Gait Abnormality

CLINICAL DIAGNOSTIC MANUAL

Gait abnormality refers to any deviation from a normal walking pattern. It can be caused by a variety of neurological, muscular, joint, and functional problems. Gait abnormalities can significantly impact the patient’s mobility and quality of life. Careful evaluation of the gait pattern and identification of associated symptoms are crucial to determining the underlying cause and providing appropriate treatment.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Functional somatization	Inconsistent, variable gait, not congruent with known neurological lesions	Medical history, physical examination, multiple symptoms without organic correlation	Psychiatric evaluation, exclusion of other causes
Contralateral pyramidal tract lesion	Spastic gait, contralateral weakness, hypertonia, Babinski sign	Medical history, neurological examination, spasticity	Brain MRI, brain CT
Parkinsonism	Festinating gait, rigidity, resting tremor, bradykinesia, loss of balance	Medical history, neurological examination, extrapyramidal signs	Neurological evaluation, response to levodopa
Cerebellar lesion	Ataxia, staggering gait, dysmetria, dysdiadochokinesia, nystagmus	Medical history, neurological examination, incoordination	Brain MRI, cerebellar coordination tests
Peripheral neuropathy	Steppage gait, distal weakness, sensory loss, diminished reflexes	Medical history, neurological examination, “glove and stocking” distribution	EMG, nerve conduction studies
Dorsal column loss	Ataxic gait, loss of proprioception, sensation of walking on cotton	Medical history, neurological examination, positive Romberg sign	Spinal MRI, nerve conduction studies
Bilateral upper motor neuron lesion	Spasticity, bilateral weakness, spastic gait	Medical history, neurological examination, signs of bilateral upper motor neuron involvement	Brain and spinal MRI
Pelvic girdle and proximal muscle weakness	Waddling gait, difficulty rising from a chair, proximal weakness	Medical history, physical examination, proximal muscle weakness	Elevated CPK, muscle biopsy, genetic studies
Muscle-level injuries	Muscle weakness, atrophy, muscle pain	Medical history, physical examination, signs of myopathy	Elevated CPK, muscle biopsy, genetic studies
Lateral popliteal nerve palsy	Foot drop, steppage gait, weakness in foot dorsiflexion	Medical history, neurological examination, foot drop	EMG, nerve conduction studies
Drug effects	Unsteady gait, ataxia, balance disturbances	Drug use history, physical examination, signs of intoxication	Toxicology tests, detailed medical history