Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddling !

Sign

The way a person walks reveals where the problem is: brain, basal ganglia, cerebellum, nerves or muscles.

Updated 2026-11-01

See it in 3D: Cerebellum · Substantia nigra · Common fibular nerve · L5 nerve root · Motor cortex

What it is

Gait brings together strength, tone, sensation, balance and coordination, which makes it one of the most informative neurological tests. Each abnormal pattern points to a different lesion site. The patient walks a few metres, turns and comes back, then walks in tandem, on the toes and on the heels.

The anatomy it tests

Corticospinal tract: hemiparesis and spasticity.
Substantia nigra and basal ganglia: parkinsonian gait.
Cerebellar vermis: trunk and gait ataxia.
Common fibular nerve and L5 root: ankle dorsiflexion; damage causes steppage.

How to elicit it

Ask the patient to walk barefoot, if safe, a few metres along a corridor, turn and come back.
Watch the base of support, step length, arm swing, posture and turning.
Tandem gait: heel to toe along a straight line.
Walking on the toes (S1) and on the heels (L4–L5).
Watch the patient rise from a chair without using the hands.
The examiner walks close to a patient at risk of falling.

Abnormal gaits and where the lesion is

Gait	What it looks like	Typical lesion
Hemiparetic	Stiff leg that swings outward (circumducts); arm flexed against the body	Upper motor neuron on one side (stroke)
Spastic scissor	Stiff legs that cross as they advance	Bilateral lesion (cerebral palsy, myelopathy)
Parkinsonian	Short shuffling steps, stooped trunk, little arm swing, festination, turning en bloc	Basal ganglia
Cerebellar ataxic	Wide-based and staggering, cannot tandem walk; same with eyes open	Cerebellum (vermis)
Sensory ataxic	Stamping, watches the floor, worse in the dark; positive Romberg	Dorsal columns or peripheral nerve
Steppage	Lifts the knee high and the foot slaps down	Foot drop: fibular (peroneal) nerve or L5 root
Waddling	Pelvis sways from side to side, like a duck	Pelvic girdle weakness (myopathy)

What a positive result means

Positive: the recognisable pattern points to the diagnosis (see the table).
Festination with freezing and little arm swing suggests Parkinson disease.
Sudden foot drop after leg crossing or a tight cast suggests compression of the fibular nerve at the fibular head.
A normal gait does not rule out a mild neurological lesion.

Usefulness and limits

Pain (antalgic gait) and osteoarthritis change gait without a neurological cause.
Examining only on the couch hides mild ataxia and parkinsonism.

Test yourself

Think of the answer, then tap the question to see it.

Which lesion causes a steppage gait?

Foot drop from weak dorsiflexion: a common fibular nerve lesion or L5 radiculopathy.

How is cerebellar ataxia told from sensory ataxia when walking?

Cerebellar ataxia is unsteady even with the eyes open; sensory ataxia worsens with the eyes closed or in the dark and has a positive Romberg.

What are the features of a parkinsonian gait?

Short shuffling steps, stooped trunk, little arm swing, festination, trouble starting and turning en bloc.

Add to my cards (3)

See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Walking abnormalities (MedlinePlus, U.S. National Library of Medicine, 2024); How To Assess Gait, Stance, and Coordination (MSD Manual Professional Edition, 2024); Parkinson Disease (MSD Manual Professional Edition, 2024).

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Representative model, for educational purposes only.