2.9 Gait Analysis & Abnormal Gait Patterns

ABPMR Physical Medicine and Rehabilitation Board Exam Study Guide Exam

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1 Chapter 1: Introduction & Exam Overview

1.1 ABPMR Part I Exam Overview & Format 1.2 Board Review Strategy & Content Blueprint Breakdown

2 Chapter 2: Musculoskeletal Medicine

2.1 Shoulder & Upper Extremity Diagnostics 2.2 Knee, Hip & Lower Extremity Conditions 2.3 Spine Pathology, Radiculopathy & Myelopathy 2.4 Inflammatory Arthritis, Tendinopathies & Concussion 2.5 Bone Health, Osteoporosis & Metabolic Bone Disease 2.6 Thoracic Outlet Syndrome & Peripheral Nerve Entrapment 2.7 Fracture Rehabilitation & Immobilization Complications 2.8 Overuse Tendinopathies & Regenerative Medicine 2.9 Gait Analysis & Abnormal Gait Patterns

3 Chapter 3: Spinal Cord Injury Rehabilitation

3.1 ASIA Examination & Impairment Scale 3.2 Spinal Cord Injury Syndromes 3.3 Autonomic Dysreflexia & Acute Complications 3.4 Neurogenic Bladder, Bowel & Secondary Complications

4 Chapter 4: Stroke & Neuromuscular Rehabilitation

4.1 Stroke Vascular Syndromes & Acute Assessment 4.2 Stroke Motor Recovery & Hemiplegic Complications 4.3 Spasticity Assessment & Multimodal Management 4.4 ALS, GBS, CIDP & Neuromuscular Disease Rehab 4.5 Multiple Sclerosis & Demyelinating Disease Rehabilitation 4.6 Parkinsonism, Movement Disorders & Functional Neurologic Disorder

5 Chapter 5: Electrodiagnostics (EMG/NCS)

5.1 Nerve Conduction Studies Principles & Physics 5.2 Needle Electromyography & MUAP Analysis 5.3 Mononeuropathies & Radiculopathy Patterns 5.4 Neuromuscular Junction Disorders & Myopathies

6 Chapter 6: Traumatic Brain Injury

6.1 TBI Severity Classification, Glasgow Coma Scale, and Pathophysiology 6.2 Rancho Los Amigos Levels of Cognitive Functioning and Disability Rating Scale 6.3 Neurobehavioral Sequelae and Agitation Management 6.4 Concussion Evaluation, Vestibular-Ocular Dysfunction, and Return-to-Play/Work Protocols

7 Chapter 7: Chronic Pain & Interventional Spine

7.1 Fluoroscopic Spine Interventions 7.2 Opioid Stewardship & Controlled Substance Compliance 7.3 Complex Regional Pain Syndrome, Fibromyalgia & Myofascial Pain 7.4 Spinal Cord Stimulation & Intrathecal Therapy

8 Chapter 8: Amputee Rehabilitation & Prosthetics

8.1 Amputation Surgical Levels & Medicare K-Levels 8.2 Socket Designs & Suspension Systems 8.3 Prosthetic Feet & Microprocessor Knee Mechanisms 8.4 Post-Amputation Care, Residual Limb & Phantom Pain

9 Chapter 9: Pediatric Rehabilitation

9.1 Cerebral Palsy Classification & GMFCS 9.2 Spina Bifida & Myelomeningocele Management 9.3 Muscular Dystrophies & Neuromuscular Disease in Children 9.4 Pediatric Brachial Plexopathy & Congenital Disorders

10 Chapter 10: Prosthetics, Orthotics & Assistive Technology

10.1 Lower Limb Orthoses — AFOs & KAFOs 10.2 Spinal & Upper Extremity Orthoses 10.3 Upper Limb Prosthetics — Body-Powered vs Myoelectric 10.4 Wheelchairs, Seating Systems & Pressure Mapping

11 Chapter 11: Medical Rehabilitation & Outcomes

11.1 Dysphagia Assessment & Management 11.2 Neurogenic Bladder & Bowel Management 11.3 Pressure Injuries & Wound Management 11.4 Outcome Measures & Medical Complications 11.5 Cancer Rehabilitation & Oncologic Rehabilitation 11.6 Burns, Endocrine/Metabolic & Medical Complications Rehabilitation

12 Chapter 12: Cardiopulmonary Rehabilitation

12.1 Cardiac Rehabilitation Phases & Metabolic Equivalents 12.2 Pulmonary Rehabilitation & COPD Management

13 Chapter 13: Foundational Rehabilitation Concepts

13.1 Kinesiology, Biomechanics & Functional Anatomy 13.2 Rehabilitation Pharmacology & Medication Management 13.3 Research Methodology, Biostatistics & Evidence-Based Practice 13.4 Nutrition, Metabolism & Energy Expenditure in Rehabilitation 13.5 Diagnostic Procedures: Imaging, MSK Ultrasound, Urodynamics & Neuropsych Assessment

2.9 Gait Analysis & Abnormal Gait Patterns

Key Takeaways Explain This Topic AI

Normal gait cycle is ~60% stance and ~40% swing; key determinants (pelvic rotation/tilt, knee flexion in stance, foot/ankle mechanisms, and lateral pelvic displacement) minimize the center-of-mass excursion and energy cost.

Gait deviations localize pathology: foot drop (steppage gait) suggests common peroneal/L5 radiculopathy; Trendelenburg gait indicates hip abductor weakness; antalgic gait shortens stance on the painful side; and Parkinsonian gait shows festination, reduced arm swing, and shuffling steps.

Functional (instrumented) gait analysis supplements observational gait assessment, quantifying kinematics, kinetics, and electromyography—especially valuable in pediatric CP and complex prosthetic/orthotic prescription.

Energy cost of gait rises with assistive-device use and abnormal patterns; a cane contralateral to a painful hip reduces joint reaction force by reducing abductor demand.

Last updated: July 2026

Gait Analysis & Abnormal Gait Patterns

Gait analysis is both a Domain A diagnostic procedure (gait analysis) and a Domain D/D rehab management topic (abnormal gait). Mastery of the gait cycle and deviation patterns lets the physiatrist localize neurologic, musculoskeletal, and prosthetic dysfunction at the bedside.

The Normal Gait Cycle

Phase Approximate Duration Key Events

Stance (~60%) Heel strike → foot flat → midstance → toe-off Single-limb support (40%), double support (20% total)

Swing (~40%) Initial swing → mid-swing → terminal swing Limb advances; foot clears ground
Double support ~10% each (initial/terminal) Both feet contact ground; shortest in running (absent)

The six determinants of gait (Saunders)—pelvic rotation, pelvic tilt, knee flexion in stance, foot mechanisms, ankle mechanisms, and lateral pelvic displacement—flatten the center-of-mass trajectory, keeping energy expenditure low (~2.5x body weight peak vertical ground reaction force at ~60% stance).

Abnormal Gait Patterns & Localization Observation Likely Localization
───────────────────────────────── ─────────────────────────────────
Steppage (foot slap/drop) → Common peroneal nerve or L5 radiculopathy
Trendelenburg (pelvic drop) → Hip abductor (gluteus medius) weakness
Antalgic (shortened stance) → Painful lower limb (hip/knee/foot)
Parkinsonian (festination) → Basal ganglia / Parkinsonism
Waddling → Myopathy / proximal muscle weakness
Scissoring → Adductor spasticity (cerebral palsy, SCI)
Circumduction → Leg length discrepancy or weak dorsiflexors
Vaulting → Functional leg lengthening (e.g., on the short side) / prosthesis issue

Trendelenburg sign : standing on one leg, the contralateral pelvis drops if the stance-side hip abductors are weak (positive). A compensated Trendelenburg gait shifts the trunk over the affected hip to reduce abductor moment.

Steppage/foot drop : excessive hip and knee flexion to clear a flail foot; causes include L5 radiculopathy, common peroneal palsy, and Charcot-Marie-Tooth.

Antalgic gait : shortened stance phase on the painful limb to reduce weight-bearing time; nonspecific but localizes the symptomatic side.

Parkinsonian gait : reduced step height and arm swing, festination (progressive acceleration), freezing of gait, and turning en bloc.

Waddling gait : hyperlordosis and pelvic elevation from proximal muscle (hip girdle) weakness, as in muscular dystrophy or myopathy.

Instrumented Gait Analysis

Three-dimensional motion capture quantifies joint kinematics (angles), kinetics (moments and forces via force plates), and dynamic electromyography. Clinical applications include surgical planning in cerebral palsy (e.g., rhizotomy, tendon lengthening), prosthetic/orthotic prescription, and outcome measurement after interventions. Observational gait analysis (e.g., Rancho/Rivermead) remains the bedside standard.

Assistive-Device Biomechanics

A cane used in the contralateral hand to a painful hip reduces hip joint reaction force by lowering the required abductor force: the cane generates a moment that partially counteracts body weight, decreasing gluteus medius demand and joint loading. Axillary crutches should bear weight through the hands, not the axillae (brachial plexus risk). walkers maximize stability at the cost of gait speed and increased upper-limb demand.

Velocity-Dependent Gait Patterns & Neurologic Localization

Neurologic gait deviations reflect lesion level:

Gait Pattern Lesion / Cause
Spastic (scissoring) UMN (cerebral palsy, SCI, MS)
Cerebellar ataxic Wide-based, staggering; cerebellar disease
Sensory ataxic Stomping, positive Romberg; proprioceptive loss (B12, tabes, neuropathy)
Parkinsonian Festination, reduced arm swing; basal ganglia
Waddling Proximal muscle weakness (myopathy, dystrophy)
Foot drop (steppage) L5 radiculopathy, common peroneal, Charcot-Marie-Tooth
Antalgic Painful lower limb (shortened stance)
Trendelenburg Hip abductor weakness (gluteus medius)
Crouch gait Bilateral spastic CP / hamstring spasticity
Vaulting Apparent leg-lengthening (LLD, prosthesis, hip pathology)
Assistive Devices & Energy Cost

Assistive devices increase stability but raise energy cost and reduce gait speed: Independent gait < Straight cane < Quad cane < Walker

(lowest energy cost / highest speed) (highest energy cost / slowest)

Selection balances stability and energy efficiency: a cane for mild balance/capacity deficits, a walker for marked instability or high fall risk. Crutch gait patterns (four-point, three-point, two-point, swing-through) are chosen by weight-bearing status and bilateral capacity. The physiatrist matches the device to the patient's balance, strength, cognition, and environment.

Prosthetic & Orthotic Gait Analysis

In transtibial and transfemoral amputees, gait analysis identifies prosthetic and alignment issues: vaulting on the sound limb (compensating for a long prosthetic side), lateral trunk bending (short prosthetic side or weak abductors), circumduction (prosthetic knee instability or excessive length), and terminal impact (hard heel at heel strike). In orthotic gait, AFO tuning (stiffness, ankle angle) influences knee stability during stance. Observational and instrumented gait analysis direct alignment and component adjustments.

Clinical Gait Examination Sequence

A structured bedside approach: observe gait from front, side, and back; assess initiation, stepping, turning (high fall-risk), and dual-task performance; evaluate footwear, braces, and assistive devices; perform neurologic and musculoskeletal correlates (Trendelenburg, foot drop, ROM). This synthesis identifies the dominant deviation, localizes pathology, and informs orthotic/prosthetic, medical, and therapy interventions.