Antalgic Gait

• Normal gait is cyclical and roughly symmetric, with stance phase making up about 60% of the cycle and swing phase about 40%.
• With a painful hip, knee, ankle, foot, or lumbar spine/nerve root problem, the patient minimizes load and time spent on the affected side to reduce pain.
• In hip disease specifically, the classic pattern is that the patient leans the trunk over the affected hip during its weight-bearing phase. This shifts the body's center of gravity directly over the joint, reducing the abductor muscle force (and therefore joint reaction force) needed to keep the pelvis level - Firestein & Kelley's Textbook of Rheumatology.
• A hyperlordotic lumbar curve may also develop to compensate for reduced hip extension.

• Antalgic gait = pain-driven trunk lean over the painful hip to unload it.
• Trendelenburg gait = weak hip abductors (commonly gluteus medius) causing the pelvis to drop on the unsupported side, with trunk shift toward the normal side. Neither sign is specific enough alone to pinpoint the exact underlying cause (Firestein & Kelley's Textbook of Rheumatology).

• Osteoarthritis of hip, knee, ankle, or foot (most common cause overall - degenerative joint disease)
• Fractures (hip, lower limb, foot)
• Soft tissue injury - muscle strains, tendon/ligament injuries
• Lumbar spine or nerve root pathology (disc herniation, sciatica) - Adams & Victor's Principles of Neurology notes "antalgia" as the broader term for pain-avoidant movement, including antalgic gait from lumbar disc or spinal/hip disease
• Infection (septic arthritis, osteomyelitis)
• Inflammatory arthropathies
• Vascular disease
• Neoplastic processes
• Foot problems (bunions, neuromas, forefoot pain causing a short propulsive phase)

• Observe gait from the side and behind - look for shortened stance phase, trunk lean, and any compensatory patterns (e.g., varus thrust at the knee, high-stepping/foot drop pattern which is a different gait type).
• Correlate location of lean/limp with the joint suspected - hip disease produces trunk lean over the hip; ankle/foot pain gives a painful, guarded gait with a short "push-off" (propulsive) phase.
• Always examine the joint above and below, check for leg-length discrepancy, and assess neurovascular status since etiologies range from mechanical/degenerative to neurologic, vascular, infectious, or neoplastic.

• Steppage/neuropathic gait - increased hip/knee flexion to clear a dropped foot (peroneal palsy, L5 radiculopathy)
• Calcaneus gait - excess ankle dorsiflexion at heel strike (gastrocnemius-soleus weakness)
• Trendelenburg gait - pelvic drop toward the unsupported side (abductor weakness)

• Musculoskeletal Disorders and Antalgic Gait - Bradley and Daroff's Neurology in Clinical Practice, p. 344
• Miller's Review of Orthopaedics, 9th Ed., Gait Evaluation, p. 541
• Firestein & Kelley's Textbook of Rheumatology, Hip / Physical Examination sections
• Bailey and Love's Short Practice of Surgery, 28th Ed., Gait/Knee/Ankle examination sections
• Adams and Victor's Principles of Neurology, 12th Ed., Referred Pain section
• Rheumatology, 2-Volume Set (Elsevier, 2022), Gait / Spine and gait sections