The following Gait Evaluation form is what I used in practice and teach students with. I am happy if you want to copy into your EHR or just as a laminated handout in your office. If you do not look, you will not see! Not only is that wise, but if you do not know what you are looking at, you still will not see it. This form helps focus your thought process on the patient walking in front of you. I hope it helps you treat your patients.
Gait Evaluation Checklist (circle findings)
1. Head Tilt (Straight, Lean Right, Lean Left)
2. Shoulder Drop
3. Asymmetrical Arm Swing
4. Dominance to One Side
5. Trunk Mobility (Limited, Normal, Excessive)
6. Hip Hike (Right or Left)
7. Belt Line (Higher Right or Left)
8. Hip Rotation (limited, normal, excessive)
9. Excessive Shock (Right or Left or Both)
10. Limited Knee Rotation(Right—straight vs external, Left—straight vs external)
11. Excessive Internal Knee Rotation (Right or Left or Both)
12. Heel Motion at Heel Contact (Right—eversion, none, inversion,
Left—eversion, none, inversion)
13. Symmetry of Arch Collapse (Right more vs Left more)
14. Digital Clawing (Right or Left or Both)
15. Angle of Gait (Right—internal, straight, external, Left—internal,
straight, external)
16. Other Structural Variations: Pes Cavus, Pes Planus, Tibial Varum,
Genu Valgum, etc
17. Correlation to Symptoms:
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18. Other Observations:
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