All you need to know about antalgic gait
Causes of antalgic gait range from minor injuries that heal on their own to painful infections and tumors in the bone or soft tissue that need specialist treatment.
All of these conditions result in a person taking uneven strides in response to the pain in areas of their lower body, including their hips, legs, and feet.
- Antalgic gait is common in children but can affect anyone.
- Pain is what causes an antalgic gait.
- Every antalgic gait is distinct, allowing diagnosis at a distance.
- Pain that results in an antalgic gait can have many causes.
Antalgic gait is a response to pain felt in various areas of the lower body.
Minor injury is the most common cause of limping in children, followed by infection and inflammation.
- Injury: This is often minor and will heal on its own. Persistent limping may indicate an underlying bone fracture.
- Infection: Viral or bacterial infections in growing bones and joints may cause pain and limping in younger children.
- Inflammation: Juvenile arthritis can affect joints and cause pain, swelling, and a characteristic antalgic limp.
Two types of arthritis may cause pain and an antalgic gait in older people.
- Osteoarthritis: This is arthritis that stems from "wear and tear" on often aging joints. Old injuries and obesity can also contribute.
- Rheumatoid arthritis: This is the formation of abnormal tissue that erodes bone, destroys cartilage and damages ligaments. It causes pain and may result in deformed joints.
Antalgic gait may be caused by issues with a person's back, including:
- Sciatica: This causes pain from irritation or compression of the sciatic nerve, the longest nerve in the body, running from the back of the pelvis, through the buttocks, down each leg, and into the feet.
- Spinal osteomyelitis: This is an infection that happens when bacteria enter the bloodstream and become lodged in a disc between the spinal vertebrae. It is most common in older people.
- Discitis: This is when disc spaces between the small bones in the spine become inflamed and irritated, causing pain and limping.
The following conditions can also cause antalgic gait.
- Tumor: These can grow into bone and soft tissue, causing pain and limping.
- Pelvic girdle pain: This can affect pregnant women when the pelvic joints move unevenly, making the pelvic girdle less stable and causing pain.
A person affected by an antalgic limp may lift and lower their foot with their ankle fixed in one position.
Often, they will carry a walking aid, such as a cane or a crutch. The aid will be used on their painful side so that the arm takes some of the load of the limb or hip where their pain originates.
Antalgic gait is often associated with pain in the foot, knee or hip, with each of these areas producing a characteristic gait:
- Foot pain: People with foot pain may bear weight on their heel only, forefoot only, or along the lateral edge of their foot.
- Knee pain: People with knee pain may have a stiff knee that does not extend or flex fully.
- Hip pain: People with hip pain may display limited hip extension.
An ultrasound may be used to help diagnose the cause of antalgic gait.
Watching and listening to a person's footsteps will often reveal an asymmetry in the gait pattern, which can help diagnosis of antalgic gait. The objective of diagnosis is to find the underlying cause of the limp.
An initial assessment is usually followed by a physical examination.
The doctor will look for tenderness, swelling, or bruising in the legs to determine if the problem is in a muscle, joint, or bone.
If it seems the pain is coming from the knee, the doctor will do a thorough examination of the ligaments and the knee movement. Swelling or abnormal movements can indicate a ligament injury.
The doctor will also check the spine for pain, stiffness, and curvature, also known as scoliosis.
The following tests may be carried out when diagnosing the underlying cause of antalgic gait.
- X-rays: These will be taken of areas where there is pain, swelling, or loss of movement. X-ray images of the unaffected side may be taken for comparison.
- Magnetic resonance imaging (MRI): If X-rays are normal, and if the pain is localized, a bone scan may help to detect a swelling, fracture, bone infection, or bone tumor.
- Ultrasound: This can be used to look for fluid in a joint and is useful for checking the hip where swelling may be difficult to see.
- Laboratory tests: These are useful for diagnosing inflammatory conditions such as viral diseases. Also, they may help identify juvenile rheumatoid arthritis.
A successful treatment program for antalgic gait will address the underlying condition and reduce the pain that is causing the limp.
Here are some of the causes along with the recommended treatments:
Osteoarthritis: Treatment can include medication and exercise. Weight loss to relieve pressure on the joints may help reduce pain from walking.
Rheumatoid arthritis: Once deformities occur, treatments may include exercise and splinting. Surgery or orthotics, such as insoles or custom casts, may be required if rheumatoid arthritis affects the feet.
Although treatment will be dependent on the underlying condition, pain management is also important.
Sciatica: Most cases resolve in around 6 weeks without treatment. Anti-inflammatory painkillers and hot or cold packs may help reduce the symptoms. Further treatment may include specialist exercise programs, anti-inflammatory injections, manual therapy and psychological support.
Discitis: This is often caused by a bacterial infection that requires antibiotics. These may be administered intravenously, for up to 3 months. Surgery may be considered if antibiotics do not work. Pain control is also important.
Tumors: Benign and cancerous tumors will require specialist treatment on a case by case basis.
Pelvic girdle pain: Manual therapy may help reduce pain by helping pelvic joints and muscles move more freely. Exercises can help to strengthen the muscles that support the pelvis. Mobility aids and pain relief may be needed during these treatments.
The outlook will depend on the severity and treatability of the underlying cause of antalgic gait.
Many minor injuries that cause antalgic gait may heal on their own without ever needing formal treatment. Recovery time for conditions that need more specialist care can vary from weeks to months. Sometimes surgery will be required.
In rare cases, an antalgic gait is caused by cancerous tumors and treatment plans will be longer and more complex to resolve these conditions.