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J Am Acad Orthop Surg, Vol 15, No 2, February 2007, 107-117.
© 2007 the American Academy of Orthopaedic Surgeons
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Evaluation of the Elderly Patient With an Abnormal Gait

Moe R. Lim, MD, Russel C. Huang, MD, Anita Wu, MD, Federico P. Girardi, MD and Frank P. Cammisa, Jr, MD

Dr. Lim is Assistant Professor of Orthopaedic Surgery, Department of Orthopaedics, University of North Carolina–Chapel Hill, Chapel Hill, NC. Dr. Huang is Assistant Professor of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, NY, and Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery, New York. Dr. Wu is Assistant Professor of Neurology, Weill Medical College of Cornell University. Dr. Girardi is Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery. Dr. Cammisa is Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Lim, Dr. Huang, Dr. Wu, Dr. Girardi, and Dr. Cammisa.

Reprint requests: Dr. Lim, Department of Orthopaedics, University of North Carolina–Chapel Hill, 3152 Bioinformatics Bldg, CB #7055, Chapel Hill, NC 27599-7055.

Distinguishing between the normal gait of the elderly and pathologic gaits is often difficult. Pathologic gaits with neurologic causes include frontal gait, spastic hemiparetic gait, parkinsonian gait, cerebellar ataxic gait, and sensory ataxic gait. Pathologic gaits with combined neurologic and musculoskeletal causes include myelopathic gait, stooped gait of lumbar spinal stenosis, and steppage gait. Pathologic gaits with musculoskeletal causes include antalgic gait, coxalgic gait, Trendelenburg gait, knee hyperextension gait, and other gaits caused by inadequate joint mobility. A working knowledge of the characteristics of these gaits and a systematic approach to observational gait examination can help identify the causes of abnormal gait. Patients with abnormal gait can benefit from the treatment of the primary cause of the disorder as well as by general fall-prevention interventions. Treatable causes of gait disturbance are found in a substantial proportion of patients and include normal-pressure hydrocephalus, vitamin B12 deficiency, Parkinson’s disease, alcoholism, medication toxicity, cervical spondylotic myelopathy, lumbar spinal stenosis, joint contractures, and painful disorders of the lower extremity.




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H. Clavet BScPT, P. C. Hebert MD MHSc, D. Fergusson PhD, S. Doucette MSc, and G. Trudel MD
Joint contracture following prolonged stay in the intensive care unit
Can. Med. Assoc. J., March 11, 2008; 178(6): 691 - 697.
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