Abnormal Gait Patterns in the Three Planes of Motion

Overview Table of Gait Abnormalities

1. Sagittal Plane Deviations (Flexion/Extension)

Parkinsonian (Festinating) Gait

• Short, shuffling steps with reduced foot clearance
• Stooped posture, flexed at hip and knees, forward lean of trunk
• Reduced or absent arm swing
• Festination: involuntary quickening of steps as the patient attempts to "catch up" with their own center of gravity
• Freezing of gait at initiation or doorways
• Cause: basal ganglia degeneration (dopamine deficiency)

Steppage (Foot-Drop) Gait

• Caused by paralysis of pretibial and peroneal muscles (inability to dorsiflex)
• The advancing foot hangs with toes pointing down
• Patient compensates with excessive hip flexion to lift the leg clear of the ground
• Foot slaps the floor on landing
• No balance disturbance (unlike sensory ataxia)
• Causes: peroneal nerve damage, L5 root lesion, polyneuropathy (diabetes, Charcot-Marie-Tooth), poliomyelitis

Hemiplegic (Spastic) Gait

• Affected leg is held stiffly, poorly flexed at hip, knee, and ankle
• Foot tends to plantar flex (equinus position), catching the toe and outer heel on the floor
• Sagittal component: inadequate knee and hip flexion in swing phase
• Frontal component (see below): circumduction - the leg swings outward in a semicircle to clear the ground
• Arm on the affected side is flexed and does not swing
• Cause: corticospinal tract lesion (stroke, trauma, tumor)

Scissor Gait (Spastic Diplegia)

• Bilateral spastic gait; legs extended/slightly bent at knees
• Thighs strongly adducted, legs nearly cross with each step
• Slow, effortful steps as if wading through water
• Cause: cerebral diplegia (cerebral palsy), cervical myelopathy

2. Frontal/Coronal Plane Deviations (Lateral Shift, Abduction/Adduction)

Waddling (Trendelenburg) Gait

• Characteristic of gluteus medius weakness (also seen in progressive muscular dystrophies, spinal muscular atrophy, congenital hip dislocation)
• In normal gait, the gluteus medius stabilizes the pelvis during single-leg stance. With weakness, the unsupported side of the pelvis drops (Trendelenburg sign)
• The trunk tilts toward the weight-bearing side to compensate (lateral trunk lurch)
• Alternating lateral trunk sway produces the "waddling" or rolling appearance
• In unilateral weakness: pelvic ptosis on one side only with overlifting of the leg
• Accentuated lumbar lordosis is common in muscular dystrophy cases

Cerebellar Gait (also involves transverse plane)

• Wide base (legs separated) - a coronal plane adaptation to instability
• Lateral veering toward the side of the cerebellar lesion
• Irregular, arrhythmic steps; reeling and lurching
• Ataxia worsened by narrow base (heel-to-toe tandem walk)
• Causes: cerebellar disease, alcohol intoxication, vestibular disease, multiple sclerosis

Antalgic Gait

• Pain-avoidance pattern: patient reduces weight-bearing time on the painful limb (shortened stance phase)
• Lateral trunk lean toward the painful side to reduce joint reaction force
• Most common coronal-plane deviation in orthopedic pathology (hip OA, knee pain)

3. Transverse Plane Deviations (Rotation)

Hemiplegic Gait - Circumduction Component

• The stiff, spastic leg swings outward in a wide semicircular arc (circumduction) to clear the ground
• This is the classic transverse-plane abnormality of hemiplegia

Vestibular/Cerebellar Yaw Deviation

• Patients with unilateral vestibular or cerebellar disease rotate (yaw) toward the affected side
• The Unterberger/Fukada stepping test reveals rotation in the yaw plane (rotation around the vertical axis)
• The patient walks in ever-widening circles or veers consistently to one side

Dystonic Gait

• Involuntary twisting and athetoid movements interrupt walking; rotational deviations in the transverse plane are common
• Slow, variable base width; erratic trunk and limb rotations
• Cause: basal ganglia dysfunction (dystonia, DYT1 mutation, Wilson disease)

4. Multi-Plane / Complex Patterns

Sensory Ataxic (Tabetic) Gait

• Proprioceptive loss from large-fiber polyneuropathy, posterior column lesions (tabes dorsalis, vitamin B12 deficiency, MS)
• Wide base, irregular uneven steps; legs flung abruptly forward and outward
• Stamping of feet on the floor (to compensate for absent proprioception)
• Markedly worsened by eye closure (positive Romberg sign)
• "Stamp and stick" (Ramsay Hunt's description)

Normal Pressure Hydrocephalus (NPH) Gait

• Classical triad: gait disorder + urinary incontinence + dementia
• Slow, short steps with reduced foot clearance; feet appear "glued" or "magnetic" to the floor
• Widened base; difficulty initiating steps and turning (multi-step turns, en bloc turning)
• Cannot be classified simply as ataxic, spastic, or apraxic
• Axial muscle management is globally impaired

Frontal Lobe Gait (Gait Apraxia)

• Severely shortened steps; patient knows HOW to step but cannot execute it when upright
• Feet tend to "stick" to the floor (magnetic gait)
• Difficulty starting and stopping; motor program for walking is disrupted
• Patients can simulate walking movements when seated or lying (dissociation between automatic and volitional gait)
• Cause: frontal lobe lesions, white matter disease, NPH, bilateral subcortical strokes

Quick Diagnostic Summary by Plane

• Adams and Victor's Principles of Neurology, 12th Edition, Chapter 6 (Types of Abnormal Gait, Table 6-1, pp. 135-141)
• Campbell's Operative Orthopaedics, 15th Ed 2026 (Pelvic Obliquity, sagittal/coronal plane gait analysis in myelomeningocele)