemarthrosis (blood accumulation in the joint)
• Lyme disease
• Sickle cell anemia
• Systemic lupus erythematosus
• Other sources of lower-body joint pain

Many gait disturbances result from neurological problems. These may occur in the brain, spinal cord, or peripheral nerves. When these nerves are affected, muscle coordination may be impaired, resulting in an abnormal gait.

Among the neurological causes of gait disturbances are chronic, progressive neurological disorders such as Parkinson’s disease, muscular dystrophy, multiple sclerosis, amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), post-polio syndrome and Huntington’s chorea. Impaired gait can also indicate Alzheimer’s disease or other dementias.

Other neurological causes include:

• Cervical spinal stenosis. A narrowing of the spinal canal in the neck that can cause pressure on the brain in the back of the skull. This may result in a spastic or ataxic gait.
  
  
• Cerebral palsy. Brain damage typically occurring before birth and resulting in muscular impairment. This may result in a variety of gait disturbances.
  
  
• Stroke. A life-threatening event in which a part of the brain is deprived of sufficient oxygen. Stroke often causes weakness or paralysis on one side of the body and results in a hemiplegic gait.
  
  
• Dizziness, vertigo, Meniere’s disease, cerebellar dysfunction or decreased sensations in the feet. Patients with any of these conditions tend to have a wide gait, which means putting the feet more outside the body’s midline than usual.
  
  
• Peripheral neuropathy. For example, diabetic neuropathy is a common cause of foot problems and may cause a disabling deformity known as Charcot foot. Neuropathies can also be due to conditions ranging from trauma to alcoholism.
  
  
• Nerve impingement in the lower back. For example, sciatica, which may be due to a herniated disc, degenerative disc disease or spinal stenosis,  can cause weakness in legs, leading to a gait disturbance.
  
  
• Complex regional pain syndrome. This chronic condition encompasses two disorders formerly known as reflex sympathetic dystrophy syndrome and causalgia. It usually occurs after a trauma to an arm or a leg and is characterized by burning or aching pain along with inflammation, skin discoloration, altered temperature, abnormal sweating and hypersensitivity of the affected area.
  
  
• Charcot-Marie-Tooth disease (CMT). Though little known to the general public, CMT is one of the more common inherited nerve conditions. Also known as hereditary motor and sensory neuropathy (HMSN) and peroneal muscular atrophy, CMT impairs peripheral nerves and may result in foot drop, high-stepping gait or deformities of the foot.
  
  
• Medications. The drugs most associated with gait disturbances are neuroleptics. Long-term use of neuroleptics, usually prescribed for psychiatric disorders and sometimes for neurological or gastrointestinal conditions, can cause tardive dyskinesia (difficulty in performing voluntary movements).

In evaluating gait disturbances, a physician will obtain the patient’s medical history, including past medical conditions, medications and other treatments. In the study of a patient’s medical history, a physician evaluating a gait disturbance may go over many factors, such as:

• Duration and possible cause of the gait disturbance
  
  
• Effect the disturbance has on the patient’s daily activities
  
  
• History of illness or trauma that may be linked to the disturbance
  
  
• Symptoms that may be associated with the disturbance, including fever, pain, swelling and redness
  
  
• Location, duration and severity of symptoms
  
  
• Aggravating and relieving factors

A gait evaluation allows a physician to study a gait disturbance and pinpoint possible weaknesses and causes. The patient will typically be asked to walk around while the physician observes a number of factors.  The patient may also be asked to run, hop on one leg, then the other, walk on heels and then toes or walk in tandem (placing one foot directly in front of the other). The physician will look for any abnormalities in gait, such as festination (involuntary tendency for steps to accelerate and become smaller), foot slap or shuffling.

During the physical examination, the physician will investigate many factors that could not be seen in a gait evaluation alone. The physician will look for or observe many factors, including:

• Range of motion of spine, hips and knees
• Muscle strength
• Tenderness in joints or bones
• Inflammation of joints, tendons or muscles
• Discrepancy in leg length
• Evidence of pinched nerves
• Abnormal curvature of the spine, such as scoliosis

To help diagnose possible causes of the gait disturbance, various tests may be ordered. X-rays are almost always performed if the cause of the gait disturbance is not obvious. Even if the cause is obvious, many physicians prefer to examine an x-ray to ensure that there are no complications, such as coexisting conditions. Other tests that may be done include:

• Bone scan. A type of radionuclide imaging that indicates abnormal areas in bones. A bone scan may locate any deformities and evaluate bone density.
  
  
• Ultrasound. Imaging of soft tissues via high-frequency sound waves. This test may identify abnormalities in soft tissue such as tears or inflammation in ligaments or tendons.
  
  
• CAT scan (computed axial tomography). Bone imaging via multiple x-rays from many angles. A CAT scan may identify bone problems (e.g., fracture) that may be hidden behind other structures in a plain film x-ray.

• MRI (magnetic resonance imaging). Body imaging via powerful magnets. MRI may locate problems in soft tissues over a much larger area than ultrasound. It may also be more sensitive than other imaging tests in the detection of problems including tears in muscle, ligaments or tendons.
  
  
• Synovial fluid analysis. Laboratory analysis of the fluid that lubricates the joints. This test may be used to identify inflammation and infection that can cause gait disturbances.
  
  
• Complete blood count (CBC). Laboratory analysis that measures the composition of blood cells in the blood. This blood test may be used to identify elevations in white blood cell levels, which may indicate infections.

The treatment and prevention of gait disturbances depends on the cause. Once the cause is treated, the disturbance will often go away. Recurrence of the disturbance can usually be prevented by preventing the injury or illness that caused the disturbance.

One of the most common causes of gait disturbances is pain. When a disturbance is caused by pain, it may be eased by rest, ice therapy, and elevation. Analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used. Typically, if the cause of the pain is removed, the resulting gait disturbance will vanish as well. Some causes of gait disturbances may require hospitalization, antibiotics or even surgery, such as arthroscopy, arthroplasty, leg surgery or spine surgery.

Devices such as splints, casts, canes or braces may improve mobility and function. These tools may be of particular assistance when gait disturbances seriously interfere in the patient’s daily activities.

There are many treatment methods that can help correct or decrease gait disturbances. These methods may focus on treating the underlying cause of the problem as well as the actual gait disturbance. These methods include:

• Physical therapy (PT). Physical therapy is commonly used to improve muscle tone, strength and balance and to teach correction techniques. PT can help determine the cause of the gait disturbance and it is often prescribed by a physician after a structural injury or surgery. PT may be particularly useful when a gait disturbance has existed for a long time and has become habitual.
  
  
• Occupational therapy (OT). Occupational therapy may be used to teach a patient how to maximize independence in daily activities, such as bathing and housekeeping, that may be affected by a gait disturbance. An occupational therapist may visit a patient’s home to make recommendations for assistive devices, such as grab bars in the shower or elevated toilets.
  
  
• Manipulation therapy. A chiropractor may help with gait disturbances with treatment for spinal problems (misalignment) or posture difficulties. Chiropractic treatment may be successful in treating the cause as well as reducing pain from gait problems.
  
  
• Complementary and alternative medicine (CAM). Therapies such as acupuncture or biofeedback may help treat the cause and reduce pain or problems from gait disturbances.

There is no sure way to avoid gait disturbances, but it helps to practice general good health measures. For example, getting regular exercise, eating nutritious food, controlling weight, having routine medical care, limiting alcohol and abstaining from tobacco may reduce the risk of conditions ranging from osteoarthritis to neuropathy. Safety measures such as driving defensively and using seatbelts and protective sports equipment reduce the risk of trauma that could impair walking.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about gait disturbances:

1. What may be causing my gait disturbance?
   
   
2. Is it associated with a medical condition?
   
   
3. Will it become worse with time?
   
   
4. Is my pain associated with my gait problem?
   
   
5. What tests can help determine the cause of my gait problems?
   
   
6. Are my problems due to muscle, bone or nerve weakness?
   
   
7. Will medications help me?
   
   
8. What other treatments can I consider for my gait disturbance?
   
   
9. Are my problems due to muscle or bone weakness?
   
   
10. Who is best suited to treat my problems?
    
    
11. How will my condition be monitored?