Abnormal Gait in Adults

Very few patients present with abnormal gait. It is more often noticed by the GP, while the patient’s complaint is usually a manifestation of the gait (e.g. unsteadiness in Parkinson’s disease) or of its cause (e.g. pain in arthritis). Congenital causes are not considered here as patients are most unlikely to present such problems to the GP.

Published: 2nd August 2022 | Updated: 15th August 2022

Differential diagnosis

Common Diagnoses

  • Trauma (Back and Leg)
  • Osteoarthritis (OA) or Other Painful Joint Problem
  • Vestibular Ataxia (Vestibular Neuritis, Ménière’s Disease, CVA)
  • Parkinson’s Disease
  • Intermittent Claudication (IC)

Occasional Diagnoses

  • Foot Drop (Peroneal Nerve Atrophy)
  • Multiple Sclerosis
  • Spinal Nerve Root Pain (Especially L5 and S1)
  • Cauda Equina Lesions
  • Myasthenia Gravis

Rare Diagnoses

  • Tabes Dorsalis (Syphilis)
  • Dystrophia Myotonica
  • Motor Neurone Disease
  • Cerebellar Ataxia
  • Functional Neurological Disorder

Ready reckoner

Key distinguishing features of the most common diagnoses

Sudden OnsetYesPossibleYesNoPossible
Painful Unilateral LimpYesYesNoNoYes
Worse with ExerciseYesYesNoNoYes
Shuffling GaitNoPossibleNoYesNo
Staggering GaitNoNoYesNoNo

Possible investigations

Likely: None.

Possible: X-ray, FBC, ESR/CRP, RA factor/anti-CCP, uric acid.

Small Print: Syphilis serology, scans, lumbar puncture, angiography.

  • FBC, ESR/CRP, RA factor/anti-CCP, uric acid: Some forms of arthritis will result in an anaemia of chronic disorder. ESR/CRP may also be raised. Depending on the pattern of joint pain, RA factor/anti-CCP and uric acid may provide useful information in the diagnosis of rheumatoid arthritis and gout.
  • X-rays useful in bony trauma. Limited value in OA except to exclude other bony pathology.
  • Syphilis serology: If tabes dorsalis suspected.
  • If neurological signs of incoordination, consider CT/MRI scan and lumbar puncture – usually arranged by the specialist.
  • Angiography: Arranged by the vascular surgeon if surgery contemplated in claudication.

Top Tips

  • Look up from the notes or computer as the patient walks in – otherwise you may miss a useful clue in the patient’s gait.
  • If the patient actually complains of problems walking, take your time in assessing the symptom – in particular, give the patient the opportunity to demonstrate the problem by walking him or her up and down the corridor.
  • If the cause is not immediately apparent from the history, perform a careful neurological examination – this is a situation where there may be hard signs which contribute significantly to diagnosis.

Red Flags

  • Vestibular neuritis usually settles within a few days. If patient remains ataxic, especially with persistent nystagmus, consider a central lesion and refer urgently.
  • Numbness in both legs (saddle pattern) with back pain and incontinence suggests a cauda equina lesion. Admit urgently.
  • If the patient is ataxic and has a past history of neurological symptoms, such as paraesthesia or optic neuritis, consider multiple sclerosis.
  • Beware of labelling the patient as hysterical – apparently bizarre gaits may signify obscure but significant neurological pathology.
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Website disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter.

The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.

This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.