#abnormal gait

But I feel like a type of danger not often talked about is that which comes from being visibly ABNORMAL but not clocked as disabled by most people in passing. Like, no mobility aid or visible disability aids, but you clearly are not getting around or acting like people expect in public. I have been in both positions. I have FND and have used a walker, a cane, and a wheelchair in public before. I no longer need a mobility aid for safe walking, but my gait and movements are still visibly abnormal. I sway from side to side at the hips, my left leg never seems to be able to turn correctly, my body will jerk a bit sometimes, and my balance is not great.

In short, I appear incredibly drunk.

And that has the potential to get me in trouble, danger even. Someone could report me to police, or confront me about it, and with my tendency to lose speech under stress I probably would not be able to explain. In public I get LOOKS. Not the quick pity-glance I would sometimes get with a mobility aid (though those suck) but these looks seem apprehensive. I LOOK DANGEROUS. And this is as a young, white, very physically small person. I can only imagine how it would be for a person of color, or any other demographic already perceived as hostile to bigots.

Being in public is terrifying for me. And fear/ stress only ever makes my symptoms worse, and thus I look even more suspicious.

Abnormal gait or gait abnormality occurs when the body systems that control the way a person walks do not function in the usual way.

Take a good look at this gals gait. In the 1st section, she is walking on relatively level ground and in the second part, the topography changes and the balance requirements become much greater. You may remember a post we did some time ago talking about proprioception and learning to walk here.

Besides the obvious gluteus medius weakness, genu valgum and pronation, R>L, can you see how when the task becomes more complex, that the system begins to break down? Did you see the increased base (wider) of gait? did you see the decreased speed of movement? Did you see the increased ancillary arm movements?

Circumducting gait.

This is a great video. This is a video we found on the internet. There is another one showing her with a much more pathologic steppage gait, we may bring this one to your attention another time.  She may have had a cerebral event or mild stroke from what the other video showed.  But we like this one, because it is subtle and much more likely what you are going to see day to day in your world.

We see here on the video a left sided circumducting gait.  What this means is that the left limb is not swinging purely through the sagittal plane from heel lift-toe off phase to repeat heel strike again.  Instead we see the foot sweep laterally. The foot moves immediately into an increased progression angle (turned out), and it sweeps around a half circular motion to repeat the contact phase again at heel strike.

In this case here it is clearly evident, especially on the lateral side view, that she is blocked out of left ankle rocker (dorsiflexion) for some reason. She does not even get to 90 degrees dorsiflexion range at the ankle mortise.  She can no longer allow the treadmill to draw her left foot backwards because she hits this limitation.  As the limitation is met, the foot must come forward now (because it cannot go anywhere else, certainly not backwards). But, she does not display enough right gluteus medius use to create hiking of the left hip to create the clearance necessary for this premature forward left leg swing.  Thus, she has to spill the left leg out to the side in a circular-circumducting fashion to clear the limb from hitting the ground.  She is also likely doing it because if you are not able to dorsiflex the ankle, you will be relatively plantarflexed at the ankle.  And if you are plantarflexed, you are much more likely to catch your toe on the treadmill-ground during the swing through phase. This case is a problem of not creating sufficient clearance for the left foot. 

Also take note of the subtle foot drop on the left. The foot cannot maintain adequate dorsiflexion, due to weakness of the anterior compartment (possibly from a cerebral event?). Did you see the lack of inversion of the left foot as well. This is usually accomplished by the tibialis anterior and long extensors, especially EHL, neither of which is seen (take a look at the amount of hallux extension on the R on the lateral view and compare it with the left). How about that subtle midfoot collapse as well?

There are other reasons for a circumducting gait.  This is just one.  Some are functional limitations, some are ablative orthopedic type limitations such as post surgical, some are neurological, and some are a combination.  Taking a good history, knowing your gait parameters and assimilating the information will bring you to an answer.

Then you have to figure out what to do.  In this case, we do not know, because we do not know what parameter is causing the compensation you see here.  This is a good case of "what you see is not what is wrong, you are just seeing what they are doing while working around limitations and finding parts to use and cheat with" to still be able to more forward.

And now... A question from a reader....

 Dr Allen- There are a few questions troubling me. The first one concerns the loss of the ankle rocker phase of gait which can have implications further up the kinetic chain. It concerns the interplay of gastroc and soleus. Is it possible for gastrocnemius to work as a knee extensor when the foot is in the closed chain position - especially if the bodies centre of mass has advanced in front of the knee joint ? Thanks - RB

Hi RB_____,

yes it is possible.......it is a retrograde movement as you have described. it is not commonly seen, but can be, and usually manifests itself, in one of 2 ways.

Typically the client is more ligamentously lax than others........and they tend to have a "kicking" type gait, where they thrust the leg out in front, like kicking a ball, with each step forward. This causes a heavy heel strike and locks the knee in preparation for midstance, and then follows your thinking. By the way, this client also seems to like standing in a hyperextended knee position at rest.

We remember that the gastroc soleus group begins to fire in the first 10% of stance phase (it is acting as a knee extensor here); to promote eccentric deceleration of the forward moving tibia, and continues to fire until terminal swing. It is believed the soleus provides much of the deceleration force and the gastroc assists in inverting the ankle at midstance and primarily flexes the knee at pre swing, just prior to toe off (Nordin, Frankel 2001). If the gastroc /soleus group fires prematurely, or excessively, particularly in prior to midstance, then we see the action you describe, and it manifests itself as premature heel rise and loss of ankle rocker.

A sudden hyperextesion at midstance or later, in a neurologically competent individual, is unlikely, as he force is too abrupt at this point and there is too much of a mechanical disadvantage.

We hope this helps explain things a bit. Please email us back if it doesn't!