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[Clinical exam](https://durgical.com/en/clinical-exam/) · [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro)

# 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](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) · [Substantia nigra](https://durgical.com/en/anatomy/substantia-nigra/) · [Common fibular nerve](https://durgical.com/en/anatomy/common-fibular-nerve/) · [L5 nerve root](https://durgical.com/en/anatomy/l5/) · [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/)

## Key points

- Hemiparetic (circumduction): stroke; scissor gait: bilateral upper motor neuron lesion.
- Parkinsonian: short shuffling steps, festination, little arm swing and turning en bloc.
- Cerebellar ataxic: wide-based and just as unsteady with eyes open; sensory: worse with eyes closed (Romberg).
- Steppage from foot drop: common fibular (peroneal) nerve lesion at the fibular head or L5 radiculopathy.
- Waddling: weakness of the gluteal and pelvic girdle muscles, as in muscular dystrophies.

## 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](https://durgical.com/en/conditions/ischaemic-stroke/) | Stiff leg that swings outward (circumducts); arm flexed against the body | Upper motor neuron on one side (stroke) |
| [Spastic scissor](https://durgical.com/en/conditions/cerebral-palsy/) | Stiff legs that cross as they advance | Bilateral lesion (cerebral palsy, myelopathy) |
| [Parkinsonian](https://durgical.com/en/conditions/parkinson-disease/) | 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](https://durgical.com/en/conditions/peripheral-neuropathy/) | Stamping, watches the floor, worse in the dark; positive Romberg | Dorsal columns or peripheral nerve |
| [Steppage](https://durgical.com/en/conditions/lumbar-disc-herniation/) | 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)](https://durgical.app/estudiar/?add=/en/clinical-exam/abnormal-gaits-hemiparetic-parkinsonian-ataxic-steppage-waddling/)

## See it in 3D

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

- [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/)
- [Substantia nigra](https://durgical.com/en/anatomy/substantia-nigra/)
- [Common fibular nerve](https://durgical.com/en/anatomy/common-fibular-nerve/)
- [L5 nerve root](https://durgical.com/en/anatomy/l5/)
- [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/)

## Related

- [Cerebellar tests: finger–nose, heel–shin and rapid alternating movements](https://durgical.com/en/clinical-exam/cerebellar-tests-finger-nose-heel-shin-and-rapid-alternating-movements/)
- [Romberg test](https://durgical.com/en/clinical-exam/romberg-test/)
- [Parkinsonian syndrome](https://durgical.com/en/clinical-exam/parkinsonian-syndrome/)
- [Cerebellar syndrome](https://durgical.com/en/clinical-exam/cerebellar-syndrome/)
- [Upper vs lower motor neuron syndrome](https://durgical.com/en/clinical-exam/upper-vs-lower-motor-neuron-syndrome/)

## Related conditions

- [Parkinson disease](https://durgical.com/en/conditions/parkinson-disease/)
- [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/)
- [Cerebral palsy](https://durgical.com/en/conditions/cerebral-palsy/)
- [Lumbar Disc Herniation](https://durgical.com/en/conditions/lumbar-disc-herniation/)
- [Peripheral neuropathy (diabetic and other)](https://durgical.com/en/conditions/peripheral-neuropathy/)
- [Degenerative cervical myelopathy](https://durgical.com/en/conditions/degenerative-cervical-myelopathy/)

[← All of the clinical exam](https://durgical.com/en/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](https://medlineplus.gov/ency/article/003199.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [How To Assess Gait, Stance, and Coordination](https://www.msdmanuals.com/professional/neurologic-disorders/neurologic-examination/how-to-assess-gait,-stance,-and-coordination) (MSD Manual Professional Edition, 2024); [Parkinson Disease](https://www.msdmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/parkinson-disease) (MSD Manual Professional Edition, 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/clinical-exam/abnormal-gaits-hemiparetic-parkinsonian-ataxic-steppage-waddling/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/abnormal-gaits-hemiparetic-parkinsonian-ataxic-steppage-waddling/