Abnormal Gait in Adults

Differential Diagnosis

Common Diagnoses

Occasional Diagnoses

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

TraumaOA/OtherVestibularParkinson’sIC
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.
Report errors, or incorrect content by clicking here.