Types of Gaits - Definition and Phases

Definition of Gait

The Normal Gait Cycle

• Step: distance between successive Initial Contact by the two different lower limbs
• Stride: distance between successive Initial Contact by the same lower limb
• Cadence: steps per unit time
• Running differs from walking in that it eliminates the double-limb support phase entirely (both feet briefly off the ground = "float phase")

Subdivisions of the Gait Cycle (Rancho Los Amigos System)

Stance Phase (60%) - 5 sub-phases:

Swing Phase (40%) - 3 sub-phases:

Types of Abnormal Gaits

1. Spastic Gait (Hemiparetic)

• Lesion: Unilateral corticospinal tract (brain or cervical cord)
• Appearance: Affected arm is adducted, internally rotated at the shoulder, flexed at the elbow, with forearm pronation and wrist/finger flexion. The leg is slightly flexed at the hip and extended at the knee, with plantarflexion and inversion of the foot. Swing phase accomplished by lateral trunk flexion and hip circumduction - "circumduction gait." Toe dragging is common. Shoe wear on the toe/outer border.

2. Spastic Paraparesis (Scissors Gait)

• Lesion: Bilateral corticospinal tracts (spinal cord)
• Appearance: Both legs stiffly extended at the knees, plantarflexed at ankles. Toes catch on floor with each step. Strong tendency to adduct the legs, creating a "scissors" pattern. Gait is slow and labored.

3. Cerebellar Ataxic Gait

• Lesion: Cerebellum or brainstem
• Appearance: Wide-based stance, lurching and staggering quality. Steps are irregular in timing (dyssynergia), length, and direction (dysmetria). Romberg sign absent (ataxia not worsened by closing eyes). Midline cerebellar lesions cause truncal ataxia; hemispheric lesions cause ipsilateral limb ataxia.

4. Sensory (Posterior Column) Ataxic Gait

• Lesion: Posterior columns of spinal cord or peripheral nerve
• Appearance: Wide-based, high-stepping "stomping" gait. Romberg sign present (dramatically worsened by eye closure, as the patient loses all proprioceptive compensation). Patient watches the ground to compensate for loss of joint position sense.

5. Hypokinetic / Parkinsonian Gait

• Lesion: Basal ganglia (substantia nigra)
• Appearance: Stooped posture with flexion of shoulders, neck, and trunk. Shuffling small steps, reduced arm swing (often asymmetric early). Festination = rapid small steps to prevent falling forward. Freezing episodes (inability to initiate steps). Retropulsion and propulsion (flurry of steps to maintain balance). - Bradley and Daroff's Neurology in Clinical Practice

6. Steppage Gait (Foot Drop Gait)

• Lesion: Distal muscle weakness - peroneal nerve palsy, peripheral neuropathy, tibialis anterior rupture
• Appearance: Increased hip and knee flexion during swing phase ("high stepping") to clear the toes from the floor. Foot slaps on the ground at Initial Contact. - Miller's Review of Orthopaedics, 9th Ed.

7. Waddling Gait (Trendelenburg Gait)

• Lesion: Proximal muscle weakness (hip abductors) - muscular dystrophy, myopathy, hip pathology
• Appearance: Exaggerated seesaw/side-to-side trunk sway. With weight bearing on the affected side, the pelvis drops and the trunk shifts to the normal side (positive Trendelenburg sign). Both legs circumducted to allow knee locking.

8. Antalgic Gait

• Lesion: Non-neurological - pain from joint disease, fracture, or soft tissue injury
• Appearance: Shortened stance phase on the affected side. The patient minimizes time weight is borne on the painful limb. Very common in hip/knee OA and after trauma.

9. Calcaneus Gait

• Lesion: Weakness of triceps surae (gastrocnemius-soleus)
• Appearance: Increased ankle dorsiflexion during heel strike; patient walks on the heel.

10. Choreic Gait

• Lesion: Basal ganglia (Huntington disease, Sydenham chorea, etc.)
• Appearance: Random involuntary movements superimpose on walking, giving a "dancing" quality. Wide-based, lurching, stumbling, stuttering steps. Trunk sways excessively; steps vary in length and timing. May be mistaken for ataxia.

11. Dystonic Gait

• Lesion: Basal ganglia; also corticospinal pathways
• Appearance: Bizarre, inexplicable postures of legs and trunk. Classic feature is excessive hip flexion during walking. Patients may hop, walk sideways (crab-like), or display a "peacock gait" (excessive hip and knee flexion with plantarflexion). Striatal toe (tonic great toe extension) may be an early sign.

12. Spastic Ataxia ("Bouncing Gait")

• Lesion: Combined corticospinal and cerebellar (e.g., multiple sclerosis, Arnold-Chiari malformation)
• Appearance: Wide-based gait with clonus precipitated by standing/walking, creating a "bouncing" motion. Ataxic movements and clonus form a vicious cycle.

13. Gait Disorder of the Elderly

• Cause: Multifactorial - bihemispheric disease, spinal cord disease, impaired proprioception, muscle weakness
• Appearance: Stooped posture, wide-based steps, often retropulsion (tendency to fall backward).

14. Hysterical / Functional Gait

• Cause: Psychiatric or behavioral disorder
• Appearance: Reeling side to side, astasia-abasia (normal limb power supine but inability to stand/walk), tightrope walker's gait (short slow steps, hips/knees flexed, arms outstretched), knee-buckling gait, dragging gait. Characteristically varies when distracted or when walking backward.

Summary Table