[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient was referred in to clinic on account of a limp.  Please inspect their gait and discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191677″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]This patient has a left sided Trendelenburg gait.

Normal gait is smooth, symmetrical and ergonomically economical, with each leg 50% out of phase with each other. Gait has two phases: stance and swing. The stance phase is from foot-strike to toe-off, when the foot is on the ground and load-bearing. The swing phase is from toe-off to foot-strike, when the foot clears the ground. When both feet are on the ground this is double stance. A limp is an abnormal gait due to pain, structural change, example: lower limb length discrepancy, tone abnormality or weakness.

An antalgic gait is one which is altered to reduce pain. Pain in a lower limb is usually aggravated by weight bearing, so the patient minimizes the time spent in the stance phase on that side. This results in a “dot-dash” mode of walking.

Patients with limb-length discrepancy may walk on tiptoe on the shorter side, and have compensatory hip and knee flexion on the longer side. There may be pelvic tilting on block testing.

In Trendelenburg gait, abductor function is poor when weight bearing on the affected side, so the contralateral hemipelvis falls. This affect may be reduced by a truncal lurch over the affected hip (Duchenne sign). Causes of Trendelenburg gait are: weakness of the hip abductors (e.g, polio), congenital dislocation of the hip and osteoarthritis. Increased tone occurs following an upper motor neuron lesion example: cerebrovascular accident or cerebral palsy.

Neurological examination of the gait is done in the following way:

  • Observe the patient walking toward you and away from you in an open area with plenty of room.
  • Note stance (how far apart the feet are), posture, stability, how high the feet are raised off the floor, trajectory of leg swing and whether there is circumduction (an arced trajectory in the medial to lateral direction), leg stiffness and degree of knee bending, arm swing, tendency to fall or swerve in any particular direction, rate and speed, difficulty initiating or stopping gait, and any involuntary movements that are brought out by walking.
  • Turns should also be observed closely.
  • When following a patient over several visits, it may be useful to time him walking a fixed distance, and to count the number of steps he took and the number of steps he required to turn around.
  • The patient’s ability to rise from a chair with or without assistance should also be recorded.