| Abnormalities | Suggestions for differential diagnosis* |
| Gait initiation, maintenance, and termination |
| Difficulty starting | - PD, atypical parkinsonism; primary progressive freezing of gait; other causes of lower-body parkinsonism (eg, normal pressure hydrocephalus, vascular parkinsonism)
|
| Sudden episodes of inability to step, particularly when turning or passing through doorways (freezing of gait) | - PD, atypical parkinsonism; primary progressive freezing of gait; other causes of lower-body parkinsonism (eg, normal pressure hydrocephalus, vascular parkinsonism)
|
| Inability to stop (festination) | - PD, atypical parkinsonism; other causes of lower-body parkinsonism (eg, normal pressure hydrocephalus, vascular parkinsonism)
|
| Step length, height, and cadence |
| Reduced step height | - PD, parkinsonism; foot drop (due to neuropathy of common fibular nerve or sciatic nerve, L5 radiculopathy, Charcot-Marie-Tooth disease, muscular dystrophy, stroke, or multiple sclerosis causing distal weakness)
|
| Small steps | - Sensitive but nonspecific
- Caused by pain (eg, orthopedic disorders)
- Caused by underlying pathology: Common in PD, atypical parkinsonism, normal pressure hydrocephalus, severe sensory impairment of the legs
- Compensation for perceived instability
|
| Irregular step size (cadence) | - Cerebellar ataxia, vestibular ataxia, higher-level gait disorders, chorea, essential tremor
|
| Reduced stance phase on the affected side (limping) | - Pain (antalgic gait) resulting from trauma or arthritis, functional gait disorders
|
| Arm swing |
| Unilaterally reduced | - Hemiparesis, dystonia, PD, orthopedic or rheumatologic disorders affecting the elbow or shoulder joint unilaterally
|
| Bilaterally reduced | - PD, parkinsonism, dystonia, orthopedic or rheumatologic disorders affecting the elbow or shoulder joint unilaterally
|
| Excessive | - Chorea, levodopa-induced dyskinesia, normal pressure hydrocephalus (as compensation for poor body propulsion), hypotonia, functional gait disorders
|
| Tremor appearing in hand during walking | |
| Posturing with the arm | - PD, dystonia, secondary to shoulder and/or neck injury, alien limb phenomenon, functional gait disorders
|
| Movement fluidity |
| Dropped foot, lifting the leg higher than normal (steppage gait) | - Neuropathy of common fibular nerve or sciatic nerve, L5 radiculopathy, Charcot-Marie-Tooth disease, muscular dystrophy or myopathy, stroke or multiple sclerosis causing distal weakness, foot dystonia causing a functional lengthening of the leg
|
| Knees giving way (buckling of the knees) | - Functional gait disorders, quadriceps weakness (eg, limb-girdle myopathy, IBM), cataplexy, negative myoclonus, dystonia
|
| Locking of the knees | - Cerebellar ataxia, severe arthrosis or arthritis of the knees, compensation for quadriceps weakness (eg, LGMD, IBM), compensation for severe sensory impairments of the legs, increased external knee extension momentum because of pes equinus (due to upper motor neuron syndrome)
|
| Pelvis drop at side of the swing leg, resulting in alternating lateral trunk movements (waddling gait, bilateral Trendelenburg gait) | - Bilateral proximal muscle weakness in the leg and hip girdle; common in muscular dystrophy (eg, LGMD, FSHD, Duchenne muscular dystrophy) and metabolic myopathy (eg, thyroid myopathy); bilateral L5 radiculopathy resulting in weakness of gluteus medius, secondary to joint instability (as in Ehlers-Danlos syndromes)
|
| Stiff gait | - Many disorders, including myotonia, dystonia, stiff person (or stiff leg) syndrome
|
| Bizarre gait pattern | - Chorea (including levodopa-induced dyskinesias), dystonia, higher-level gait disorders, functional gait disorders
|
| Twisting of the foot (varus deviation of the hindfoot) | - Fixed or dynamic varus due to muscular imbalance around the ankle and tarsal joints (eg, due to upper motor neuron syndrome), young-onset PD (exercise-induced dystonia), cerebrovascular (or other) basal ganglia lesion resulting in dystonia, corticobasal degeneration resulting in dystonia, primary dystonia, functional gait disorders
|
| Gait speed |
| Slow | - Nonspecific
- Perceived imbalance, PD, higher-level gait disorders, functional gait disorders, pain caused by orthopedic disorders, advanced stages of PSP
|
| Fast, safe | - Vestibular syndromes, orthostatic tremor
|
| Fast, unsafe | - AD, frontal disinhibition, early stages of PSP
|
