An antalgic gait likely indicates that the patient has pain while walking.
Antalgic Gait Definition
The best way to define antalgic gait is to say that it is a gait abnormality that “develops as a way to avoid pain while walking”. A non-antalgic gait is desired. The antalgic gait pattern is one “where the stance phase of gait is abnormally shortened relative to the swing phase”. In other words, the patient avoids putting weight on the leg that is in pain.1 It presents as limping.2 When a gait is antalgic, it is different from other abnormal gaits. By contrast, an ataxic gait is an uncoordinated and unsteady walking style where the feet are “thrown out” and the walk has a “wide base”. With an ataxic gait, the patient first strikes down on the heel and then the toes come down with a “double tap”. There are many other abnormal gaits, including the double-step, drag-to, equine, festinating, four-point, gluteal, helicopod, hemiplegic, intermittent double-step, scissors, spastic, steppage, stuttering, swing-through, swing-to, tabetic (another ataxic gait), three-point, two-point, waddling, and Oppenheim’s gait. Diagnosis of antalgic gait can be done through gait analysis of a patient when they walk in a straight line. Walking patterns consists of the stance phase where “one leg and foot are bearing most…of the body weight” and the swing phase, in which “the foot is not touching the walking surface”. There is also a phase in the walking cycle called the double-support phase, and this refers to the point in which “both feet are in contact with the floor at the same time”. Causes of abnormal gaits include musculoskeletal injury, disease, amputation, or neurologic causes.3
Antalgic Gait Causes
The antalgic gait is painful. Due to the pain, the patient tries to put as little weight on the affected leg as possible during the stance phase of the walking pattern. It might not just be the leg that is in pain; patients may be trying to avoid landing on the foot, ankle, or knee. As a result, the stride is then “shortened on the injured side”, leading to a change in gait and posture. This style of walking can come on gradually or suddenly, depending on the cause, and it can range in severity from mild to severe. Antalgic gait might be permanent or only temporary. The people most often affected are the elderly, athletes, and men, but it can impact anyone. One example of a temporary and sudden antalgic gait is when one sits on a leg or foot, awkwardly, and then experiences “pins and needles” when getting up. Gout, a type of joint arthritis, can bring on an antalgic gait more gradually. In this example, there is an accumulation of uric acid crystals that affects any joint, but if it affects the big toe, this abnormal style of walking may result, due to “feeling like (the) toe is on fire”. As noted before, there is a stance and swing phase to walking. The swing phase has three parts: “the initial double stance, single limb stance, and terminal double limb stance”, which are also known as “acceleration, midswing, and deceleration”. For the cycle to go smoothly, the pelvic rotation, tilt, strength, and balance, and the joints, need to be unimpaired from the toes through the hips. When healthcare professionals diagnose an antalgic gait, they look for an altered walking pattern that seems to indicate avoiding pain, pain when the patient tries to walk normally, uneven swing phase strides, and a shortened stance phase. Causes of this abnormality also include trauma, diabetic/peripheral neuropathy, deformity, fracture, infection, tumor, blisters, ingrown toenail, calluses, leg cramps, ankle sprain, tendon or muscle injury, or a foreign body.4 This condition may also be brought on by sports, work or car injuries, rheumatoid or psoriatic arthritis, osteoarthritis, rickets (vitamin D deficiency), joint subluxation, bone malalignment, fracture, soft tissue inflammation, knee, hip, or ankle sprain, or a tendon or muscle tear/rupture.5
Medical Treatment Options
Once the underlying cause is known for the gait abnormality, the problem typically goes away once it is treated. In the meantime, to reduce pain, a healthcare professional may recommend a walker, cane, or crutches, medications for pain and swelling, and cross-training or modified activities. Once the symptoms are reduced, mobility and balance can return. If, for example, a broken foot bone doesn’t heal normally, though, a podiatrist might recommend fusing the bone with a bone graft. This would lead to an abnormal gait while healing. Ingrown toenails could be a recurring cause of this condition, and if they keep recurring, a doctor may choose to “surgically remove the nail root”. Again, once the situation has healed, the patient should walk normally.6 Sometimes a doctor might order additional bloodwork, scans, or an ultrasound examination to diagnose the cause of the condition. Medications may include NSAIDs, opioids, and muscle relaxants, but there are side-effects and addiction concerns with some prescriptions. Biking and swimming could be recommended, as well as physiotherapy. For some patients, calcium, vitamin D, or estrogen may be prescribed. Arthritis medications could also be ordered. In certain situations, surgery may be necessary, such as for arthritis, dislocation, fracture, tumors, or to repair muscles or tendons. In general, surgery will take 3-4 months of recovery time.7
An antalgic gait can lead to other musculoskeletal issues, as the patient walks with an abnormal posture to compensate for the pain. Aside from the gait, a patient may also present with an antalgic lean or antalgic list, which is commonly seen in cases of back pain. This means that the patient bends or leans to one side without realizing it. Resolving the pain should eliminate the problem.8 Chiropractors, experts in musculoskeletal conditions, are trained to deal with patients with abnormal postures and gaits. At first, they will examine the patient for the type of gait abnormalities and then check for the underlying condition. For example, a toe-out or toe-in gait may represent hamstring tightness. There might be, as another example, a weakness in the gluteus maximus. If the stride is shortened, the hamstrings or hip flexors may be tight. If there is a lean, it could be due to weak lower abdominal muscles or hip flexors. Chiropractors can perform muscle and orthopedic tests, such as “Ober’s test; Trendelenberg’s test; sit-and-reach test; Nachlas’ test; Ely’s test; Valsalva’s test; Kemp’s test; and straight leg raising test”. Treatment will be designed to control the pain, increase flexibility and strength of the lumbopelvic musculature, to decrease the patient’s stress, and to train the body to do certain types of motions. Techniques that may be used include Active Release Technique (ART), manipulation (such as a high-velocity, low-amplitude thrust to “free up joint fixations”), and teaching patients about stretches they can do at home. They can stretch their hip flexors, hamstrings, adductors, abductors, external hip rotators, quadriceps, and erector spinae musculature with a flex-band. Flex-bands tend to have more compliance, due to convenience, than exercise balls. Chiropractors may also use electrical muscle stimulation and ultrasound (or a combination of the two) on patients. Ultrasound is useful “for heating localized areas of deeply placed tissues”. Electrical muscle stimulation is beneficial in breaking down or stretching adhesions, leading to improved range-of-motion.9