A. Causes

• Pain/Antalgic: A protective limp to reduce weight-bearing time on a painful limb.
• Weakness: Insufficient muscle strength (e.g., Gluteus Medius weakness causing Trendelenburg gait).
• Neurological: Impaired motor control, spasticity, or paralysis (e.g., Foot Drop from nerve injury).
• Joint Limitation: Restricted range of motion (e.g., ankle stiffness) preventing normal stride.
• Proprioception Deficit: Poor joint awareness and balance leading to instability.

B. Symptoms

• Limp: An obvious asymmetry in the timing or movement between steps.
• Asymmetrical Stride: Unequal step length and/or unequal time spent on each leg.
• High Energy Cost: Excessive fatigue from inefficient movement patterns.
• Instability: Feelings of unsteadiness or increased risk of falling.
• Compensatory Pain: Secondary pain in the back, hip, or non-injured limb due to altered load.

C. Diagnosis

• Visual Gait Analysis: Detailed observation of the patient walking barefoot and with shoes.
• Gait Cycle Assessment: Breaking down the pattern into Stance (foot on ground) and Swing (foot in air) phases.
• Specific Testing: Isolating muscle groups (e.g., Gluteus Medius strength for Trendelenburg).
• Balance Assessment: Using tests (e.g., Berg Balance Scale) to quantify instability.

D. Physiotherapy Treatment Plan

• Address Primary Cause: Treating the pain source (Antalgic) or strengthening the weak muscle (Trendelenburg).
• Specific Strengthening: Targeting the muscles responsible for the deviation (e.g., Dorsiflexors for Foot Drop).
• Proprioception Training: Balance exercises on stable and unstable surfaces to improve control.
• Gait Retraining: Step-by-step instruction to normalize step length, cadence, and weight shift.
• Assistive Devices: Prescription, fitting, and training on the correct use of canes or crutches.
• Functional Integration: Dual-task training (walking while talking) to improve safety and cognitive load.