SymptomBrain & nerves
Gait Abnormality: Abnormal Walking Patterns and What They Mean
A gait abnormality is a change in the way you walk, such as shuffling, limping, staggering, dragging a foot or walking with a wide base. It can come from pain in a hip, knee or foot, from weak muscles, or from problems in the brain, spinal cord or nerves that control balance and movement. The pattern of walking often points to the cause. A sudden change in walking is an emergency that may mean a stroke; a gradual change should be assessed because it raises the risk of falls.
Also called: Abnormal gait, walking abnormality, gait disturbance, unsteady walking, difficulty walking
At a glance
- What it is
- Any abnormal pattern of walking: limping, shuffling, staggering, waddling or high-stepping.
- Main causes
- Joint pain, weakness, nerve damage, Parkinson's disease, stroke, cerebellar problems, spinal problems.
- Clues
- The type of gait, how fast it developed, and accompanying symptoms.
- Risk
- Falls, especially in older adults.
- Treatment
- Treat the cause, plus physical therapy, walking aids and fall prevention.
When to get help
Call 911 or go to the ER
- Sudden difficulty walking with weakness or numbness on one side, facial droop, slurred speech or confusion (possible stroke)
- Sudden inability to walk or leg weakness with numbness between the legs or loss of bladder or bowel control
- New unsteadiness after a head injury, especially with headache, vomiting or drowsiness
See a doctor within a day or two
- Walking getting rapidly worse over days, or ascending weakness from the feet upward
- Staggering with severe vertigo and vomiting
- A child who suddenly refuses to walk or limps with fever
Book a routine appointment
- Gradually slower, shuffling or unsteady walking over months
- Repeated falls or near-falls
- Dragging a foot or catching your toes when walking
- Unsteadiness with memory problems and bladder urgency
- Numbness or tingling in the feet with poor balance in the dark
What normal gait involves
Walking needs strength in the legs and trunk, flexible joints, sensation from the feet and joints telling the brain where your limbs are, a working balance system in the inner ear, coordination from the cerebellum, and smooth movement control from the brain's basal ganglia. A problem in any one of these produces a recognizable gait pattern.
Types of gait abnormality
| Gait | What it looks like | Common causes |
|---|---|---|
| Antalgic (painful) | Short time on the painful leg, limping | Hip, knee or foot arthritis, injury, stress fracture |
| Parkinsonian (shuffling) | Small shuffling steps, stooped, reduced arm swing, trouble starting and turning, freezing | Parkinson's disease, some medicines |
| Ataxic (staggering) | Wide-based, unsteady, lurching, like being drunk | Cerebellar stroke, alcohol, MS, inherited ataxias |
| Sensory ataxia | Stamping, watching the feet, much worse in the dark or with eyes closed | Peripheral neuropathy, B12 deficiency |
| Steppage (high-stepping) | Lifting the knee high so the dropping foot clears the ground | Foot drop from a nerve or disc problem |
| Hemiplegic | One leg stiff and swung outward in an arc, arm bent | Stroke, brain injury |
| Spastic / scissoring | Stiff legs crossing over each other | Cerebral palsy, spinal cord problems, MS |
| Waddling | Body swaying side to side | Weak hip muscles from muscle disease, late pregnancy, hip dysplasia |
| Magnetic | Feet seem stuck to the floor, short steps | Normal pressure hydrocephalus, small vessel disease |
| Cautious | Slow, wide steps, holding on to furniture | Fear of falling, often after a fall |
Causes of gait abnormality
Musculoskeletal
- Osteoarthritis of the hip or knee
- foot problems: bunions, plantar fasciitis, deformities
- leg length differences, injuries and fractures
- muscle weakness from disuse, illness or muscle disease
Nerves and spinal cord
- peripheral neuropathy from diabetes, alcohol, B12 deficiency or chemotherapy
- lumbar spinal stenosis: leg pain and heaviness on walking that eases when sitting or bending forward
- a herniated disc causing foot drop
- spinal cord compression from neck arthritis, tumors or injury
- multiple sclerosis
Brain
- stroke
- Parkinson's disease and related conditions
- normal pressure hydrocephalus: the classic triad of walking problems, memory loss and bladder urgency, which is partly treatable
- ataxia from cerebellar damage
- dementia, brain tumors and head injury
Other
- inner ear (vestibular) disorders causing vertigo
- vision problems
- medicines: sedatives, sleeping pills, some antidepressants, antipsychotics, anti-seizure drugs, and blood pressure medicines causing dizziness
- alcohol use
- low blood pressure on standing
Gait abnormality in children
Toddlers normally walk with a wide base, and many children have in-toeing, flat feet or mild bowlegs that self-correct. Concerns include not walking by 18 months, toe-walking that persists after age 3, a new limp, loss of walking skills, or asymmetric movement. A limping child with fever needs urgent assessment for a joint or bone infection.
How doctors assess walking problems
Your doctor will ask when it started, how fast it changed, about falls, pain, numbness, weakness, dizziness, memory, bladder symptoms, alcohol and medicines. They will watch you walk, turn, walk heel-to-toe and stand with eyes closed (the Romberg test), and test strength, reflexes, sensation, coordination and blood pressure lying and standing. A simple "Timed Up and Go" test measures fall risk.
Tests may include:
- blood tests: B12, thyroid, blood sugar and others
- X-rays of painful joints
- MRI of the brain or spine
- nerve conduction studies
- referral to a neurologist, orthopedic surgeon or falls clinic
Treatment
- Treat the cause: joint replacement for severe arthritis, Parkinson's medicines, B12 replacement, decompression surgery for spinal stenosis or cord compression, a shunt for normal pressure hydrocephalus.
- Physical therapy: strength, balance and gait training. Programs that include balance exercises reduce falls in older adults.
- Walking aids: a cane in the hand opposite the painful leg, a walker, or an ankle-foot orthosis for foot drop.
- Medicine review: reducing sedating drugs.
- Home safety: good lighting, removing loose rugs, grab bars and sturdy footwear.
- Vision and hearing checks.
Frequently asked questions
What are the types of abnormal gait?
The main types are antalgic (limping from pain), parkinsonian (shuffling), ataxic (staggering), sensory (stamping, worse in the dark), steppage (high-stepping from foot drop), hemiplegic (after stroke), spastic, waddling, and magnetic gait. Each pattern points toward a different cause.
What causes a sudden change in walking?
A sudden change can be caused by a stroke, a spinal cord problem, a head injury, an inner ear disorder or an infection. Sudden walking difficulty with weakness, numbness, facial droop or speech problems is an emergency: call 911 or your local emergency number.
What causes a shuffling gait?
The most common cause is Parkinson's disease. Other causes include medicines that block dopamine, normal pressure hydrocephalus, small vessel disease in the brain and advanced dementia. A doctor should assess any new shuffling.
Can a gait abnormality be corrected?
Many can be improved. Treating the underlying cause, physical therapy, walking aids, orthotics and medicine changes often make walking safer and more efficient. Some causes, such as normal pressure hydrocephalus and B12 deficiency, can be largely reversed if found early.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Family Physicians: Gait and Balance Disorders in Older Adults
- MedlinePlus: Walking problems
- National Institute of Neurological Disorders and Stroke: Ataxia
- CDC STEADI: Older adult fall prevention
- NHS: Normal pressure hydrocephalus